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[2019冠状病毒病(COVID-19)疫情期间胃肠外科恢复常规诊疗的管理策略]

[Management strategy for the resumption of regular diagnosis and treatment in gastrointestinal surgery department during the outbreak of coronavirus disease 2019 (COVID-19)].

作者信息

Zhen L, Lin T, Zhao M L, Chen H, Chen T, Guo W H, Zhao L Y, Liu H, Hu Y F, Yu J, Li G X

机构信息

Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Apr 25;23(4):321-326. doi: 10.3760/cma.j.issn.1671-0274.2020-0316-00146.

Abstract

Acute abdomen, abdominal trauma, gastrointestinal bleeding and gastrointestinal tumors are the main conditions that are routinely treated in gastrointestinal surgery department with high incidence and critical condition. These conditions need emergency or selective operations. During the outbreak of the coronavirus disease 2019 (COVID-19), it's a great challenge for us to meet the patients' requirement under the situation. As the COVID-19 was brought under control in China, the Department of General Surgery in Nanfang Hospital resumed regular medical services gradually. Based on our clinical practice, the four major measures of strengthening pre-hospital screening, perioperative prevention and control, medical staff protection, and ward management were adopted. These main measures include the strict implementation of the appointment system and triage system before admission; the conduction of epidemiological and preliminary screening of viral nucleic acids; the chest CT examination during the perioperative period to re-screen COVID-19; the reduction of the risk of droplets and aerosol transmission; the minimally invasive surgery combined with enhanced recovery program in order to reduce patient's susceptibility and shorten the length of postoperative hospital stay; the reinforcement of specific infection control training for medical staff; the strict implementation of hierarchical protection; the establishment of gastrointestinal surgery prevention and control system; the rehearsal of emergency exercise; the installation of quarantine wards; the screening and management of family care-givers; the strict disinfection of environment and materials. Our preliminary practice shows that following the work guidelines issued by the Guangdong Province COVID-19 Prevention and Control Office and adopting precise management strategies in combination with the specific clinical features of gastrointestinal surgery, it is possible to safely resume regular care for the patients and comply to epidemic control at the same time.

摘要

急腹症、腹部创伤、胃肠道出血和胃肠道肿瘤是胃肠外科常规治疗的主要病症,发病率高且病情危急。这些病症需要急诊或选择性手术。在2019年冠状病毒病(COVID-19)疫情期间,在这种情况下满足患者需求对我们来说是一个巨大的挑战。随着COVID-19在中国得到控制,南方医院普通外科逐渐恢复了常规医疗服务。基于我们的临床实践,采取了加强院前筛查、围手术期防控、医护人员防护和病房管理这四项主要措施。这些主要措施包括入院前严格执行预约制度和分诊制度;进行流行病学调查和病毒核酸初步筛查;围手术期进行胸部CT检查以重新筛查COVID-19;降低飞沫和气溶胶传播风险;采用微创手术结合加速康复计划以降低患者易感性并缩短术后住院时间;加强对医护人员的特定感染控制培训;严格执行分级防护;建立胃肠外科防控体系;演练应急演习;设置隔离病房;对家庭护理人员进行筛查和管理;对环境和物品进行严格消毒。我们的初步实践表明,遵循广东省COVID-19防控办公室发布的工作指南,并结合胃肠外科的具体临床特点采取精准管理策略,有可能在安全恢复对患者的常规护理的同时,符合疫情防控要求。

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