[1]潘　力　温健鹏　黄　河　秦　杰　赵曰圆　沈春发　闫林海　石　纪　向伟楚　杨　铭　马廉亭.新型冠状病毒肺炎高风险地区出血性卒中的治疗对策[J].中国临床神经外科杂志,2020,(05):268-270.[doi:10.13798/j.issn.1009-153X.2020.05.004]
　PAN Li,WEN Jian-peng,HUANG He,et al.Treatment strategies for hemorrhagic stroke in high-risk areas of Corona Virus Disease 2019[J].,2020,(05):268-270.[doi:10.13798/j.issn.1009-153X.2020.05.004]
点击复制

新型冠状病毒肺炎高风险地区出血性卒中的治疗对策()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年05期
页码:
268-270
栏目:
论著
出版日期:
2020-05-25

文章信息/Info

Title:
Treatment strategies for hemorrhagic stroke in high-risk areas of Corona Virus Disease 2019
文章编号:
1009-153X（2020）05-0268-03
作者:
潘　力　温健鹏　黄　河　秦　杰　赵曰圆　沈春发　闫林海　石　纪　向伟楚　杨　铭　马廉亭
430070 武汉，中国人民解放军中部战区总医院神经外科（潘　力、温健鹏、黄　河、秦　杰、赵曰圆、沈春发、闫林海、石　纪、向伟楚、杨　铭、马廉亭）
Author(s):
PAN Li;  WEN Jian-peng;  HUANG He;  QIN Jie;  ZHAO Yue-yuan;  SHEN Chun-fa;  YAN Lin-hai;  SHI Ji;  XUANG wei-chu;  YANG Ming;  MA Lian-ting.
Department of Neurosurgery, General Hospital of Central Theater Command, PLA, Wuhan 430070, China
关键词:
出血性脑卒中; 新型冠状病毒肺炎; 介入治疗; 显微手术
Keywords:
Hemorrhagic stroke;  Corona Virus Disease 2019;  Endovascular intervention;  Microsurgery
分类号:
R 743.34; R 184.6
DOI:
10.13798/j.issn.1009-153X.2020.05.004
文献标志码:
A
摘要:
目的 探讨新型冠状病毒肺炎（COVID-19）高风险地区神经外科开展出血性卒中救治的方法及防控对策。方法 回顾性分析2020年1月22日至2020年3月31日中国人民解放军中部战区总医院神经外科收治的51例出血性卒中的隔离防护、诊治措施和结果。结果 所有出血性卒中病人入院时均视为COVID-19高危疑似感染者，采取三级防护，隔离区单间病房或ICU负压病房收治，待两次核酸检测后在负压手术间进行手术。51例中，2例确诊COVID-19，外科处理后转入感染科隔离病房治疗。自发性蛛网膜下腔出血20例中，颅内动脉瘤介入手术12例、开颅夹闭术4例；烟雾病3例对症治疗，1例颅后窝动静脉瘘行OYNX和GRUB胶介入栓塞治疗。31例高血压性脑出血中，22例行开颅血肿清除术或立体定向血肿穿刺引流术；9例血肿较小行保守治疗。未发生COVID-19交叉感染。出院时改良Rankin量表评分0分13例，1分6例，2分5例，3分18例，4分5例，5分3例；6分（死亡）1例。高等级安全防护和病毒排查导致手术时间平均拖延2~5 d，颅内动脉瘤及血管畸形再次破裂率及介入手术中脑血管痉挛发生率增高。结论 COVID-19高风险地区，神经外科收治出血性脑卒中时，严格按三级防护措施处理病人是防止COVID-19交叉感染的关键。但等待核酸检测可能会影响出血性脑卒中救治时机和疗效，进一步优化COVID-19核酸检测时间是当务之急
Abstract:
Objective To explore the treatment methods of the hemorrhagic stroke in high-risk areas of Corona Virus Disease 2019 (COVID-19) and preventive measures for COVID-19 cross-infection. Methods The clinical data of 53 patients with hemorrhagic stroke admitted to our hospital from January 22, 2020 to March 31, 2020 were retrospectively analyzed. Results All the patients were treated as high-risk suspected COVID-19 infection on admission. When the nucleic acid tests were negative twice, the operation was performed under tertiary protection in the negative pressure operation room. Of these 51 patients, 2 were diagnosed as COVID-19, and then transferred to the isolation ward of the infectious department after surgical treatment. Of 20 patients with spontaneous subarachnoid hemorrhage, 12 patients with intracranial aneurysms received endovascular intervention, 4 patients with intracranial aneurysms received clipping, 3 patients with moyamoya disease received conservative treatment, and 1 patient with arteriovenous fistula in the posterior fossa received embolization with OYNX and GRUB glue. Of 31 patients with hypertensive cerebral hemorrhage, 22 patients received craniotomy or stereotactic hematoma drainage, 9 with small hematoma received conservative treatment. No cross-infection of COVID-19 occurred. At discharge, 13 patients had modified Rankin scale (mRS) score of 0, 6 had mRS score of 1, 5 had mRS score of 2, 18 had mRS score of 3, 5 had mRS score of 4, 3 had mRS score of 5, and 1 had mRS score of 6. Conclusion In the high-risk areas of COVID-19, the treatment should be performed in the patients with hemorrhagic stroke according to three-level protective measures, which is the key to preventing COVID-19 cross-infection. However, waiting for nucleic acid testing may affect the surgical timing and efficacy of treatment of hemorrhagic stroke, and further optimization of COVID-19 nucleic acid testing is a top priority

参考文献/References:

[1] Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia [J]. N Engl J Med, 2020, 382(13): 1199-1207.
[2] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [J]. Lancet, 2020, 395(10223): 497-506.
[3] 国家卫生健康委脑卒中防治工程专家委员会. 神经病学 专业防控新型冠状病毒感染专家共识（第一版）. 2020.
[4] 中国医师协会神经介入专业委员会. 神经介入专业防控 新型冠状病毒感染专家推荐意见（试行第一版）. 2020.
[5] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus- infected pneumonia in Wuhan, China [J]. JAMA, 2020, 323: 1061- 1069.
[6] Bradley A, Brian T, Robert M, et al. Cerebral intraparenchy- mal hemorrhage: a review [J]. JAMA, 2019, 321(13): 1295- 1303.

相似文献/References:

[1]汪志忠　别毕洲　陈迎春　盛柳青　李欢欢　游慧超　叶建锋　李　俊.新型冠状病毒肺炎疫情期间诊治神经重症合并肺部病变10例报道[J].中国临床神经外科杂志,2020,(03):186.[doi:10.13798/j.issn.1009-153X.2020.03.022]
[2]冯娟娟　张　纯　郑　婷　方　艳　赵　畅　王昭艳　张　青　叶建锋　陈迎春　李欢欢.颅内动脉瘤合并新型冠状病毒肺炎的围手术期护理及医护人员防护[J].中国临床神经外科杂志,2020,(04):241.[doi:10.13798/j.issn.1009-153X.2020.04.017]
[3]湖北省脑血管病防治学会.新型冠状病毒肺炎防疫期间湖北省脑卒中绿色通道管理[J].中国临床神经外科杂志,2020,(04):254.[doi:10.13798/j.issn.1009-153X.2020.04.022]
[4]袁　波　蔡　新　王建春　胡小鹏　李志文　卢　婷　安亚文.新型冠状病毒肺炎病人康复早期心理应激状态调查及影响因素分析[J].中国临床神经外科杂志,2020,(08):531.[doi:10.13798/j.issn.1009-153X.2020.08.011]
　YUAN Bo,CAI Xin,WANG Jian-chun,et al.Investigation of psychological stress state of during early convalescence of patients with coronavirus disease 2019 and analysis of its influencing factors[J].,2020,(05):531.[doi:10.13798/j.issn.1009-153X.2020.08.011]
[5]苏晓娟　华　莎.抗疫护理团队参与新型冠状病毒肺炎重症监护病区组建和运行的思考[J].中国临床神经外科杂志,2020,(08):557.[doi:10.13798/j.issn.1009-153X.2020.08.020]
[6]李　炳　汪　欢　余　鹏　王羡科.新型冠状病毒肺炎期间神经外科医护人员职业暴露的相关因素分析[J].中国临床神经外科杂志,2020,(09):590.[doi:10.13798/j.issn.1009-153X.2020.09.005]
　LI Bing,WANG Huan,YU Peng,et al.Analysis of related factors of occupational exposure of medical staff in our department during COVID-19 epidemic based on DEMATEL method[J].,2020,(05):590.[doi:10.13798/j.issn.1009-153X.2020.09.005]
[7]陶　祥　张文斐　刘骏辉　朱晓楠　冀保卫　张　戈　徐海涛　陈治标.新型冠状病毒性肺炎疫情下神经外科急诊诊疗行为的建议及策略[J].中国临床神经外科杂志,2020,(09):594.[doi:10.13798/j.issn.1009-153X.2020.09.006]
　TAO Xiang,ZHANG Wen-fei,LIU Jun-hui,et al.Strategies and suggestions for emergency diagnosis and treatment of neurosurgery during coronavirus disease 2019 epidemic[J].,2020,(05):594.[doi:10.13798/j.issn.1009-153X.2020.09.006]
[8]詹昱新　李素云　韩克霞等.综合医院神经外科应对新型冠状病毒肺炎的护理应急管理[J].中国临床神经外科杂志,2021,26(03):206.[doi:10.13798/j.issn.1009-153X.2021.03.023]
[9]黄　娜　乐革芬　欧阳燕等.一级响应常态化防控下神经外科病房护理管理[J].中国临床神经外科杂志,2021,26(03):209.[doi:10.13798/j.issn.1009-153X.2021.03.024]
[10]姜　辉　罗俊华　李　娟.新型冠状病毒肺炎疫苗的研究进展[J].中国临床神经外科杂志,2021,26(07):567.[doi:10.13798/j.issn.1009-153X.2021.07.025]

备注/Memo

备注/Memo:
（2020-04-12收稿）
更新日期/Last Update: 1900-01-01