Ma L, Chen Y, Chen X L
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
Zhonghua Yi Xue Za Zhi. 2020 Dec 22;100(47):3768-3774. doi: 10.3760/cma.j.cn112137-20200814-02385.
To explore the improvement of emergency admission screening and perioperative management protocols in the scenario of the coronavirus disease 2019 (COVID-19) pandemic and its regular prevention and control for patients with ruptured intracranial aneurysms, which are the most common emergency cases with the most urgent needs for emergent surgery. The response protocol of the emergency surgical management of ruptured intracranial aneurysm during the epidemic period (from January to March, 2020) at Beijing Tiantan Hospital, Capital Medical University was reviewed. The prognosis of emergent aneurysm surgery under different levels of protection or during the same period of 2019 and 2020 was further compared to describe the operation and prognosis under the new management protocol. A total of 127 emergency cases with aneurysmal subarachnoid hemorrhage were referred to Beijing Tiantan Hospital, Capital Medical University from January 20 to March 25, 2020, and 42 cases(33.1%) underwent emergent aneurysm clipping after multi-desciplinary consultation. Admissions of emergency cases required epidemiological, laboratory, and imaging screenings for COVID-19, with additional throat swab virus nucleic acid screening afterwards. During the same period, 9 cases of COVID-19 were confirmed in the emergency screening, and no false negative cases were found. Compared with the same period in 2019, the interval between emergency visits and emergency craniotomy did not increase significantly due to the preoperative screening ((37±17) hours during the epidemic period versus (29±12) hours at the same period in 2019, 0.058). There was no significant difference in the incidence of perioperative adverse events and postoperative neurological dysfunction (0.779). According to the screening results, the corresponding operative and postoperative management protocol and protection standards were adopted. There was no significant difference in the prognosis of emergent surgery between patients with a negative initial screening and those who were to be excluded or suspected in the initial screening (0.678). Although viral nucleic acid screening tended to prolong the time interval before surgical intervention ((36±15) hours before nucleic acid screening versus (40±20) hours after nucleic acid screening, 0.453), there was no statistically significant difference in the preoperative adverse events and postoperative neurological function (0.653). The current protocol of COVID-19 screening and stratified emergent surgery management based on screening results can effectively identify suspected and confirmed COVID-19 cases, thereby ensuring timely, safe and effective emergent surgery and prohibiting nosocomial spread.
探讨在2019冠状病毒病（COVID-19）大流行情况下，如何改进颅内动脉瘤破裂患者的急诊入院筛查和围手术期管理方案及其常态化防控措施，颅内动脉瘤破裂是最常见的急诊病例，也是最急需紧急手术的情况。回顾首都医科大学附属北京天坛医院在疫情期间（2020年1月至3月）颅内动脉瘤破裂急诊手术管理的应对方案。进一步比较不同防护级别下或2019年与2020年同期急诊动脉瘤手术的预后情况，以描述新管理方案下的手术情况和预后。2020年1月20日至3月25日，共有127例动脉瘤性蛛网膜下腔出血急诊病例被转诊至首都医科大学附属北京天坛医院，其中42例（33.1%）经多学科会诊后接受了急诊动脉瘤夹闭术。急诊病例入院时需要进行COVID-19的流行病学、实验室和影像学筛查，之后还需额外进行咽拭子病毒核酸筛查。同期，急诊筛查中确诊COVID-19患者9例，未发现假阴性病例。与2019年同期相比，由于术前筛查，急诊就诊至急诊开颅手术的间隔时间没有显著增加（疫情期间为(37±17)小时，2019年同期为(29±12)小时，P=0.058）。围手术期不良事件发生率和术后神经功能障碍发生率无显著差异（P=0.779）。根据筛查结果，采取相应的手术和术后管理方案及防护标准。初始筛查阴性患者与初始筛查拟排除或疑似患者的急诊手术预后无显著差异（P=0.678）。虽然病毒核酸筛查往往会延长手术干预前的时间间隔（核酸筛查前为(36±15)小时，核酸筛查后为(40±20)小时，P=0.453），但术前不良事件和术后神经功能无统计学显著差异（P=0.653）。目前基于COVID-19筛查结果的分层急诊手术管理方案能够有效识别疑似和确诊的COVID-19病例，从而确保及时、安全、有效地进行急诊手术，并防止院内传播。
