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新型冠状病毒感染后何时手术?DGC/BDC 和 DGAI/BDA 最近共识推荐的回顾。

When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA.

机构信息

Department of General, Visceral, Thoracic, Transplantation and Pediatric Surgery, University Hospital of Giessen, Rudolf-Buchheim-Strasse 7, 35392, Giessen, Germany.

Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany.

出版信息

Langenbecks Arch Surg. 2022 Jun;407(4):1315-1332. doi: 10.1007/s00423-022-02495-8. Epub 2022 Mar 21.

Abstract

Since the eruption of the worldwide SARS-CoV-2 pandemic in late 2019/early 2020, multiple elective surgical interventions were postponed. Through pandemic measures, elective operation capacities were reduced in favour of intensive care treatment for critically ill SARS-CoV-2 patients. Although intermittent low-incidence infection rates allowed an increase in elective surgery, surgeons have to include long-term pulmonary and extrapulmonary complications of SARS-CoV-2 infections (especially "Long Covid") in their perioperative management considerations and risk assessment procedures. This review summarizes recent consensus statements and recommendations regarding the timepoint for surgical intervention after SARS-CoV-2 infection released by respective German societies and professional representatives including DGC/BDC (Germany Society of Surgery/Professional Association of German Surgeons e.V.) and DGAI/BDA (Germany Society of Anesthesiology and Intensive Care Medicine/Professional Association of German Anesthesiologists e.V.) within the scope of the recent literature. The current literature reveals that patients with pre- and perioperative SARS-CoV-2 infection have a dramatically deteriorated postoperative outcome. Thereby, perioperative mortality is mainly caused by pulmonary and thromboembolic complications. Notably, perioperative mortality decreases to normal values over time depending on the duration of SARS-CoV-2 infection.

摘要

自 2019 年末/2020 年初全球 SARS-CoV-2 大流行爆发以来,许多择期手术干预被推迟。通过大流行措施,为了重症 SARS-CoV-2 患者的重症监护治疗,择期手术能力减少。尽管间歇性低感染率允许择期手术增加,但外科医生必须在其围手术期管理考虑和风险评估程序中纳入 SARS-CoV-2 感染的长期肺和肺外并发症(特别是“长新冠”)。这篇综述总结了最近由包括 DGC/BDC(德国外科协会/德国外科医生专业协会)和 DGAI/BDA(德国麻醉学和重症监护医学协会/德国麻醉师专业协会)在内的德国各协会和专业代表发布的关于 SARS-CoV-2 感染后手术干预时间点的最新共识声明和建议,范围涉及最近的文献。目前的文献表明,患有术前和围手术期 SARS-CoV-2 感染的患者术后结局明显恶化。因此,围手术期死亡率主要由肺部和血栓栓塞并发症引起。值得注意的是,围手术期死亡率随着 SARS-CoV-2 感染时间的延长而逐渐降至正常水平。

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