新型冠状病毒肺炎疫情下胸外科面临的挑战与对策

2019年12月以来,湖北省武汉市陆续出现2019新型冠状病毒(2019-nCoV,SARS-CoV-2)感染病例,疫情持续蔓延,全国其他地区也相继发现了此类病例。新型冠状病毒肺炎疫情给胸外科临床实践带来了巨大挑战。门诊需要加强对磨玻璃影及肺内斑块影病例的鉴别诊断。疫情期间严格控制手术指征,推迟择期手术;拟行限期手术患者,需隔离2周且核酸检测阴性后,方可开展手术;在疫区拟行急诊手术患者,术前应注意排查是否合并新型冠状病毒感染,必要时行核酸检测;拟行急诊手术患者,必要时术前应开展核酸检测,术中按三级防护处理。严格开展手术消毒隔离措施。在术后患者中,积极排查合并新型冠状病毒感染患者。在新型冠状病毒感染患者抢救过程中,需要注意预防、治疗相关并发症,包括机械通气相关性气胸或纵隔气肿以及气管插管后损伤。

Challenges and countermeasures of thoracic surgery in the epidemic of novel coronavirus pneumonia

Since December 2019,a novel coronavirus(2019-nCoV,SARS-CoV-2)pneumonia(COVID-19)outbreak has occurred in Wuhan,Hubei Province,and the epidemic situation has continued to spread.Such cases have also been found in other parts of the country.The spread of the novel coronavirus pneumonia epidemic has brought great challenges to the clinical practice of thoracic surgery.Outpatient clinics need to strengthen the differential diagnosis of ground glass opacity and pulmonary plaque shadows.During the epidemic,surgical indications are strictly controlled,and selective surgery is postponed.Patients planning to undergo a limited period of surgery should be quarantined for 2 weeks and have a nucleic acid test when necessary before surgery.For patients who are planning to undergo emergency surgery,nucleic acid testing should be carried out before surgery,and three-level protection should be performed during surgery.Patients who are planning to undergo emergency surgery in the epidemic area should be confirmed with or without novel coronavirus pneumonia before operation,and perform nucleic acid test if necessary.Surgical disinfection and isolation measures should be strictly carried out.Among postoperative patients,cases with new coronavirus infection were actively investigated.For the rescue of patients with novel coronavirus infection,attention needs to be paid to prevention and treatment and related complications,including mechanical ventilation-related pneumothorax or mediastinal emphysema,and injury after tracheal intubation.