新型冠状病毒感染期行心脏大血管手术的术后管理  

Postoperative management of cardiac and vascular surgery in the period of COVID-19

作　　者：常硕[1] 张心怡 黄晟 范宇欣 潘湘斌[3] 王小啟 CHANG Shuo;ZHANG Xinyi;HUANG Sheng;FAN Yuxin;PAN Xiangbin;WANG Xiaoqi(Adult Surgery Center,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing,100037,P.R.China;Adult Surgery Center,Cardiovascular Hospital Affiliated to Kunming Medical University,Fuwai Cardiovascular Hospital,Kunming,650102,P.R.China;Structural Heart Disease Center,National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院,阜外医院成人外科中心,北京100037 [2]云南省阜外心血管病医院,昆明医科大学附属心血管病医院成人外科中心,昆明650102 [3]中国医学科学院北京协和医学院,国家心血管病中心,阜外医院结构性心脏病中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2024年第7期967-973,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨新型冠状病毒感染(coronavirus disease 2019,COVID-19)期患者行心脏大血管手术的术后特点及管理体会。方法 选取2022年12月7日—2023年1月5日于云南省阜外心血管病医院行心脏大血管手术的COVID-19患者,回顾性分析其临床病史、手术相关信息及术后恢复过程和治疗方案。结果 纳入患者18例,其中男11例(61.1%)、女7例(38.9%),平均年龄(58.1±10.9)岁。既往高血压7例、糖尿病5例、呼吸系统疾病3例、合并慢性肾功能不全2例。急诊手术5例(27.8%),择期手术13例(72.2%)。18例患者均为COVID-19期行心脏大血管手术,末次核酸阳性时间距手术时间为1.50(1.00,6.25)d。术前出现肺部影像学改变8例,包括3例肺CT表现为斑片影,2例肺CT表现为双肺渗出,3例胸部X线片表现为肺纹理增粗、紊乱。全组病例术前均未行抗病毒治疗。术后病毒性肺炎3例,其中2例为重症肺炎,行气管切开,另1例轻症肺炎经过抗病毒治疗后痊愈。1例患者出现颈内静脉血栓形成,经肝素、低分子肝素抗凝治疗后好转。全组患者无手术相关死亡病例,围术期死亡1例,病死率5.6%。结论 COVID-19患者行心脏大血管手术风险较高,具有高危因素患者可能快速进展为重症肺炎。术前有肺部影像学改变或合并其他脏器基础病变患者手术时机应综合考虑,对急诊手术患者尽早使用抗病毒联合免疫调节等治疗可能有助于改善预后。Objective To explore the postoperative characteristics and management experience of patients with coronavirus disease 2019(COVID-19) undergoing cardiac and vascular surgery.Methods From December 7,2022 to January 5,2023,the patients with COVID-19 who were admitted to Cardiovascular Hospital Affiliated to Kunming Medical University and underwent cardiac and vascular surgery were selected.The clinical history,surgical information,postoperative recovery process and treatment plan were analyzed retrospectively.Results There were 18 patients in this group,including 11(61.1%) males and 7(38.9%) females,with an average age of 58.1±10.9 years.There were 7 patients of hypertension,5 patients of diabetes,3 patients of respiratory diseases,and 2 patient of chronic renal insufficiency.There were 5(27.8%) patients receiving emergency operations and 13(72.2%) elective operations.All the 18 patients underwent cardiac and vascular surgery in the period of COVID-19,and the time between the last positive nucleic acid test and the surgery was 1.50(1.00,6.25) days.There were 8 patients of pulmonary imaging changes,including 3 patients with chest patch shadow,3 patients with thickened and disordered lung markings,and 2 patients with exudative changes before operation.Antiviral therapy was not adopted in all patients before operation.Three patients were complicated with viral pneumonia after operation,including 2 patients with high risk factors before operation,who developed into severe pneumonia after operation,and underwent tracheotomy.One patient with thrombus recovered after anticoagulation treatment.Another patient of mild pneumonia recovered after antiviral treatment.The other 15 patients recovered well without major complications.There was no operation-related death in the whole group.One patient died after surgery,with a mortality rate of 5.6%.Conclusion Patients with COVID-19 are at high risk of cardiac and vascular surgery,and patients with high-risk factors may rapidly progress to severe pneumonia.Patients with preoperativ

关 键 词：新型冠状病毒肺炎 新型冠状病毒感染 心脏大血管手术 围术期 

分 类 号：R654.2[医药卫生—外科学]