目的 探讨肺部超声(LUS)在高龄(≥75 岁)感染新型冠状病毒肺炎(COVID-19)患者中的应用及后续对病程的监测及诊断价值。方法 回顾性分析2022年11月1日—2023年1月15日本院内科收治的25例COVID-19高龄患者进行病例归纳总结,除临床资料外,动态监测肺部超声检查情况,并与肺CT结果对比,观察检查结果,以及对病程转归的预判及影响。结果 LUS检查提示患者出现不同程度肺间质损伤,包括离散型B线(间质渗出)或融合型B线(渗入肺泡)以及肺实变(肺泡萎陷)。随着病情好转,LUS可见肺实变范围缩小,B线逐步稀疏到消散,A 线出现。结论 LUS与同期胸部CT结果一致性良好。LUS检查安全简便,重复性好,可实时动态监测,即可作为初筛手段,亦可运用于特殊人群,协助临床治疗决策。

Objective To explore the application and follow-up monitoring and diagnostic value of lung ultrasound (LUS) in elderly patients(≥75y) with novel coronavirus pneumonia (COVID-19). Methods Data of 25 COVID-19 elderly patients admitted to the Department of Internal Medicine from November 1, 2022 to January 15, 2023 were retrospectively analyzed and summarized. In addition to clinical data, dynamic monitoring of LUS was performed, and the results were compared with lung CT results. The examination results, as well as the prediction and impact on the course of disease were observed. Results LUS imaging indicated that patients had different degrees of interstitial lung injury, including discrete type B line (interstitial exudation) or fusion type B line (alveolar infiltration) and lung consolidation (alveolar collapse). With the improvement of the disease, the range of lung consolidation seen in LUS was reduced, the B-line was gradually sparse to dissipate, and the A-line appeared. Conclusions The results of LUS and chest CT in the same period are consistent. LUS examination is safe, simple, reproducible, and can be monitored dynamically in real time. It can be used as a primary screening method, and also be used in special patients to assist clinical treatment decision-making.

目的 探讨在COVID-19流行期间血库资源紧张状态下输血时机对儿童输血效果及临床预后的影响。方法 本回顾性队列研究纳入2020年1月—2020年12月在广州市妇女儿童医疗中心儿科急诊就诊并申请输血的患儿的临床预后。结果 共566例发起红细胞和血小板的非手术输血申请的患儿纳入研究,包括 260 例的红细胞申请和306例血小板申请。260份红细胞申请中:209 例及时输血,40 例延时输血,11 例未输血;及时组和延时组的输血有效率分别为37.8%和35.0%(P=0.737);1名不良预后的死亡病例出现在及时组中,余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.886)。306份血小板申请中:195 例及时输血,108 例延时输血,3例未输血;1名不良预后的死亡病例出现在及时组中(0.51%),3名不良预后的死亡病例出现在延时组中(2.78%),余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.131)。结论 符合红细胞与血小板输血指征的非急诊手术用血的急诊患儿中,及时组、延时组和未输血组之间的临床结局没有差异。输血时机进一步需要大样本的循证研究加以确定。

Objective To investigate the influence of blood transfusion timing on blood transfusion efficacy and clinical prognosis in children under the strain of blood bank resources during COVID-19 pandemic. Methods This retrospective cohort study included clinical outcomes of pediatric emergency patients who applied for blood transfusion in Guangzhou Women and Children's Hospital from January 2020 to December 2020. Results A total of 566 children applicated blood transfusion for red blood cells and platelets for non-emergency surgical use were enrolled, including 260 red blood cells cases and 306 platelets cases. Among the 260 applications for red blood cells, 209 cases received timely transfusion, 40 cases received delayed transfusion, and 11 cases did not receive transfusion.The effective rate of transfusion for red blood cells was 37.8% in the timely group and 35.0% in the delayed group (P=0.737). One death case with poor prognosis was found in the timely transfusion group, and the clinical prognosis of the rest cases was good. There was no statistical difference in the clinical outcomes among the three groups (P=0.886). Among 306 applications for platelet, 195 cases had timely transfusion, 108 cases had delayed transfusion, and 13 cases did not had transfusion.One case with poor prognosis died in the timely transfusion group (0.51%), and three with poor prognosis died in the delayed transfusion group (2.78%). The rest of the cases had good clinical prognosis, and there was no statistical difference in clinical outcomes among the three groups (P=0.131). Conclusions There were no significant differences in clinical outcomes among the timely transfusion group, the delayed transfusion group, and the non-transfusion group for red blood cell and platelet transfusion respectively. The timing of transfusion may need to be determined by evidence-based studies with large samples.

目的 分析探讨健康驿站新冠病毒肺炎病例感染来源,评估驿站站内感染风险,规范驿站管理,降低感染风险。方法 对驿站2022年2月21日—3月9日全部14例新冠肺炎病例自入境到报告进行全链条风险分析。结果 14例病例为7批次不同时间入住,其中病例1、2、3、4、5、6、7、8、9、10、12、13共12例病例入境后即确诊,病例11入住5天(其共同入境、同住人员病例10,入境后即确诊)确诊、病例14入住10天发病确诊,其余病例均未呈现感染发病时间特异性,未呈现入境后交叉感染时间特异性,未见入住后空间、通风系统、排污系统交集,未见交叉感染情况。结论 该驿站目前报告新冠肺炎病例均有相关旅居史,主要在香港本土感染。13名病例大概率均在香港感染,入境隔离时发病确诊,其中病例1、2、3、4,病例6、7、8,病例10、11是3起呈现家庭聚集性感染发病,病例5、9是独立个案,病例14需要进一步排除,驿站未规范管理会导致误报及进一步扩大站内感染风险。

Objective To investigate and analyze the source of infection of COVID-19 cases in health station, assess the risk of infection, standardize the management and reduce the risk of infection. Methods From February 21 to March 9, 2022, the whole chain risk analysis of all 14 COVID-19 cases from entry to reporting was carried out. Results Fourteen cases were admitted in 7 batches at different times. Except for case 11 who diagnosed at the 5th day (the case of co-entry and co-resident case 10 was diagnosed after entry), and case 14 who diagnosed at the 10th day, the rest of the cases were diagnosed after entry, which did not show infection-onset time specificity, no time specificity of cross-infection after entry, no intersection of space, ventilation system and sewage system after entry, and no cross-infection. Conclusions The COVID-19 cases reported by the station were mainly infected in Hong Kong. Those 13 cases were highly likely infected in Hong Kong, all were diagnosed at the time of entry quarantine, while cases 1~4, cases 6~8, and cases 10~11 were 3 cases of family cluster infection, case 5 and 9 were an independent case, and case 14 needed to be further investigation. Failure to standardize the management of the station will lead to false alarms and further increase the risk of infection in the station.

目的 基于防控要求,快速建立临时隔离病区,合理优化影像学检查,更好的加强病区的管理工作,控制新型肺炎、防止交叉感染。方法 基于我院现有条件、人员、检查设备,结合抗击SARS经验,合理调整病区布局,建立有效的就诊,分诊,转运机制,明确工作职责,优化检查流程,放射检查防控等。结果 自新型肺炎临时病区建立以来,无1例医护人员感染和院内交叉感染。结论 思想重视,认真落实分诊,就诊;转运措施得当,科学防控,一站式,一体化,快速有效的检查方式,快速建立临时隔离病区,防止交叉感染的发生。在防控COVID-19新型肺炎中可以发挥巨大作用。

Objective Based on prevention and control requirements, to establish temporary isolation of ward quickly, rationally optimize medical imaging examinations and strengthen the management of ward to control the novel pneumonia, and prevent cross infection. Methods Based on the existing materials conditions, personnels, and examination equipments of our hospital, combined with the experiences of fighting against SARS, we rationally adjust the layout of the ward, establish an effective consultation, triage, and transfer mechanism, clarify job responsibilities, optimize examination procedures, and take strict prevention and control measures of medical imaging examinations. Results Since the establishment of the COVID-19 temporary ward, there was no cases of medical staff infection and nosocomial infection. Conclusion Highly valued opinion, conscientiously implements triage-visit-transportation measures, scientific prevention and control, one-stop-integrated fast and effective examination procedures and quickly establishement of a temporary isolation ward have played a huge role in preventing and controlling COVID-19.

目的 分析2019新型冠状病毒(COVID-19)肺炎的肺部影像表现,提高对该病的影像学诊断认识。方法 回顾性分析2020年1月20日—2020年2月20日在我院就诊并最终经临床确诊的COVID-19肺炎患者的影像学及临床资料,所有患者均在入院后三天内行胸部X线检查或高分辨率CT平扫,分别记录每位患者两种影像检查方式的影像学表现,包括病灶累及的肺叶、磨玻璃影(GGO)、实变影、铺路石征、纤维索条及小叶间隔增厚等征象。结果 共22例确诊为COVID-19肺炎,其中男:女为1:1,年龄范围20~82岁;平均年龄为(52.9±16.2)岁。21例行胸部X线检查,其中有3例患者同时行肺部CT平扫检查;1例患者仅行胸部CT平扫检查。21例X线检查中16例(76%)胸片表现为斑片状、絮状致密影,余5例(24%)检查双肺未见异常征象。4例CT扫描患者中均可以见到病灶(100%),其中有3例(75%)累及5个肺叶,1例(25%)仅累及1个肺叶;均表现为胸膜下磨玻璃影、斑片状实变影、铺路石征、小叶间隔增厚、小血管增粗及支气管气象;其中1例(25%)出现淋巴结肿大;2例(50%)出现纤维索条影。结论 影像学检查对COVID-19的诊断和病情评估具有重要价值,其中X线检查对于部分病灶显示欠佳, 胸部CT平扫对于病变的检查较为准确,可作为COVID-19首选的影像学检查方法,为临床上早期诊断及治疗提供依据。

Objective To analyzed the pulmonary imaging manifestations of 2019 novel coronavirus (COVID-19) pneumonia, in order to improve the imaging diagnosis of the disease. Methods Retrospective analysis of the imaging and clinical data of 22 patients infected with the 2019 Novel Coronavirus (COVID-19) were reviewed, which all the patients took the X-ray or CT scan, and to record the images in the two types of inspection for each patient, including the involvement of the consolidation of the lung, ground-glass opacification, consolidation, paving stone chippings, fiber cable and interlobular septal thickening and so on. Results A total of 22 patients were diagnosed with COVID-19, and the ratio of male to female was 1:1, age range is 20~82, mean age is (52.9±16.2.21) patients received chest X-ray examination, including 3 patients received the non-contrast CT examination at the same time; 1 patient received chest CT plain examination only. 16 (76%) among the 21 patients with X-ray showed patchy and flocculent dense shadows, while the remaining 5 patients (24%) showed no abnormal signs in both lungs. 4 patients with CT scan can find the lesions. Among the 4 patients with detect CT scan, 3 patients (75%) involved 5 pulmonary lobes, and 1 patient (25%) only involved 1 pulmonary lobe. All of them showed subpleural ground-glass opacification, consolidation, paving stone chippings, fiber cable and interlobular septal thickening, including lymph node enlargement occurred in 1 case (25%), fiber strip shadows were observed in 2 cases (50%). Conclusion The imaging examination is of great value for the diagnosis and disease evaluation of COVID-19, among which X-ray examination is not good for some lesions, and CT plain scan is relatively accurate for the examination of lesions, which can be used as the preferred imaging method of COVID-19, providing further theoretical basis for early clinical diagnosis and treatment.

目的 研究在新型冠状病毒COVID-19疫情期间,政府采取的干预措施对医院检测的流行性感冒(简称流感)阳性率的影响,为制定流感预防措施提供依据,也为间接评价新型冠状病毒的预防效果提供参考。方法 回顾性收集广州市第一人民医院总院2018—2020年年廿三至正月十五期间的流感抗原检测数据,对政府干预前后的流感抗原检测阳性率进行分析比较。结果 在春节前后,2018年和2019年的流感检测阳性率总体上维持稳定。其中,2018年春节前后,流感阳性率在15.6%～46.5%范围内波动,2019年春节前后,流感阳性率在11.9%～30.4%范围内波动。2020年同期的流感阳性率变化曲线与前两年不同,在正月初四前曲线变化较为稳定,维持在20.0%～44.1%范围内。在正月初四后曲线呈现显著下降趋势,在正月十二和正月十五,流感检测阳性率变为0。进一步的分析表明,政府干预对流感阳性率的影响无性别差异,对5～64岁人群效果最佳。结论 当前针对新型冠状病毒COVID-19的政府干预措施能显著降低流感阳性率,预防流感的发生,也为预防同样以呼吸道传播为主的新型冠状病毒的传播提供了间接证据。

Objective The aim of the study was to study the effect of government interventions on the positive rate of influenza detected in Guangzhou First People's Hospital during the outbreak of COVID-19, and to provide a basis to develop prevention measures against influenza and a reference for the indirect evaluation of the preventive effect of COVID-19. Methods Influenza antigen detection data of Guangzhou First People's Hospital were collected retrospectively from 23rd of the 12th lunar month to 15th of the 1st lunar month in 2018—2020, and the positive rates of influenza antigen detection before and after the government intervention were analyzed and compared. Results The positive rates of influenza were generally stable in 2018 and 2019 before and after the Spring Festival, where the positive rate fluctuated in the range of 15.6%～46.5% in 2018, and the positive rate fluctuates in the range of 11.9%～30.4% in 2019. The temporal change of the positive rate in 2020 was different from that of the previous two years. The positive rate curve was relatively stable before the fourth day of the first lunar month, maintaining a range of 20.0%～44.1% in 2020. After the fourth day of the first lunar month, the curve showed a significant downward trend. On the 12th and 15th day of the first lunar month, the positive rate of influenza became 0. Furthermore, the effect of government intervention on the positive rate of influenza showed no gender difference, and the effect was significant for people aged 5～64 years. Conclusion The current government intervention measures against COVID-19 could significantly reduce the positive rate of influenza, prevent the occurrence of influenza, and provide indirect evidence for the prevention of the spread of COVID-19, which was also mainly spread by respiratory tract.

新型冠状病毒肺炎是一种新发的急性呼吸道疾病,如何准确、完整、及时的记录好新冠肺炎患者的病历信息,为医学研究提供科学的依据是医院病案管理统计的工作重点。本文结合国家相关的规定和某新冠肺炎定点救治医院疫情防控工作经验,提出针对新冠肺炎病历的管理方案,包含病历的书写、编码、运行管理三方面,配合医院做好疫情防控工作的同时妥善记录好新冠肺炎患者病历信息。

Coronavirus disease 2019 is a new type of acute respiratory disease. Recording accurately, completely and timely the medical records of patients with COVID-19 and providing a scientific basis for medical research are the focus of the medical records management statistics. This paper proposes a management plan including writing, coding, and operation management for COVID-19 medical records, combining with the relevant national regulations and a COVID-19 designated hospital's experiences of epidemic prevention and control. This management plan cooperates with the hospital to do epidemic prevention and control work, and properly recordes the medical records of COVID-19 patients.