新冠肺炎疫情期间急诊胸痛、卒中、创伤中心患者特征分析及应对

Characteristics and countermeasures of emergency patients in chest pain, stroke and trauma centers in tertiary hospital during epidemic of Coronavirus Disease 2019

  • 摘要:
      目的  探讨扬州新型冠状病毒肺炎(COVID-2019)疫情暴发期间江苏省苏北人民医院急诊胸痛中心、卒中中心、创伤中心(简称“三大中心”) 患者特征变化,并提出应对策略。
      方法  统计2021年7月28日—8月27日(扬州COVID-2019疫情暴发期)、2019年7月28日—8月27日(无疫情期)和2020年7月28日—8月27日(疫情常态防控期)急诊抢救室救治的“三大中心”患者的资料,观察“三大中心”患者性别、年龄、疾病、急性生理学和慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分,比较主要效率指标(急性心肌梗死患者入院至接受再灌注治疗时间、缺血性脑卒中患者入院至开始静脉溶栓时间和严重创伤患者术前等待时间),分析可能的变化原因并拟定对策。
      结果  扬州疫情暴发期,本院急诊抢救室胸痛、严重创伤患者占危重患者比率均低于前2年同期,且胸痛中心急性冠脉综合征患者占比下降,差异有统计学意义(P < 0.05)。疫情暴发期,“三大中心”80岁及以上患者占比、患者APACHE Ⅱ评分均高于前2年同期,差异有统计学意义(P < 0.05), 患者主要抢救效率指标与前2年同期相比,差异无统计学意义(P>0.05)。
      结论  COVID-19疫情局部暴发时,三级医院急诊抢救室“三大中心”的救治重点需向高龄患者及危重症患者方向倾斜,且急诊抢救室可通过调整布局和优化流程保证“三大中心”患者的救治效率。

     

    Abstract:
      Objective  To explore the characteristic changes of emergency patients visiting chest pain, stroke, and trauma centers in Subei People's Hospital during the outbreak of the Coronavirus Disease 2019 (COVID-19) in Yangzhou, and to propose corresponding strategies.
      Methods  The materials of patients visiting three major centers in our emergency rescuing department from July 28 to August 27, 2021(during the outbreak of COVID-19 in Yangzhou), July 28 to August 27, 2019 (no outbreak of epidemic) and July 28 to August 27, 2020 (regular prevention and control stage) were analyzed. The clinical parameters of the patients in the above period were observed, including gender, age, disease, Acute Physiology and Chronic Health Status Scoring System Ⅱ(APACHE Ⅱ) score, and the main efficiency indicators such as the time from admission to receiving reperfusion therapy for patients with acute myocardial infarction, the time from admission to the start of intravenous thrombolysis for patients with ischemic stroke and the waiting time before surgery for patients with severe trauma were compared. The possible causes of changes were analyzed and countermeasures were put forward.
      Results  During the outbreak of the epidemic in Yangzhou, the proportions of patients with chest pain and severe trauma in the emergency department were lower than those in the same period of previous two years (P < 0.05). The proportion of patients with acute coronary syndrome in the chest pain center decreased significantly (P < 0.05). The ratio of patients aged 80 years and above and the APACHE Ⅱ score of patients were higher than those in the same period of the previous two years (P < 0.05). There were no significant differences in the main rescue efficiency indicators during the outbreak compared with those in the same period of the previous two years (P>0.05).
      Conclusion  During local outbreaks of COVID-19, the three major centers of the emergency department in the tertiary hospitals need to be more concerned about elderly and critically ill patients. At this stage, the emergency center can ensure the medical efficiency of three centers by adjusting the layout and optimizing the process.

     

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