在疫情大流行時執行冠狀動脈介入治療？心導管室因應新冠肺炎之可行模式

Performing a Percutaneous Coronary Intervention in the Pandemic? A Paradigm for a Catheterization Laboratory Responding to Covid-19

林見財(Chien-Tsai Lin) ； 陳韋任(Woei-Renn Chen) ； 楊宗烜(Tsung-Hsuan Yang) ； 繆孝謙(Hsiao-chien Miao) ； 林治瑩(Chih-Ying Lin) ； 曾孟媛(Meng-Yuan Tzeng) ； 葉淑貞(Shu-Chen Yeh) ； 李香君(Hsiang-Chun Lee) ； 邱正安(Cheng-An Chiu) ； 林宗憲(Tsung-Hsien Lin)

《臺灣醫事放射期刊》 8卷2期 (2020/12) Pp. 7-12

https://doi.org/10.6717/JTMRT.202012_8(2).0002

摘要

面對新冠病毒等具高度傳染力經氣體傳播的呼吸道疾病，負壓隔離病房是減少病毒擴散造成院內群聚感染的必要設施。當新冠肺炎患者發生急性心肌梗塞，必須為其執行介入性心導管治療以減少其死亡威脅，團隊的現實困境，就是無負壓心導管室。我們以現有的心導管室空間與空調設施，進行以下幾項測試，以尋找可行解決辦法。第一，病人進入檢查室之前即必須暫時關掉空調設備的運轉，進行心導管儀器的耐溫測試；第二，醫療人員著雙層防護具加鉛衣後是否對正常臨床反應靈敏度有影響，進行SpO2監測評估；第三，發煙管進行檢查室壓差測試。以上幾項發現：第一項結果檢查室與機械室在個別獨立空調情況下，關掉檢查室空調90分鐘後，儀器運轉的平均溫度為攝氏20.14±0.93度（°C），平均濕度為57.64±1.86（%），皆在建議條件的攝氏18-30度（°C）和35-70（%）以內。第二項結果接受測試的醫療人員，年齡分別為60y/o及30y/o，經90分鐘的穿戴防護監測；於35分鐘時呼吸稍不順暢，於60分鐘時額頭明顯濕潤，於80分鐘時背部開始流汗，但無體力不堪負荷的情況，SpO2皆維持96%以上。第三項結果發煙管的煙從控制室往檢查室內流動，證實具相對負壓效果。結果顯示，複合心導管室的雙獨立空調，經暫時關閉檢查室空調下持續操作心導管90分鐘，具相對負壓、可容許儀器耐溫、醫療人員穿戴防護衣也無體力透支。雖無負壓心導管室，我們的因應措施，可兼顧心導管正常運轉與醫療人員安全防護，足以在類似武漢疫情下擔負起介入性治療的救命任務。

關鍵字

新冠病毒 ； 冠狀動脈介入治療 ； 負壓心導管室

並列摘要

The face of air-born, highly contagious respiratory diseases, such as Covid-19, the negative-pressure isolation room is one of important strategies for prevention of in-hospital transmission. Nevertheless, there is no ＂negative-pressure＂ Catheterization Laboratory among 26 medical centers in Taiwan. With this real limitation, encountering Covid-19 heart attack patient can be truly a challenge and also a dilemma for a life-saving percutaneous coronary intervention. In response to this situation, we postulated a practical model and tested the feasibility with three aspects as following: firstly, we turned off the air-condition of the examination room and performed the temperature and humidity test; secondly, we checked the reactivity and responsiveness of interventionalists on personal protective equipment that was added on their ordinary protection garments; thirdly, we used air-flow test tubes to determine the direction of air flow against the examination room. The results: first, at 90 minutes after turning off the air-conditioning of the examination room, which was separately with the machine room, the operation temperature and humidity was 20.14 ± 0.93°C and 57.64 ± 1.86 %, respectively and were within the appropriate operation temperature and humidity for the equipment; secondly, the oxygen saturation was above 96% for young (30 y/o) and middle aged (60 y/o) interventionalists with normal reactions, and sweating without exhaustion; third, the direction of the air flow shown by white smoke in the testing was from the operation room into the examination room, indicating that a negative pressure had been created in this paradigm. According to the above results, temporary turning of air-conditioning of the examination room for 90 minutes creates a negative pressure effect in air flow, with temperature and humidity tolerable for equipment operation, and endurable for interventionalists performance. In conclusion, this is a paradigm that can secure both health providers and the operation equipment at a Catheterization Laboratory while performing a life-saving coronary intervention in the pandemic such as Covid-19.

並列關鍵字

Covid-19 ； CoronaryPCI ； Negative pressure isolation room