新型冠状病毒肺炎疫情暴发期间儿科发热门诊急危重症救治流程优化经验总结  

Experience in optimization of treatment of emergency and severe diseases process in pediatric fever clinic during the outbreak of corona virus disease 2019

作　　者：孟建华[1] 沈国妹[1] 周利军[1] 王佳丽[1] 周璋[1] 翟晓文 MENG Jianhua;SHEN Guomei;ZHOU Lijun;WANG Jiali;ZHOU Zhang;ZHAI Xiaowen(Outpatient and Emergency Management Office,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Hematology,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院门急诊办公室,上海201102 [2]复旦大学附属儿科医院血液科,上海201102

出　　处：《世界临床药物》2022年第10期1337-1342,共6页World Clinical Drug

摘　　要：目的比较分析新型冠状病毒肺炎(corona virus disease 2019,COVID-19)疫情暴发前、后儿科发热门诊急危重症患儿的救治,探讨儿科发热门诊管理模式的有效性和可行性。方法统计复旦大学附属儿科医院发热门诊COVID-19暴发前组(2021年12月1日至2022年2月28日)及后组(2022年3月1日至2022年5月31日)急危重症患儿的临床情况,通过评估疗效差异,评价其管理模式的有效性和可行性。描述发热门诊的设置与管理:①双重预检分诊。②实施诊前检验。③配备完善的功能区(抢救单元、留观单元等)。④医护配备。⑤医患双方闭环管理。⑥多部门会诊协作。⑦人员培训与模拟演练。结果疫情前组和后组分别接诊49860例和7784例患儿,共检测出COVID-19阳性病例38例,疫情前组为0例,疫情后组为38例。后组病情危重程度较前组高[儿童早期预警评分:(0.29±0.64)分vs(0.49±0.98)分,P<0.05],以惊厥、脓毒血症和重症肺炎的占比最高。疫情后组滞留时间较前组长[(202.2±42.9)min vs(118.2±25.6)min,P<0.05],延长的主要环节在核酸送检时间及转诊时间。疫情前、后组回家/专科就诊分别为1977例(95.5%)和495例(85.9%),留观/收住儿科重症监护室(pediatric intensive care unit,PICU)分别为94例(4.5%)和81例(14.1%),差异有统计学意义(P<0.05)。其中,转入重症留观分别为89例(4.3%)和80例(13.9%),收住PICU分别为5例(0.24%)和1例(0.17%)。结论通过施行合理的预检分诊、诊前检验、缩短核酸送检时间、充分配备急危重症抢救设施单元和人员及患儿安全转运等一系列措施,在疫情暴发期间儿科发热门诊的闭环管理切实有效,不仅发挥COVID-19疫情的“哨点”功用,也能及时识别并救治急危重症患儿,保证医疗安全。Objective To compare and analyze the treatment of children with emergency and severe diseases in pediatric fever clinics before and after the outbreak of corona virus disease 2019(COVID-19),and to explore the effectiveness and feasibility of the management model in pediatric fever clinics.Methods The clinical data of children with emergency and severe diseases in the fever clinic of children's hospital of Fudan university were collected from the pre-outbreak group(from December 1,2021 to February 28,2022)and the post-outbreak group(from March 1,2022 to May 31,2022).The effectiveness and feasibility of the management model were evaluated by evaluating the differences in treatment efficacy.Describe the setting and management of fever clinic:①Double pre-examination triage.②The implementation of pre-diagnosis examination.③Equipped with perfect functional areas(rescue unit,observation unit,etc.).④Medical and nursing facilities.⑤Closed-loop management between doctors and patients.⑥Multi-department consultation and collaboration.⑦Personnel training and simulation exercises.Results A total of 49860 and 7784 children were diagnosed in the pre-epidemic group and post-epidemic group,respectively.A total of 38 COVID-19 positive cases were detected,0 in the pre-epidemic group and 38 in the post-epidemic group.The severity of illness in the latter group was higher than that in the former group[early warning score:(0.29±0.64)vs(0.49±0.98),P<0.05],and convulsion,sepsis and severe pneumonia accounted for the highest proportion.The retention time of the latter group was longer than that of the former group[(202.2±42.9)min vs(118.2±25.6)min,P<0.05],and the main links were prolonged in nucleic acid detection time and referral time.There were 1977 cases(95.5%)and 495 cases(85.9%)in the pre-epidemic and post-epidemic groups,and 94 cases(4.5%)and 81 cases(14.1%)in the pediatric intensive care unit(PICU),respectively.The difference was statistically significant(P<0.05).Among them,89 cases(4.3%)and 80 cases(13.9%)were t

关 键 词：新型冠状病毒肺炎 儿科发热门诊 急危重症 

分 类 号：R95[医药卫生—药学]