北京市通州区新型冠状病毒肺炎流行初期肺炎病例呼吸道病原流行特征分析

  目的   研究北京市通州区新型冠状病毒肺炎（COVID-19）流行初期肺炎病例中主要呼吸道病原的流行情况。  方法   252例肺炎病例被纳入本研究,采集病例的呼吸道样本（对144例病例同时收集咽拭子和痰液样本）进行32种呼吸道病原的实时荧光PCR方法检测。  结果   病毒、细菌和肺囊虫的阳性率分别为13.10%（33/252）、50.00%（126/252）和1.59%（4/252）。 43例病例呼吸道样本中检出多种病原,混合感染率为17.06%（43/252）,其中13例病例为病毒与细菌或病毒与肺囊虫的混合感染,30例病例为细菌与细菌或细菌与肺囊虫的混合感染。 患基础疾病和无基础疾病病例中流感嗜血杆菌（χ2=9.557,P=0.002）、肺炎支原体（χ2=7.831,P=0.005）的阳性率差异均有统计学意义。 5个年龄组病例中病毒（χ2=16.112,P=0.003）、肺炎支原体（χ2=10.741,P=0.030）的阳性率差异均有统计学意义。 144例肺炎病例的痰液和咽拭子样本病毒阳性率差异无统计学意义（χ2=1.003,P=0.316）,而痰液样本中肺炎链球菌的检出率高于咽拭子样本（χ2=5.533,P=0.019）。  结论   COVID-19流行初期（2020年1—3月）,肺炎病例呼吸道中存在一定比例的混合感染,其下呼吸道样本（痰液）的细菌阳性率高于咽拭子样本。     

北京市海淀区新型冠状病毒肺炎确诊病例流行病学特征分析

目的对北京市海淀区新型冠状病毒肺炎（COVID-19）病例进行分析，为有效防控COVID-19提供基础数据。方法采用实时荧光定量PCR方法对病例临床标本进行新型冠状病毒（2019-nCoV）核酸检测。 采用描述流行病学方法，对海淀区COVID-19病例人口学特征、就诊情况、感染来源等进行描述，并对轻症和重症病例相应特征进行比较。结果2020年1月20日至3月8日，海淀区共报告COVID-19确诊病例63例，其中男性30例（47.6%），病例的中位年龄为47岁（四分位间距:36～67，范围:9月龄至88岁），60～79岁年龄组病例数最多（20例，占31.7%），职业中干部职员病例数最多（21例，占33.3%），医务人员3例（4.8%）。 2020年1月23 — 28日，病例以武汉市输入为主（12/22，54.6%），之后以本地传播为主（25/41，61.0%）。 全区共报告家庭聚集性疫情12起，累计发病39例。 全区4例患者因COVID-19死亡，病死率为6.3%，因肺纤维化死亡1例，余58例（92.0%）痊愈出院。 重症病例17例（27.0%），轻症46例（73.0%）；较大年龄［≥50岁 vs. <50岁，比值比（OR）=9.632；95% 可信区间（CI）:2.238～41.456］和从发病到发热门诊就诊较长间隔（≥7 d vs. <7 d，OR=4.175；95% CI:1.116～15.610）是重症的危险因素。结论海淀区COVID-19疫情早期以武汉市输入病例为主，后继以本地传播为主；出现症状后及早就诊是减少重症和死亡发生的关键，特别是对于≥50岁者更为重要。     

新型冠状病毒肺炎患者常见呼吸道病原体混合感染分析

目的了解新型冠状病毒肺炎(COVID-19)患者呼吸道病原体混合感染情况。方法将500例COVID-19患者分为轻型组(205例)、普通型组(195例)、重型组(65例)和危重型组(35例),采用间接免疫荧光法检测所有COVID-19患者8种常见呼吸道病原体(流感病毒A型、流感病毒B型、副流感病毒、呼吸道合胞病毒、腺病毒、肺炎支原体、肺炎衣原体、嗜肺军团菌)Ig M抗体。结果轻型组、普通型组、重型组、危重型组分别有20、20、12和10例合并呼吸道病毒感染,分别占各组的9.76%、10.26%、18.46%和28.57%,差异有统计学意义(P0.05)。62例(12.4%)合并呼吸道感染患者中,有26例(5.2%)为多重感染。轻型、普通型、重型、危重型组合并感染率呈递增趋势,差异有统计学意义(P0.05)。结论 COVID-19患者呼吸道病原体混合感染率与COVID-19严重程度有关,在临床诊疗过程中要注意联合用药,以提高治愈率。     

新型冠状病毒疑似感染病例下呼吸道病原谱分析

目的 了解2020年1-3月北京市朝阳区100例新型冠状病毒(SARS-CoV-2)疑似感染病例的下呼吸道病原谱.方法 采用实时荧光定量聚合酶链式反应(real-time PCR)方法检测疑似病例痰标本中28种呼吸道病原,包括14种病毒、11种细菌、肺炎支原体、肺炎衣原体、真菌.结果 100份SARS-CoV-2疑似感...     

新型冠状病毒肺炎患者出院标准探讨并文献复习

目的 基于新型冠状病毒肺炎(COVID-19)的临床表现、实验室检查特点、影像学特点,探讨COV-ID-19的出院标准.方法 对5例COVID-19确诊患者进行影像学、血清学、流式细胞学、实时荧光逆转录聚合酶链反应(RT-PCR)检查.结果 5例患者经RT-PCR确诊为新型冠状病毒(SARS-CoV-2)感染,实验室检...     

新型冠状病毒肺炎疫情基层医疗机构防控探讨

2019年末新型冠状病毒肺炎作为一种新发传染病迅速在全球各地蔓延,我国新疆地区也经历了 3次大的疫情挑战.自治区和兵团疫情防疫领导组及时成立了专项督导组并多次深入基层,通过现场督查的方式,对发热门诊预检分诊的布局流程、工作人员防护用品的使用、手卫生执行、环境清洁与消毒、医疗活动过程等环节了解感染管理及控制现状,旨在最大...     

慢性肾脏病患者新型冠状病毒肺炎的防治

新型冠状病毒肺炎(corona virus disease 2019, COVID-19)是由新型冠状病毒(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)感染引起的一类急性传染病,传播力极强 [1-3].由于全球疫情仍在蔓延,且有可能存在较长时期,...     

维持性血液透析患者新型冠状病毒肺炎的感染防治

新型冠状病毒肺炎(corona virus disease 2019, COVID-19)是一种严重威胁人类健康的流行病.维持性血液透析患者因伴随多种并发症、免疫力低下等因素,成为COVID-19感染的高危人群 [1-2].本文就目前国内的疾病防控形势及本中心的相关经验,探讨维持性血液透析患者的COVID-19感染防治...     

12例儿童新型冠状病毒肺炎的临床护理

目的 通过分析和总结12例儿童新型冠状病毒肺炎的临床护理工作,为儿童新型冠状病毒肺炎患儿的护理工作提供参考。方法 分析2020年1月21日至2020年2月30日我院收治的12例确诊的新型冠状病毒肺炎患儿临床护理资料。 结果 12例患儿症状均消失,且新型冠状病毒咽拭子检查全转阴,3例新型冠状病毒肛拭子转阴,9例肛拭子阳性患儿转我院急诊综合病区行医学观察。无一例陪同家属及医务人员感染。结论 儿童新型冠状病毒肺炎的临床特点和护理管理有所不同,护理工作中除了注意消毒隔离防护外,还需根据不同年龄患儿给予个性化护理,并注意患儿、陪同人员和护理工作者的心理状况积极给予心理疏导。     

Characteristics of hospitalized COVID-19 patients with other respiratory pathogens identified by rapid diagnostic test

Rapid diagnostic tests (RDTs) significantly impact disease treatment strategy. In Japan, information on the use of RDTs for patients with COVID-19 is limited. Here, we aimed to investigate the RDT implementation rate, pathogen detection rate, and clinical characteristics of patients positive for other pathogens by using COVIREGI-JP, a national registry of hospitalized patients with COVID-19.A total of 42,309 COVID-19 patients were included. For immunochromatographic testing, influenza was the most common (n = 2881 [6.8%]), followed by Mycoplasma pneumoniae (n = 2129 [5%]) and group A streptococcus (GAS) (n = 372 [0.9%]). Urine antigen testing was performed for 5524 (13.1%) patients for S. pneumoniae and for 5326 patients (12.6%) for L. pneumophila.The completion rate of M. pneumonia loop-mediated isothermal amplification (LAMP) testing was low (n = 97 [0.2%]). FilmArray RP was performed in 372 (0.9%) patients; 1.2% (36/2881) of patients were positive for influenza, 0.9% (2/223) for the respiratory syncytial virus (RSV), 9.6% (205/2129) for M. pneumoniae, and 7.3% (27/372) for GAS. The positivity rate for urine antigen testing was 3.3% (183/5524) for S. pneumoniae and 0.2% (13/5326) for L. pneumophila. The positivity rate for LAMP test was 5.2% (5/97) for M. pneumoniae. Five of 372 patients (1.3%) had positive FilmArray RP, with human enterovirus being the most frequently detected (1.3%, 5/372).The characteristics of patients with and without RDTs submission and positive and negative results differed for each pathogen. RDTs remain an important diagnostic tool in patients with COVID-19 in whom coinfection with other pathogens needs to be tested based on clinical evaluation.     

2009-2012年北京市海淀区实验室诊断麻疹病例流行病学分析

目的 分析北京市海淀区2009-2012年实验室诊断麻疹病例的流行病学特征,为防控和消除麻疹提供依据。 方法 对北京市海淀区实验室诊断麻疹病例发病情况和含麻疹疫苗接种情况进行描述流行病学分析。 结果 除2010年外,2009-2012年海淀区麻疹发病率呈下降趋势,2012年麻疹发病率达历史新低;2009-2012年共报告实验室诊断麻疹病例333例,占全部麻疹病例的60.65%(333/549)。实验室诊断麻疹病例中,269例(80.78%)在2-6月发病;有详细资料的328例麻疹病例中,8月龄和20~39岁病例占全部病例的58.85%;外省户籍病例占74.09%;有含麻疹成分疫苗(measles containing vaccine,MCV)免疫史的占20.12%,无免疫史的占42.68%,免疫史不详的37.20%;全区麻疹病例送检的病原学标本中麻疹病毒分离率为26.09%(6/23),均为H1基因型。 结论 海淀区麻疹发病水平达到历史新低。要进一步降低麻疹的发病率,需提高适龄儿童首剂MCV及时接种率和加强常规接种、对重点儿童开展补充免疫等措施提高MCV接种率,对外省户籍成人采取以接种麻疹疫苗为核心的措施,最终实现消除麻疹。     

北京市海淀区351名5岁儿童患龋状况调查分析

目的 了解海淀区351名5岁学龄前儿童患龋齿情况,为儿童龋病预防提供依据。方法 采用多阶段分层等容量随机整群抽样,按照第三次全国口腔流行病学调查方法,调查北京市海淀区351名5岁城乡常住儿童的乳牙患龋齿状况。结果 调查结果显示,351例受检者总患龋率为64.10%,其中男、女童患龋率分别为61.49%和66.67%,二者间差异无统计学意义(P0.05);龋齿充填率为31.54%,女童龋齿充填率高于男童龋齿充填率(P0.05)。结论 5岁学龄前儿童患龋情况严重,应当重视学龄前儿童口腔健康,家长应督促孩子做好口腔保健,养成良好的口腔卫生习惯,定期口腔检查,发现龋病及时治疗。     

预立医疗照护计划在老年呼吸慢病终末期患者及其家属中的应用

目的 预立医疗照护计划在老年呼吸慢病终末期患者及其家属中的应用.方法 对2018年10月至2019年12月本院收治的80例老年呼吸慢病终末期患者实施预立医疗照护计划干预,比较干预前后患者的生存质量、患者家属的心理应激以及患者对维持生命治疗的态度和临终治疗护理意愿.结果 除身体不适和食物关注外,干预后患者的生存质量总分及...     

The end of life of patients with COVID-19 in intensive care unit and the stress level on their family members: A cross-sectional study

Background

During the Coronavirus disease 2019 (COVID-19) pandemic, hospital visits were suspended and video calls were offered to connect patients with their family members, especially toward the end of life (EoL).

Aim

The primary aim was to describe EoL care for COVID-19 patients dying in an intensive care unit (ICU). The secondary aim was to explore whether making video calls and allowing visits was associated with lower death-related stress in family members.

Design

Single centre cross-sectional study. The setting was the ICU of a COVID-19 center in northern Italy, during the first year of the pandemic. Data on patients who died in the ICU were collected; death-related stress on their family members was measured using the Impact of Event Scale-Revised (IES-R). The statistical association was tested by means of logistic regression.

Results

The study sample included 70 patients and 56 family members. All patients died with mechanical ventilation, hydration, nutrition, analgesia and sedation ongoing. Resuscitation procedures were performed in 5/70 patients (7.1%). Only 6/56 (10.7%) of the family members interviewed had visited their loved ones in the ICU and 28/56 (50%) had made a video call. EoL video calls were judged useful by 53/56 family members (94.6%) but all (56/56, 100%) wished they could have visited the patient. High-stress levels were found in 38/56 family members (67.9%), regardless of whether they were allowed ICU access or made a video call. Compared with other degrees of kinship, patients' offspring were less likely to show a positive IES-R score (odds ratio [OR] 0.22, 95% confidence interval [CI] 0.05 to 0.89).

Conclusions

During the first year of the COVID-19 pandemic, patients died without their family members at the bedside while on life-sustaining treatment. Stress levels were high in most family members, especially in patients' spouses. Video calls or ICU visits were judged favourably by family members but insufficient to alleviate death-related stress.

Relevance for Clinical Practice

During a pandemic, ICU access by patients' family members should be considered, particularly as the time of death approaches. Although generally appreciated by family members, EoL video calls should be arranged together with other measures to alleviate death-related stress, especially for the patient's spouse.