摘要
为更好地防治和管理2019冠状病毒病(COVID-19)疑似患者,避免这些潜在的患者或者病毒携带者引起继发感染,上海市呼吸内科临床质控中心联合赴武汉工作的首批专家特制定本共识。本共识侧重于明确COVID-19流行期间,如何重点做好呼吸科门诊工作以及如何做好呼吸科门诊质量控制这两个重要问题。通过质量控制管理好疑似和可疑患者,特别是隔离潜在感染源、切断一切传播途径,最终杜绝医师和患者之间的交叉感染,杜绝传播,同时也能保护医师、患者及其家庭安全。做好门诊质控要点是严格进行相关培训,包括熟悉诊治指南、做好自我防控(包括接诊前穿好专用工作服和戴好医用口罩)、杜绝社交和不接触任何风险。做好呼吸科门诊工作要求诊室做好消毒和通风;呼吸科医师开诊前后做好必要的消毒和防护;诊疗过程要求严格执行指南要求;有条件的单位可用物联网或者互联网辅助门诊,尽可能减少传播可能。本共识建议尽量减少不必要的检查,并列出了患者做检查及入院时的注意事项及特殊情况的应对策略。本共识特别强调COVID-19是传染病,不应漏掉病毒携带者、有症状的发病者和超级传播者,以免造成社会危害;在诊断和鉴别诊断有困难时,应该重视临床表现;对于不能排除潜在接触史的患者,当其有相关症状、影像表现为肺部感染、白细胞不高,即使核酸检测阴性,也应该考虑为COVID-19疑似患者或者可疑病例,建议立即隔离。
In order to better prevent and manage suspected patients of coronavirus disease 2019(COVID-19)and avoid secondary infections caused by these potential patients or carriers of the virus,experts from Shanghai Respiratory Clinical Quality Control Center including those assigned to Wuhan specially developed this consensus.This consensus is developed with a special focus on how to do a better job for respiratory clinic quality control,and how to do a better job for respiratory clinics during the secondary COVID-19 epidemic time.By managing suspected patients through quality control,especially by isolating potential sources of infection,cutting off all transmission routes,and ultimately eliminating cross-infection between physicians and patients,we aimed to eliminate transmission and protect physicians and patients and their families in this special time.The key point of clinical quality control is strict training,including familiarity with diagnostic and treatment guidelines,self-control(including special work clothes and medical masks before serving the patients),and eliminating social events and not touching any risks.Doing better job for respiratory clinics requires disinfection and ventilation,respiratory physicians should also be prepared to do the necessary before-and after-care disinfection and protection.The consultation process requires strict implementation of the guidelines.It is recommended that hospitals equipped with necessary instruments serve patients in their home with Internet of Things or Internet,to minimize the possibility of transmission.It is also recommended to minimize unnecessary examinations as much as possible,points of paying attention to the patient’s examination and admission precautions are also listed,with special circumstances response strategies.In addition,special emphasis is needed to consider COVID-19 as an infectious disease.Physicians should not miss the patients or virus-carriers,and should avoid overlooking of the super-spreaders,so as not to cause social harm.When diagnosis and differential diagnosis are difficult,attentions should be paid to opinions from the chest physicians.For patients who cannot rule out a potential history of exposure,i.e.,with related symptoms,imaging shows lung infection,white blood cells are not high,even if the nucleic acid test is negative,they should also be considered have 2019-nCoV pneumonia,or are suspected cases,and should be recommended rapid isolation.
出处
《复旦学报（医学版）》
CAS
CSCD
北大核心
2020年第2期143-150,共8页
Fudan University Journal of Medical Sciences
基金
This work was supported by the Shanghai Municipal Key Clinical Specialty,“Strong Body”Construction Program-Department of Pulmonary Medicine,Zhongshan Hospital,Fudan University.
关键词
2019冠状病毒病
肺炎
门诊
自我防护
临床诊断
质量控制
共识
COVID-19
pneumonia
outpatient department
self-protection
clinical diagnosis
quality control
consensus
作者简介
通讯作者:白春学,上海市领军人才,复旦大学附属中山医院教授、博士生和博士后导师,上海市呼吸内科临床质控中心主任,上海市呼吸病研究所和复旦大学呼吸病研究所所长。兼任中国肺癌防治联盟主席,上海市控烟协会会长,中国非公医协物联网医疗分会会长,亚太呼吸学会(APSR)Treasure,Clinical eHealth主编。先后获国家自然科学基金重大、重点项目等48项科研课题,发表论著600余篇,其中SCI索引期刊论著200余篇,牵头国内外呼吸病指南和共识17项,总SCI影响因子累计1030余分。主编《现代呼吸病学》、《急性呼吸窘迫综合征》和《物联网医学》等10部专著,获专利46项。侧重3项开创性工作:(1)创立物联网医学:在主编的4部物联网医学专著中完善顶层设计,提出智能诊治COVID-19的nCapp、三级联动的物联网医学架构和5A流程,在慢阻肺等呼吸病和肺结节诊治中发挥重要作用.(2)肺癌早诊:牵头制定《亚太肺结节评估指南》、《中国肺结节诊治专家共识》,在全国800家医院建立中国肺癌防治联盟肺结节诊治分中心,每年惠众百万。(3)国际交流:分别在美国胸科学会(ATS)、APSR、欧洲呼吸学会(ERS)和世界肺癌大会(WCLC)创立中国日。创立国际呼吸病学会(ISRD),并与ATS和APSR签订协议,已有200余名中国青年参会获奖,对扩大中国影响和推动青年走向世界起到重要作用,E-mail:cxbai@fudan.edu.cn;宋元林,复旦大学附属中山医院呼吸科与危重医学科主任,上海市教委特聘教授,博士生导师,上海市呼吸病研究所副所长,中华医学会呼吸分会常务委员,上海市呼吸病学会候任主任委员,亚太呼吸病学会感染学组组长。长期从事呼吸系统疾病的医教研工作。擅长支气管扩张症,慢阻肺等气道疾病,肺部感染,急慢性呼吸衰竭的诊断和治疗。先后主持国家自然科学基金面上项目、973子课题、上海市科委重大和重点项目、教育部博士点基金项目,参与国家自然科学基金重大和重点项目等。获得授权专利8项,转化3项。发表论文150余篇,编写论著10余部。先后获上海市科技进步奖二等奖,上海市医学科技奖二等奖,中华医学奖三等奖。
