17例手术后新型冠状病毒肺炎病例临床分析  

Clinical analysis of 17 cases of COVID-19 after operation

作　　者：沈小康 任杰[2] 江文洋[1] 卢子龙 熊锐 冯浩洁 芦伟 雷天润 秦显尧 张云龙 耿庆[1] SHEN Xiaokang;REN Jie;JIANG Wenyang;LU Zilong;XIONG Rui;FENG Haojie;LU Wei;LEI Tianrun;QIN Xianyao;ZHANG Yunlong;GENG Qing(Dept.of Thoracic Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Otorhinolaryngology Head and Neck Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Orthopaedics,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Neurosurgery,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China;Dept.of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)

机构地区：[1]武汉大学人民医院胸外科,湖北武汉430060 [2]武汉大学人民医院耳鼻咽喉-头颈外科,湖北武汉430060 [3]武汉大学人民医院胃肠外科,湖北武汉430060 [4]武汉大学人民医院骨科,湖北武汉430060 [5]武汉大学人民医院神经外科,湖北武汉430060 [6]武汉大学人民医院泌尿外科,湖北武汉430060

出　　处：《武汉大学学报（医学版）》2021年第2期245-249,共5页Medical Journal of Wuhan University

摘　　要：目的:研究新型冠状病毒肺炎(COVID-19)疫情期间外科手术风险因素及控制方法,总结疫情下外科手术防治COVID-19的单中心临床经验。方法:分析2020年1月3日至1月22日武汉大学人民医院17例外科手术后确诊为COVID-19患者的临床资料。按COVID-19诊疗方案(试行第五版修正版)对疾病进行分型,将轻型和普通型归为非重症组,将重型和危重型归为重症组,比较两组间患者一般信息、临床症状、实验室检查结果及转归。结果:2020年1月3日至1月22日武汉大学人民医院行外科手术患者共3339例,术后确诊为COVID-19患者共17例,发病率为0.51%。其中重症患者7例(41.2%),死亡2例(11.8%),死亡原因均为呼吸衰竭。临床表现主要为发热(76.47%)和咳嗽(58.82%)。实验室检查:白细胞计数正常(70.59%),淋巴细胞计数降低(88.24%)和C-反应蛋白升高(88.24%);部分患者T细胞免疫功能受损明显,其中CD3^(+)、CD4^(+)和CD8^(+)T淋巴细胞亚群计数降低的患者分别占62.5%、75%和62.5%。外科开放手术COVID-19重症率显著高于微创手术(71.43%vs 20%,P=0.034)。结论:外科手术患者合并COVID-19重症率、死亡率高于普通COVID-19患者,开放手术比微创手术COVID-19重症率高。疫情期间应推迟择期或限期手术,严格把握急诊手术指征,如需急诊手术,应尽量选择微创手术方式。加强术后排查,对COVID-19患者早发现、早报告、早隔离和早治疗。Objective:To explore the risk factors and control methods of surgical operation during the outbreak of coronavirus disease 2019(COVID-19),and to summarize the experience of prevention and treatment methods of COVID-19 under surgical conditions from a single center during the epidemic.Methods:The clinical data of 17 patients diagnosed as COVID-19 postoperatively in Renmin Hospital of Wuhan University from January 3 to January 22,2020 were collected and analyzed.The diseases were classified according to the Chinese Diagnosis and Treatment of Novel Coronavirus Infected Pneumonia(5 th trial edition).The mild and moderate type patients were incorporated into the non-severe group,while the severe and critical ones were categerized into the severe group.Then we compared the general information,clinical symptoms,laboratory test results,and outcomes between the two groups.Results:The clinical data of 3339 patients underwent surgical operation were reviewed,and17 patients were diagnosed as COVID-19 after operation,with a 0.51%incidence rate.Among them,7 cases(41.2%)were severe,and 2 cases(11.8%)died of respiratory failure.The clinical manifestations were mainly fever(76.47%)and cough(58.82%).Laboratory examination results showed that in most patients,the leukocyte count was normal(70.59%),lymphocyte count was lower(88.24%),and C-reactive protein level was higher(88.24%).Immune function tests showed that cellular immune function was significantly impaired in some patients.Among them,62.5%,62.5%and 75%of the patients had decreased CD3 count,CD4 count and CD8 count.The percentage of severe COVID-19 cases in open surgery patients was significantly higher than that in minimally invasive surgery ones(71.43%vs 20%,P=0.034).Conclusion:The proportion of severe cases and mortality in COVID-19 patients undergone surgery are higher than those who haven′t;and the severity rate of them receiving open surgery is higher than those performed minimally invasive surgery.During the epidemic,elective or confine surgery should be postponed an

关 键 词：新型冠状病毒 新型冠状病毒肺炎 手术 免疫功能 

分 类 号：R563.1[医药卫生—呼吸系统]