Please wait a minute...
浙江大学学报(医学版)  2020, Vol. 49 Issue (2): 209-214    DOI: 10.3785/j.issn.1008-9292.2020.03.15
原著     
2019冠状病毒病(COVID-19)疑似患者多学科协作诊治分析
丁叔波1(),俞世安2,陈海君3,*(),张德和3,徐叶进3,朱丹4,陈琨5
1. 金华市中心医院放疗科, 浙江 金华 321000
2. 金华市中心医院肝胆外科, 浙江 金华 321000
3. 金华市中心医院感染科, 浙江 金华 321000
4. 金华市中心医院呼吸与危重症科, 浙江 金华 321000
5. 金华市中心医院重症医学科, 浙江 金华 321000
Roles of multidisciplinary team in diagnosis and treatment of suspected cases of COVID-19
DING Shubo1(),YU Shi'an2,CHEN Haijun3,*(),ZHANG Dehe3,XU Yejin3,ZHU Dan4,CHENG Kun5
1. Department of Oncology Radiotherapy, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
2. Department of Hepatobiliary Surgery, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
3. Department of Infectious Diseases, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
4. Department of Respiratory and Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
5. Department of Critical Care Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, Zhejiang Province, China
 全文: PDF(1052 KB)   HTML( 38 )
摘要:

目的: 分析多学科协作诊疗(MDT)在2019冠状病毒病(COVID-19)疑似病例诊治中的参与情况及处置结果,总结MDT在COVID-19诊治中的作用。方法: 回顾性分析2020年1月21日至3月20日就诊于金华市中心医院的48例COVID-19疑似患者的临床资料及诊治经过,进一步分析MDT在患者处置流程和诊断中的作用。结果: 18例确诊COVID-19,30例排除COVID-19。确诊患者经MDT讨论2~12次,平均每例患者讨论(4.7±3.2)次;非COVID-19患者多学科讨论2~4次,平均每例患者讨论(2.3±0.6)次。MDT对COVID-19疑似患者诊疗流程及诊断标准进行了讨论及调整。在MDT主导下,1例危重型患者积极治疗后转省级定点医院治疗,1例COVID-19合并急性胆囊炎患者行胆囊穿刺置管引流术手术,1例高度疑似患者行肺泡灌洗液检查排除COVID-19。除1例COVID-19危重型患者转省级医院治疗外,17例COVID-19患者均治愈出院,未发现院内及疑似患者交叉感染,无死亡病例,无医务人员感染发生,非COVID-19患者及时转到相应专科治疗。结论: 在COVID-19疑似患者诊治过程中,MDT的参与提高了诊治效率,尤其对疑难复杂病例诊治有重要作用。

关键词: 2019冠状病毒病严重急性呼吸综合征冠状病毒2新型冠状病毒肺炎疑似病例多学科协作诊断治疗    
Abstract:

Objective: To analyze the roles of multidisciplinary team (MDT) in the diagnosis and treatment of suspected cases of coronavirus disease 2019 (COVID-19). Methods: The clinical data of 48 patients with suspected COVID-19 admitted in Jinhua Municipal Central Hospital from January 21, 2020 to March 20, 2020 were retrospectively analyzed. Results: In the 48 suspected cases, 18 were diagnosed with COVID-19, and 30 were excluded. Each of the confirmed cases were discussed among MDT for 2 to 12 times with an average of (4.7±3.2) times; while for non-COVID-19 patients were discussed for 2 to 4 times with an average of (2.3±0.6) times. With the guidance of MDT, one COVID-19 patient was transferred to designated provincial hospital after effective treatment; one patient complicated with acute cholecystitis underwent gallbladder puncture and drainage; and COVID-19 was excluded in a highly suspected patient after alveolar lavage fluid examination. Except one transferred patient, all 17 confirmed COVID-19 patients were cured and discharged. There was no cross-infection occurred in suspected patients during the hospitalization. There were no deaths and no medical staff infections. Conclusion: The efficiency of diagnosis and treatment for suspected COVID-19 patients can be improved with MDT, particularly for complicated cases.

Key words: Coronavirus disease 2019    Severe acute respiratory syndrome coronavirus 2    Novel coronavirus pneumonia    Suspected case    Multidisciplinary team    Diagnosis    Treatment
收稿日期: 2020-03-04 出版日期: 2020-04-10
:  R511  
通讯作者: 陈海君     E-mail: jhyyys@163.com;jhchenhaijun@126.com
作者简介: 丁叔波(1978-), 男, 硕士, 副主任医师, 主要从事肿瘤放化疗研究; E-mail:jhyyys@163.com; https://orcid.org/0000-0002-4533-4624
服务  
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章  
丁叔波
俞世安
陈海君
张德和
徐叶进
朱丹
陈琨

引用本文:

丁叔波,俞世安,陈海君,张德和,徐叶进,朱丹,陈琨. 2019冠状病毒病(COVID-19)疑似患者多学科协作诊治分析[J]. 浙江大学学报(医学版), 2020, 49(2): 209-214.

DING Shubo,YU Shi'an,CHEN Haijun,ZHANG Dehe,XU Yejin,ZHU Dan,CHENG Kun. Roles of multidisciplinary team in diagnosis and treatment of suspected cases of COVID-19. J Zhejiang Univ (Med Sci), 2020, 49(2): 209-214.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.15        http://www.zjujournals.com/med/CN/Y2020/V49/I2/209

1 PAULES C I , MARSTON H D , FAUCI A S . Coronavirus infections-more than just the common cold[J]. JAMA, 2020, 323 (8): 707- 708
doi: 10.1001/jama.2020.0757
2 MUNSTER V J , KOOPMANS M , VAN DOREMALEN N A et al. A novel coronavirus emerging in China-key questions for impact assessment[J]. N Engl J Med, 2020, 382 (8): 692- 694
doi: 10.1056/NEJMp2000929
3 GUAN W J , NI Z Y , HU Y et al. Clinical characteristics of coronavirus disease 2019 in China[J]. N Engl J Med, 2020,
doi: 10.1056/NEJMoa2002032
4 YANG X , YU Y , XU J et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China:a single-centered, retrospective, observational study[J]. Lancet Respir Med, 2020,
doi: 10.1016/S2213-2600(20)30079-5
5 徐凯进, 蔡洪流, 沈毅弘 et al. 2019冠状病毒病(COVID-19)诊疗浙江经验[J]. 浙江大学学报(医学版), 2020, 49 (2): 147- 157
XU Kaijin , CAI Hongliu , SHEN Yihong et al. Management of COVID-19:the Zhejiang experience[J]. Journal of Zhejiang University (Medical Sciences), 2020, 49 (2): 147- 157
doi: 10.3785/j.issn.1008-9292.2020.02.02
6 中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[A/OL].国卫办医函[2020] 145号.(2020-02-18)[2020-02-20].http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel coronavirus pneumonia (trial version 6)[A/OL]. No.145[2020] of the General Office of the National Health Commission. (2020-02-18)[2020-02-20]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml. (in Chinese)
7 HOLSHUE M L , DEBOLT C , LINDQUIST S et al. First case of 2019 novel coronavirus in the United States[J]. N Engl J Med, 2020, 382 (10): 929- 936
doi: 10.1056/NEJMoa2001191
8 周晶, 张德和, 陈海君 et al. 新型冠状病毒肺炎胸部CT表现不典型一例及文献复习[J]. 中华临床感染病杂志, 2020, 13 (1): 36- 38
ZHOU Jing , ZHANG Dehe , CHEN Haijun et al. Atypical chest CT in coronavirus disease:A case report and literature review[J]. Chinese Journal of Clinical Infectious Diseases, 2020, 13 (1): 36- 38
doi: 10.3760/cma.j.issn.1674-2397.2020.0002
9 周海华, 章义利, 周一波 et al. 新型冠状病毒肺炎合并急性胆囊炎手术治疗一例[J]. 中华外科杂志, 2020, 58
ZHOU Haihua , ZHANG Yili , ZHOU Yibo et al. A case of surgical treatment of new coronavirus pneumonia with acute cholecystitis[J]. Chinese Journal of Surgery, 2020, 58
doi: 10.3760/cma.j.cn112139-20200221-00114
10 上海市新型冠状病毒病临床救治专家组 . 上海市2019冠状病毒病综合救治专家共识[J]. 中华传染病杂志, 2020, 38
Shanghai Clinical Treatment Expert Group for Corona Virus Disease 2019 . Comprehensive treatment and management of coronavirus disease 2019:expert consensus statement from Shanghai[J]. Chinese Journal of Infectious Diseases, 2020, 38
doi: 10.3760/cma.j.issn.1000-6680.2020.0016
[1] 王锦程,刘锦鹏,王园园,刘伟,陈小群,孙超,沈晓勇,汪启东,吴亚平,梁文杰,阮凌翔. 2019冠状病毒病(COVID-19)患者胸部CT影像学动态变化[J]. 浙江大学学报(医学版), 2020, 49(2): 191-197.
[2] 张小燕, 孙伟, 尚世强, 毛建华, 傅君芬, 舒强, 江克文. 2019冠状病毒病(COVID-19)疫情期生物样本保藏生物安全防护原则及建议[J]. 浙江大学学报(医学版), 2020, 49(2): 170-177.
[3] 曹盛力,冯沛华,时朋朋. 修正SEIR传染病动力学模型应用于湖北省2019冠状病毒病(COVID-19)疫情预测和评估[J]. 浙江大学学报(医学版), 2020, 49(2): 178-184.
[4] 陈军,刘丹萍,刘莉,刘萍,徐庆年,夏露,凌云,黄丹,宋树丽,张丹丹,钱志平,李涛,沈银忠,卢洪洲. 硫酸羟氯喹治疗2019冠状病毒病(COVID-19)普通型患者的初步研究[J]. 浙江大学学报(医学版), 2020, 49(2): 215-219.
[5] 陈志敏,傅君芬,舒强,汪伟,陈英虎,华春珍,李甫棒,林茹,唐兰芳,汪天林,王颖硕,徐玮泽,杨子浩,叶盛,袁天明,张晨美,张园园. 儿童2019冠状病毒病(COVID-19)诊疗指南(第二版)[J]. 浙江大学学报(医学版), 2020, 49(2): 139-146.
[6] 徐凯进,蔡洪流,沈毅弘,倪勤,陈瑜,胡少华,李剑平,王华芬,俞亮,黄河,裘云庆,魏国庆,方强,周建英,盛吉芳,梁廷波,李兰娟. 2019冠状病毒病(COVID-19)诊疗浙江经验[J]. 浙江大学学报(医学版), 2020, 49(2): 147-157.
[7] 姜赛平,李璐,茹仁萍,张春红,饶跃峰,林彬,王融溶,陈娜,王小娟,蔡洪流,盛吉芳,周建英,卢晓阳,裘云庆. 2019冠状病毒病(COVID-19)重型、危重型患者用药管理经验[J]. 浙江大学学报(医学版), 2020, 49(2): 158-169.
[8] 李鑫,代甜,王虹,石军年,袁薇,栗静,陈利军,张天明,张珊珊,孔焱,岳宁,时慧,何玉苹,胡惠芳,柳芙蓉,杨彩霞. 2019冠状病毒病(COVID-19)疑似患者合并焦虑和抑郁的临床分析[J]. 浙江大学学报(医学版), 2020, 49(2): 203-208.
[9] 骆嵩,杨丽娟,王春,刘传苗,李殿明. 血浆置换和托珠单抗治疗六例2019冠状病毒病(COVID-19)重型患者临床分析[J]. 浙江大学学报(医学版), 2020, 49(2): 227-231.
[10] 洪东升,倪剑,单文雅,李璐,胡希,羊红玉,赵青威,张幸国. 基于监测数据的药物不良反应快速识别及R语言实现[J]. 浙江大学学报(医学版), 2020, 49(2): 253-259.
[11] 钟琦,李志,沈晓勇,徐凯进,沈毅弘,方强,陈峰,梁廷波. 2019冠状病毒病(COVID-19)不同临床分型患者胸部CT影像学特征[J]. 浙江大学学报(医学版), 2020, 49(2): 198-202.
[12] 康仙慧,张荣,何慧梁,姚永兴,郑跃英,温小红,祝胜美. 一例妊娠合并2019冠状病毒病(COVID-19)患者的剖宫产麻醉管理[J]. 浙江大学学报(医学版), 2020, 49(2): 249-252.
[13] 陈旭,李央,王金希,蔡洪流,曹红翠,盛吉芳. 三例妊娠合并2019冠状病毒病(COVID-19)患者诊治分析[J]. 浙江大学学报(医学版), 2020, 49(2): 240-244.
[14] 沈利华,黄菲,陈祥,熊钻,杨晓玉,李慧,程丰,郭健,龚国富. 严重急性呼吸综合征冠状病毒2(SARS-CoV-2)核酸检测试剂盒临床诊断效能评估[J]. 浙江大学学报(医学版), 2020, 49(2): 185-190.
[15] 张胜,李丹萍,陈华忠,郑丹,周益萍,陈葆国,石卫武,林荣海. 糖皮质激素治疗一例2019冠状病毒病(COVID-19)危重型患者炎症反应动态观察[J]. 浙江大学学报(医学版), 2020, 49(2): 220-226.