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COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice.

新型冠状病毒肺炎大流行: 耳鼻喉科和头颈外科实践的效果和循证建议。

  • 影响因子:2.60
  • DOI:10.1002/hed.26164
  • 作者列表:"Kowalski LP","Sanabria A","Ridge JA","Ng WT","de Bree R","Rinaldo A","Takes RP","Mäkitie AA","Carvalho AL","Bradford CR","Paleri V","Hartl DM","Vander Poorten V","Nixon IJ","Piazza C","Lacy PD","Rodrigo JP","Guntinas-Lichius O","Mendenhall WM","D'Cruz A","Lee AWM","Ferlito A
  • 发表时间:2020-06-01
Abstract

:The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities. There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists. Health workers represent between 3.8% and 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter). All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55 to 65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases, and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Health care facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for patients with cancer. For those who are working with COVID-19 infected patients' isolation is compulsory in the following settings: (a) unprotected close contact with COVID-19 pneumonia patients; (b) onset of fever, cough, shortness of breath, and other symptoms (gastrointestinal complaints, anosmia, and dysgeusia have been reported in a minority of cases). For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves. The procedures described are essential in trying to maintain safety of health care workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.

摘要

2019 新型冠状病毒 (新型冠状病毒肺炎) 是一种由SARS-CoV-2 通过呼吸道分泌物传播的人与人之间的高度传染性人畜共患病。它被世卫组织宣布为突发公共卫生事件。需要机械通气的最易感人群是老年人和有相关合并症的人。对于麻醉师、牙医、头颈外科医生、颌面外科医生、眼科医生和耳鼻喉科医生来说,存在重要的传染风险。卫生工作者占受感染人口的 3.8% 至 20%; 大约 15% 将产生严重的投诉,其中许多人将失去生命。大量患者没有明显的体征和症状 (发热/呼吸),然而对外科医生构成了真正的风险 (他们应该知道这一事实,因此必须对他们遇到的所有患者应用呼吸保护策略)。所有有可能雾化吸入空气消化分泌物的干预措施都应避免或仅在强制性情况下使用。卫生工作者: 怀孕,55 至 65 岁以上,有慢性病史 (未控制的高血压、糖尿病、慢性阻塞性肺病、和免疫抑制可行的所有临床情况,包括诱导治疗慢性炎症和器官移植)应避免潜在感染患者的临床注意。卫生保健机构应优先考虑紧急和紧急访视和程序,直到目前病情稳定; 真正的选择性护理应停止,并对癌症患者进行逐案讨论。在以下情况下,对那些与感染新型冠状病毒肺炎患者一起工作的人必须进行隔离 :( a) 与密切接触者肺炎患者进行无保护新型冠状病毒肺炎; (b) 发热、咳嗽、呼吸短促,和其他症状 (少数病例报告了胃肠道不适、嗅觉丧失和味觉障碍)。对于上呼吸消化道区域的任何护理或干预,无论环境和确诊 (例如,门诊环境中的鼻镜检查或柔性喉镜检查以及麻醉下气管切开术或刚性内镜检查),强烈建议所有卫生保健人员佩戴个人防护装备,如N95,礼服,帽,眼睛保护和手套。所描述的程序对于在大流行期间努力维护卫生保健工作者的安全至关重要新型冠状病毒肺炎。特别是,耳鼻喉科医生、头颈部和颌面外科医生在照顾新型冠状病毒肺炎阳性受试者时暴露于最大的感染风险,在目前情况下,保护他们应被视为优先事项。

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呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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