中国北京非重大新冠疫情地区急诊动脉瘤开颅夹闭术的管理方案
Management protocol for emergency aneurysm craniotomy clipping in non-major COVID-19 epidemic areas in Beijing, China.
作者信息
Chen Yu, Chen Xiaolin, Ma Li, Deng Xiaofeng, Li Zelin, Ye Xun, Wang Hao, Kang Shuai, Zhang Yan, Wang Rong, Zhang Dong, Cao Yong, Zhao Yuanli, Wang Shuo, Zhao Jizong
机构信息
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China.
出版信息
Chin Neurosurg J. 2020 Dec 22;6(1):38. doi: 10.1186/s41016-020-00217-x.
BACKGROUND
An epidemic of COVID-19 broke out in Wuhan, China, since December 2019. The ordinary medical services were hindered. However, the emergency cases, including aneurysmal subarachnoid hemorrhage (aSAH), still required timely intervention. Thus, it provoked challenges to the routine management protocol. In this study, we summarized our experience in the emergency management of aSAH (Beijing Tiantan Protocol, BTP) in Beijing, China.
METHODS
Demographic, clinical, and imaging data of consecutive emergency aSAH patients who underwent craniotomy clipping during the COVID-19 epidemic season were reviewed and compared with the retrospective period last year. Subgroup analysis was further performed to assess the outcomes of different screening results and several detailed protocols. Neurological outcomes were evaluated by the modified Rankin Scale (mRS).
RESULTS
A total of 127 aSAH were referred to our emergency department, and 42 (33.1%) underwent craniotomy clipping between January 20, 2020, and March 25, 2020. The incidence of preoperative hospitalized adverse events and the perioperative outcomes were similar (- 0.1, 95% CI - 1.0 to 0.8, P = 0.779) to the retrospective period last year (January 2019-March 2019). After the propensity score matching (PSM), there were still no statistical differences in prognostic parameters between the two groups. Eight (19.0%) of the 42 individuals were initially screened as preliminary undetermined COVID-19 cases, in which 2 of them underwent craniotomy clipping in the negative pressure operating room (OR). The prognosis of patients with varied COVID-19 screening results was similar (F(2, 39) = 0.393, P = 0.678). Since February 28, 12 cases (28.6%) received COVID-19 nucleic acid testing (NAT) upon admission, and all showed negative. The false-negative rate was 0.0%. The preoperative hospitalized adverse events and postoperative prognosis were still similar between patients with and without COVID-19 NAT (- 0.3, 95% CI - 1.4 to 0.9, P = 0.653).
CONCLUSIONS
Our emergency surgery management protocol (BTP) is reliable for scheduling emergency aneurysm craniotomy clipping in non-major epidemic areas.
背景
自2019年12月以来，中国武汉爆发了新型冠状病毒肺炎（COVID-19）疫情。普通医疗服务受到阻碍。然而，包括动脉瘤性蛛网膜下腔出血（aSAH）在内的急诊病例仍需要及时干预。因此，这对常规管理方案提出了挑战。在本研究中，我们总结了在中国北京对aSAH进行急诊管理（北京天坛方案，BTP）的经验。
方法
回顾了在COVID-19流行季节接受开颅夹闭手术的连续性急诊aSAH患者的人口统计学、临床和影像学数据，并与去年的回顾性时期进行比较。进一步进行亚组分析以评估不同筛查结果和几个详细方案的结果。通过改良Rankin量表（mRS）评估神经功能结局。
结果
共有127例aSAH患者转诊至我院急诊科，其中42例（33.1%）于2020年1月20日至2020年3月25日期间接受了开颅夹闭手术。术前住院不良事件的发生率和围手术期结局与去年（2019年1月至2019年3月）的回顾性时期相似（-0.1，95%CI -1.0至0.8，P = 0.779）。倾向得分匹配（PSM）后，两组之间的预后参数仍无统计学差异。42例患者中有8例（19.0%）最初被筛查为COVID-19初步未确诊病例，其中2例在负压手术室（OR）接受了开颅夹闭手术。不同COVID-19筛查结果患者的预后相似（F(2, 39) = 0.393，P = 0.678）。自2月28日起，12例（28.6%）患者入院时接受了COVID-19核酸检测（NAT），所有结果均为阴性。假阴性率为0.0%。接受和未接受COVID-19 NAT的患者术前住院不良事件和术后预后仍相似（-0.3，95%CI -1.4至0.9，P = 0.653）。
结论
我们的急诊手术管理方案（BTP）对于在非重大疫区安排急诊动脉瘤开颅夹闭手术是可靠的。
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