新冠肺炎疫情防控专家答疑平台系列（双语版） 【下】

xiaozhuohc

新冠肺炎疫情防控专家答疑平台系列（双语版）

【下】

中华医学会麻醉学分会

答疑专家：卞金俊，陈向东，程宝莉，戴茹萍，董海龙，邓小明，方向明、郭向阳，黄文起、李茜，李师阳，李天佐，林云，刘艳红，路志红，罗爱林，梅伟，米卫东，彭宇明，宋丹丹，苏殿三，谢克亮，徐懋王东信，王国林，王天龙，王云，王钟兴，吴安石，夏中元，朱涛，赵磊，张林忠，左明章

编辑：王晟 龚亚红

总负责：黄宇光

新冠肺炎疫情防控专家答疑平台第四期——学术与指南解读篇

（专家意见仅供参考）

COVID-19 prevention and control experts Q&A platform (4)—Academic and Guidelines interpretation (Expert’s opinion is for reference only)

1、乙醚可以杀灭病毒，其他吸入麻醉药物（七氟烷和地氟烷等）可以杀灭病毒吗？哪些麻醉药物对重要脏器有保护作用？

Ether is with antiviral activity. Is it possible that other inhaled anesthetics, such as sevoflurane and desflurane, has antiviral potential? What kind of protection could inhaled anesthetics exert on the vital organs?

董海龙，路志红 Dong Hailong，Lu Zhihong

很有趣的问题，但恐怕这并不会成为麻醉药物应用的新领域。

乙醚可以杀灭冠状病毒的原因是，作为一种脂溶剂，可以将包含脂质成分的冠状病毒包膜破坏，从而杀灭病毒。但值得注意的是，这些都是体外完成的，将乙醚用作体内抗病毒药物尚无先例。杀灭病毒所需的乙醚浓度远高于临床安全的乙醚浓度(麻醉浓度仅需3.6%)。我们可以看到目前体外杀灭病毒多为短时间使用50%以上浓度的乙醚，对最低浓度的报道是20%乙醚，但需持续使用16h以上，且效果不确切（Crandell RA. J Clin Microbiol. 1975）。这些剂量是我们无法加用在患者身上的。尽管尚无其他新型吸入麻醉剂与冠状病毒的研究，但根据其结构和脂溶特性，它们有可能干扰病毒的包膜，但效应要弱于乙醚，可以推测杀灭病毒所需的浓度也将更高。通过给患者吸入麻醉的方式想要达到能杀灭病毒的肺泡浓度从理论上来讲是不可能的。此外，目前的研究尽管提示新型的吸入麻醉剂如七氟烷和地氟烷有着潜在的肺保护作用，但总体来说麻醉药物对呼吸系统的效应是不良影响和有益效应并存的。对于已经发生了肺部损伤、炎性反应机制已经被激活的新冠状病毒肺炎患者，麻醉药物的有益效应恐怕微乎其微。对麻醉药物的使用应当局限于有镇静、镇痛、肌松等需求的患者。

　　The idea is interesting, but I’m afraid anti-virus therapy would not be a novel area for the application of anesthetics.

The antiviral mechanism of ether is based on its lipo-solubility. It can destroy the lipid in the envelope of the coronavirus. However, the evidences were all based on in vitro study. There has been no report of in vivo antiviral effect of ether. Moreover, the concentration needed for killing virus is much higher than that needed for anesthesia (about 3.6%). In the in vitro studies on antiviral effect of ether, the protocols were short-term use of high concentration ether (higher than 50%), or long-term (longer than 16 hour) use of lower concentration ether (the lowest concentration reported was 20%). And the effect of the latter was questioned (Crandell RA, J Clin Microbiol,1975). Ether with such high concentration could be lethal for patients. Though there has been no study on the antiviral effect of the novel inhaled anesthetics, theoretically their lower lipo-solubility compared with ether means higher concentration needed for killing virus. It’s impossible for the anesthetists to achieve an alveolar concentration high enough to reach the antiviral level. Furthermore, though there had been evidences supporting the potential organ protective effect of novel inhaled anesthetics including sevoflurane and desflurane, the effect of these agents on respiratory system have pros and cons. Patients with COVID-19 could have severe injury of the respiratory system, the use of inhaled anesthetics may not show protective effect and we should weigh the benefit.  

2、右美托咪啶在新冠肺炎患者有创及无创加强通气供氧中镇静镇痛之外对改善支气管周围血管收缩引起减轻肺炎改变是否有作用？

In invasive and non-invasive ventilation COVID-19 cases, Could dexmedetomidine ease the pneumonia through improving the vasoconstricition around bronchus besides sedation and analgesia?

方向明、程宝莉 Fang Xiangming，Cheng Baoli

(1)、右美具有拮抗儿茶酚胺释放、抑制交感神经、加强迷走神经活性等作用，细胞和动物研究提示右美能够抑制巨噬细胞NLRP3炎性体通路减轻炎症反应、经由α2AR/PI3K/Akt信号途径抑制肺上皮细胞的凋亡以及减轻ROS氧化应激等机理缓解急性肺损伤；

(2)、临床研究文章证明无创或者有创通气患者使用右美，能够改善肺通气血流比，还有研究显示其对心脏有保护作用，而这次新冠肺炎显示对心脏的攻击比较明显，这是它的优势；

(3)、新冠肺炎一个重要、特异性的病理生理机制就是通过结合ACE2受体、进而干扰其相关的整个肾素血管紧张素系统，右美能够抑制交感系统活性继而抑制肾素生成，可能通过这个机制而发挥保护作用（有待临床及基础研究证实）。

(1) 、Dexmedetomidine is a specific and selective alpha-2 adrenoceptor agonist.It inhibits the release if norepinephrine, therefore, causes the decrease of sympathetic tone by binding to the pre-synaptic alpha-2 adrenoceptors. The cell level and animal experiments showed that Dexmedetomidine could decrease the lung injury by reliving the NLRP3 inflammasome dependent inflammation in macrophage, reducing the apoptosis of lung epithelial cells through α2AR/PI3K/Akt pathway, and alleviating ROS involved oxidative stress response.

(2) 、Clinical trials have observed that the use of dexmedetomidine is associated with improved outcomes for both invasive and non-invasive mechanically ventilated patients. And evidences also supported it had cardiovascular protective effect, therefore, dexmedetomidine may benefit COVID-19 patients whose cardiovascular system had been attacked by the virus.

(3) 、Studies showed that ACE2 receptors binds to the novel coronavirus with affinity about 10- or 20-fold higher than its binding to the SARS virus. And the high binding affinity may disturb the function of the whole renin-angiotensin-aldosterone system. As mentioned above, the dexmedetomidine decrease the sympathetic tone, so it may rescue the disorder of the RAS.(clinical and experimental evidence are needed)

3、肺表面活性物质是否有用?

Dose the pulmonary surfactant work in COVID-19 ?

方向明、程宝莉Fang Xiangming，Cheng Baoli

(1)、从病理生理机制上，SARS、MERS及目前的新冠肺炎，肺部病理生理机制均涉及肺表面活性物质减少，适当补充应该能够纠正ARDS；

(2)、文献上，未见直接使用肺表面活性物质治疗成人冠状病毒肺炎的证据；

(3)、氨溴索是国内团队通过计算机模拟筛选出的ACE2受体阻滞剂，同时也能够促进肺表面活性物质产生，可能能够提供间接的证据。

(1)、The autopsy pathologic examinations revealed that, the novel coronavirus triggers inflammatory symptoms in the respiratory tracts and air sacs of the lungs, and the lungs exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration which were always reported in the condition of ARDS. So from mechanism-based hypothesis, the pulmonary surfactant should work in COVID-19.

(2)、However, till now, there are no clinical or experimental evidences directly supported the application of pulmonary surfactant in adult COVID-19 patients.

(3)、Ambroxol, which was reported as a candidate drug to treat COVID-19, is a mucolytic agent, could enhance pulmonary surfactant production.This may be an indirect evidence.

4、尽早给患者采用CRRT，会不会有更好的治疗效果？

Will COVID-19 cases get better response when CRRT was applied earlier？

方向明、程宝莉Fang Xiangming，Cheng Baoli

(1)、临床表现提示，新冠肺炎患者转为重症危重症，可能与肺外器官严重损伤有关（如肾、心等），ACE2受体在心、肾中高表达也支持这个现象[1-2]；

(2)、CRRT是重症医学一项成熟的器官支持技术，不仅替代肾脏功能，还能够减轻肺水、加吸附柱还能够清除炎症介质、细菌毒素，减少脏器损伤，有观点认为CRRT可以清除新冠肺炎的炎症风暴，尤其是合并AKI时，早点上应该会更好（不仅是清除炎症介质，也利于液体管理，减少肺部渗出，改善肺氧合）；比较积极的是：一旦发现尿量减少小于0.5ml/kg/h持续6小时或以上，或肌酐有升高（即存在AKI），就可以上。抗凝的使用，现在一般选择低分子肝素，有明显出血风险的，则选择枸橼酸局部抗凝，即在引血端使用枸橼酸钠，回血端使用钙剂中和；

(3)、然而，目前CRRT的应用也存在有争议，一是穿刺操作带来的风险，二是CRRT设备、超滤液/吸附柱和专业操作人员的要求较高，在一线使用增加医疗工作负荷及资源消耗（防护服等），有一定局限性，三是如对循环影响可能进一步激活肾素血管紧张素系统（一线大规模早期应用还是需要临床证据支持）

(1)、Clinical presentation among reported critically ill cases of COVID-19 showed complications including cardiac injury, acute kidney injury, septic shock, and multi-organ failure；

(2)、Continuous renal replacement therapy (CRRT) is commonly used to provide renal support for critically ill patients with acute kidney injury, particularly patients who are hemodynamically unstable. It could reduce the pulmonary edema, help clearing the proinflammatory factors and relive the organ injury. So some experts supported that we should apply the CRRT to severe and critical ill cases ASAP to shut down the inflammatory storm; Timing of Initiation：urine output≤0.5ml/kg/h for more than 6hrs，or serum Cr inscreases sharply; anticoagulating agents: we generally select Low-molecular-weight Heparin and sometimes use sodium citrate/calcium agent to avoid haemorrhage；

(3)、However, there remained some debates about CRRT in COVID-19: Firstly, the risk of the invasive manipulation; sencondly, the facilities and physicians/nurses who could run the CRRT were limited; thirdly, the potensial effect on RAS through disturbing the hemodynamics stability.(clinical and experimental evidence are needed)

5、胸片可以代替CT吗？

Can X-ray replace to chest CT scan?

王东信，彭宇明Wang Dongxin,Peng Yuming

不能。早期胸部平片多无异常发现。核酸检测阳性的普通型患者，多表现为两肺中外带和胸膜下的局限性斑片状，或多发节段性片状阴影为主。胸片对新冠肺炎患者早期渗出性病变不能及时发现，病变初期多无异常发现，漏诊率高，不推荐使用。

　 No, X-ray could not replace chest CT scan. In early stage, no abnormal in chest radiograph was founded in most cases. The common findings of chest X-ray manifests as peripheral and subpleural localized opacification, or multiple patchy consolidation in patients with positive results of nucleic acid testing. Early exudative lesions cannot be detected by X-ray in COVID-19 patients. Thus X-ray is not recommended to be used at early stage because of no abnormalities and the high rate of false negative.

6、新冠感染患者，急诊手术全身麻醉期保护性肺通气策略？

Protective pulmonary ventilation strategies during general anesthesia in emergency surgery of COVID-19 patients.

王天龙，赵磊Tianlong Wang, Lei Zhao

新冠肺炎患者由于全身及肺部严重的炎症反应，肺顺应性受到明显损害，气道由于炎症状态其反应性也会急剧增加，因此全身麻醉期间肺保护性通气策略需要采用通气保护策略联合全身给药。具体方法为：

(1)、提供有效抗应激措施，防止由于抗应激不足导致机体内环境紊乱，加重全身炎性反应，且由于严密防护的时限性不主张采用全麻联合外周神经阻滞，可以给与充分剂量瑞芬太尼，辅助给与右美托咪定；

(2)、采用目标导向液体管理联合预防性缩血管药物，实施限制性输液管理方案；

(3)、给与抗炎药物乌司它丁10000单位/kg,抑制过重炎性反应；

(4)、维持患者心率在基线心率80%至120%范围内，特别是老年患者；

(5)、如果术中气道分泌物过多，建议静脉给与戊乙奎醚0.5～1.0mg；

(6)、实施肺保护性通气策略，包括低潮气量6～8ml/kg，PEEP（5-10cmH2O）, 每小时肺复张性通气手法，在确保动脉血氧饱和度100%前提下，使用最低吸入氧浓度；

(7)、根据需要对气道进行吸引清理。

For COVID-19 patients, the lung compliance and airway reactivity are heavily affected by severe systematic and pulmonary inflammatory response, so it is necessary to combine protective pulmonary ventilation strategies with systematic medication. The details are as follows:

(1)、To prevent the internal environmental disorders and the aggravation of systemic inflammatory response which are caused by insufficient anti-stress, effective anti-stress measures such as sufficient remifentanil infusion assisted with dexmedetomidine should be taken. General anesthesia combined with peripheral nerve block is not recommended because of the time limitation in OR.

(2)、Infused fluid volume should be restricted through goal-directed fluid therapy combined with preventive vasoconstrictive medication.

(3)、Ulinastatin infusion of 10,000 U/kg can effectively inhibit excessive inflammatory response by surgery and anesthesia.

(4)、Heart rate should be maintained between 80% and 120% of baseline heart rate, especially for elderly patients；

(5)、If there are excessive airway secretion during operation，0.5～1.0mg intravenous penehyclidin is considerable；

(6)、Protective pulmonary ventilation strategies includes low tidal volume of 6~8 ml/kg, PEEP 5~10 cmH2O, lung recruitment maneuver 3-5 times/h, and keep the inspired fraction of oxygen as low as possible provided that SaO2 can be maintained at 100%；

(7)、Keep airway clear with aspirator.

7、抑制分泌物用什么药比较好？

Which drug is available to inhibitairway secretion?

王天龙，赵磊Tianlong Wang, Lei Zhao

抑制气道分泌物的最佳药物为抗胆碱药物，此类药物包括戊乙奎醚（长托宁），东莨菪碱，阿托品和格隆溴铵，在这些药物当中，戊乙奎醚除外抑制气道分泌物外，还具有改善肺部顺应性的效应，可适用于儿童和成人，由于在上述四种药物中，戊乙奎醚最易通过血脑屏障（戊乙奎醚>东莨菪碱>阿托品>格隆溴铵），影响神经元的神经递质胆碱的合成及传递，导致术后谵妄的风险增加，因此不建议用于老年患者，如果要用于老年患者推荐剂量不超过0.008mg/kg。老年患者不通过血脑屏障的格隆溴铵可能是较好的选择，麻醉前用药的剂量为0.005-0.01mg/kg，成人最大剂量0.2-0.3mg。

Anticholinergic agents, including penehyclidin, scopolamine, atropine and glycopyrronium bromide are considered as clinical option to inhibit airway secretion. Among these drugs, penehyclidin can not only inhibit airway secretion, but also improve lung compliance, which is suitable for both adults and children. But penehyclidin is inappropriate for the eldly patients, because it is the easiest to cross the blood-brain barrier comparing to other anticholinergic agents (penehyclidin> scopolamine> atropine> glycopyrronium bromide), which can increase the risk of postoperative delirium in elderly patients by affecting the synthesis and transmission of neurotransmitter acetyl choline. If the use of penehyclidin on the aged cannot be avoided, the recommended dosage is no more than 0.008mg/kg. For eldly patients, glycopyrronium bromide may be a better choice since it is hard to cross the blood-brain barrier. The dose is 0.005~0.01mg/kg as pre-anesthetic drug and the maximum dose for adult is 0.2~0.3mg.　

新冠肺炎疫情防控专家答疑平台第五期——院感管理篇（专家意见仅供参考）

COVID-19 prevention and control experts Q&A platform (5)—Management of nosocomial infection (Expert’s opinion is for reference only)

1、如何做好科室的院感管理？

How to make infection control measures in the department of anaesthesiology?

邓小明，卞金俊(Deng Xiaoming, Bian Jinjun)

科室应遵循所在医院的院感管理方案或流程，结合科室手术间条件、设备及人员等因素，因地制宜，制定适用于本科室的感控管理预案或流程。原则上，应当加强所属全部人员的培训考核，对此次新型冠状病毒肺炎的流行病学和临床特征予以充分掌握，可参考中华医学期刊网“新型冠状病毒肺炎防控和诊治专栏”发表的最新文章学习。科室应加强麻醉科、手术室环境、设备及医疗废弃物的感控管理，落实并细化各项感控制度。应加强新冠肺炎疑似病例的排查工作，根据患者的不同类型，采取不同的麻醉及相应的防护措施。对确需手术或急诊插管的患者，具体流程可参照《麻醉科防控新型冠状病毒肺炎工作建议（第一版）》、《新型冠状病毒肺炎围术期感染控制的指导建议》等。

The department should first follow the protocol or document of infection control released by the hospital, and then make applicable plan or protocol for their own. In principle, the training and assessment of all anesthesia care providers should be strengthened. All staff should fully understand the epidemiology and clinical characteristics of COVID-19, which can be learned from the latest articles published in the column of prevention, control and diagnosis of COVID-19 by Chinese Medical journal Network (http://medjournals.cn/2019NCP/index.do). At the department level, Infection control measures, safety of operating room environment, management of equipment and medical waste should be focused on and strengthened. Implementation of every infection control measure should be emphasized. Any procedure during the pandemic of COVID-19 should be fully evaluated to make sure whether the patients is with COVID-19 or not, and then choose appropriate  anesthesia method and protective measures. For patients who need emergent surgery or tracheal intubation, procedures should follow  "Anesthesia and Nursing Standard Operation Protocol in the Operating Rooms for Patients with Suspected and Confirmed NOVID-19" released by CSA and CAA, "Recommendations for tracheal intubation in critically ill COVID-19 patients (Version 1.0) " released by CSA Task Force on Airway Management.

2、如何避免手术室及恢复室内患者的交叉感染？

How to prevent cross-infection among patients in operating room and PACU?

邓小明，卞金俊Deng Xiaoming, Bian Jinjun

在疫情期间，应尽可能选择神经阻滞、椎管内麻醉等非全麻方式，避免将手术室的患者送至恢复室进行苏醒、气管拔管等操作。为疑似或确诊的新型冠状病毒肺炎患者实施手术麻醉时，应严格遵循三级防护标准和转运标准。如为全身麻醉患者，应在手术室内苏醒并气管拔管；若患者无法或不需要气管拔管，则应直接经专门转运通道，送至ICU等科室进一步治疗。如为非全身麻醉患者，应按照相应标准送回原病房等。在疫情较严重的地区，可将所有患者视为潜在的疑似患者，有条件的话均宜采取二级或三级防护。

During the epidemic of COVID-19, regional anesthesia including peripheral nerve blocks and neuroaxial  anesthesia should be preferred than general anesthesia. Patients with general anesthesia should be woken up and extubated in the operating room, not the PACU, for recovery. The Third-level protection and transport criteria should be strictly followed when performing anesthesia and procedures for patients with COVID-19 confirmed or suspected. If tracheal extubation is not required, unable or unnecessary, the patient should be directly transferred to ICU or other departments for further management through predefined transport channels. Those who underwent non-general anesthesia should be returned to their original wards according to relevant standards. In areas considered as severe pandemic, all patients may be considered as COVID-19 suspected, and the second or third protection should be taken where possible.

3、没有负压手术室，怎么开展新冠感染病例手术麻醉工作，是否能在正压手术室做手术？手术结束后，中央空调及层流净化如何处理？

How to perform anesthesia and surgical procedures for COVID-19 patients in lack of negative pressure operating room? Does the surgery can be performed in the positive pressure operating room? After the operation, how to manage the central air conditioning and laminar flow purification?

邓小明，卞金俊Deng Xiaoming, Bian Jinjun

如没有负压手术室，不建议开展新型冠状病毒感染患者的手术麻醉，确诊患者可转至当地指定定点医院如公共卫生中心进行手术治疗。如为必须立即实施的紧急手术，且只有正压手术室条件时，必须做到增加手术室内排风，使洁净手术室保持不低于5Pa负压，人为创造一个负压环境。可以考虑手段的手段如下：1）更换该手术室的排风机，加大排风量；2）如该手术室有外墙，增加带高效过滤器的排风装置后，可直接向外排放；3）如该手术室位于内部，则在非洁净区走廊侧设置带高效过滤器的排风装置，并向该区域排放。同时，非洁净区走廊窗户或通向外部的门应打开。
    在手术结束后，应当更换回风口和排风口过滤器。擦拭并消毒排风口、回风口与送风口。但不用更换天花板送风装置内的高效过滤器。如过滤器不合格或效率交叉，则难以确保飞沫不进入管道，还应消毒管道。
    若无负压手术室，条件允许还可在空旷地临时搭建帐篷或板房临时手术间为疑似或确诊患者实施手术，或者使用远离大手术室外的小型手术室，以减少对大手术室的污染。　

If there is no negative pressure operating room, it is not recommended to perform anesthesia and surgical procedures for patients with COVID-19. Patients should be transferred to a designated hospital such as public health center for further therapy. If an emergent procedure should be performed immediately, and only with positive pressure operating room, preparation and measures are as follows. Increase the exhaust air in the operating room to keep the negative pressure of the clean operating room no less than 5Pa, artificially creating a negative pressure environment. 1) replace the exhaust blower in the operating room and increase the exhaust air volume; 2) if the operating room has an external wall, the exhaust device with a high-efficiency filter can directly discharge the air outward; 3) if the operating room is located interior, the exhaust device with an efficient filter can arranged at the side of the corridor and discharge the air to the non-clean area. Meanwile, open windows or doors outside the non-clean area.

After the operation, the air in and  out filter should both be replaced. Please wipe and disinfect the exhaust outlet, air in and air out. There is no need to replace the high-efficiency particulate air in the ceiling air supply unit. If the filter is not qualified or working well, unable to prevent the entry of droplets into the pipeline, the pipeline should be also sterilized.

When there is no negative pressure operating room, it is allowed to temporarily set up a tent or board room in the open area to perform operations for patients with COVID-19 suspected or confirmed if possible. Another choice is using a small and remote operating room far away from the major operation center or unit, so as to reduce the underlying pollution to a less extent

4、 同一手术间或患者通道如何控制患者间交叉感染？

How to prevent cross-infection between patients in the operating room or transport channel?

邓小明，卞金俊Deng Xiaoming, Bian Jinjun

应当设置专门的手术间，为疑似或确诊的新型冠状病毒感染患者进行手术。专用手术间按照隔离病房消毒规范进行消毒，一般不做连续接台手术。在转运通道设置和路径上，也应有充分的预案，患者术后经专用通道转入指定的隔离房间，根据是否合并确诊、疑似或无明确接触史且无明显新型冠状病毒肺炎临床表现者分类进行处理。
在人员管理上，当某一手术间为疑似或确诊的新型冠状病毒感染患者手术时，室内人员在术中穿隔离衣不得离开隔离手术间，室外人员无特殊情况不得进入。手术结束后，离开手术间的人员按照标准脱摘程序脱下防护用品，必须先消毒双手再更换手套，然后脱防护衣、脚套并丢弃在医疗废桶内。脱手套后用手消毒剂按照七步洗手法消毒双手，再脱口罩、防护目镜/面屏等，出手术间后用流动水洗手，时间持续2 min。所有参与手术人员沐浴更衣后离开手术室。
    在手术间管理上，手术所需物品应标识明确，固定在专用手术间，推荐使用一次性物品，药品和一次性物品单向流动，只进不出。非一次性使用设备、物品必须依据相关规范进行使用后处理。在呼吸回路麻醉机端，进气口和出气口均应放置一次性过滤器，复合式人工鼻放置于患者端，以减少对呼吸回路的污染，过滤器3～4 h更换一次。纤维支气管镜等麻醉设备按特殊感染患者消毒标准进行充分洗消。按照规范及时用消毒机对麻醉机呼吸回路进行消毒。所有医疗废物用双层医疗废物袋密闭封装，按照感染性医疗废物处置。

Set up the designated operating rooms for patients with COVID-19 suspected or confirmed. Disinfect the designated operating rooms according to the isolation ward disinfection standard, and in principle,  should not arrange another operation. Make plans in advance on the setting and scheme of transport channel. After the operation, patients with COVID-19 should be transferred to the specific isolation ward through a special channel and receive therapy accordingly.

In terms of personnel management, when a certain operation room is used for patients with COVID-19 suspected or confirmed, personnel wearing isolation clothing should not leave the operating room before the end of surgery, and personnel outside should not enter the room during the operation, unless needed for help. After the operation, personnel should remove the protective equipment according to the standard before leaving the operating room. Hands hygiene must be performed before taking off gloves, and then the protective clothing and shoe covers  be removed and discarded into the medical waste bucket. Once the gloves removed, disinfect hands immediately according to 7 steps of handwashing rules, and then take off the face mask, eye mask, and face shield. Wash hands with running water when leaving the operating room for two minutes at least. All surgical staff should take a bath before leaving the operating center or unit.

In terms of operating room management, items should be clearly marked and fixed in the designated operating room. It is recommended to use disposable items. Non-disposable equipment and items must be disinfected in accordance with the relevant criteria after use. At the end of surgery, the respiratory circuit and disposable filters of the anesthesia machine should be replaced. A high-efficiency filter should be placed at the patient's end to reduce the possibility of infection in the respiratory circuit. The filters should be replaced every 3 to 4 hours. Fiberoptic bronchoscopy and other anesthesia equipment should be effectively cleared and disinfected according to the standards. Sterilize the circuit of anesthesia machine with a special sterilizer in time. All clinical waste should be sealed in a double-layer waste bag and disposed as infectious clinical waste.

5、插管之后喉镜如何消毒？

How to sterilize the laryngoscope after intubation?

朱涛，李茜Zhu Tao, Li Qian

建议采用可视喉镜插管，减少插管次数，使用一次性喉镜片，以及一次性透明保护套保护显示屏和镜柄，普通患者插管后采用过氧化氢反复擦拭。疑似或确诊患者插管之后的喉镜交由医院中心供应室统一消毒。

　  It is recommended to use visual laryngoscopes for intubation, since we are aiming to reduce the number of intubation attempts. Use disposable laryngoscope blades for the procedure and apply disposable transparent protective sleeves to protect the display and handle. Wipe equipment with hydrogen peroxide for sterilization after intubation procedures with ordinary patients. However, for patients of suspected or confirmed COVID-19, the laryngoscope should be delivered to the hospital’s central supply for sterilization.

6、麻醉科设备怎样确保彻底消毒？

How to ensure the complete sterilization of anesthesia equipment?

朱涛，李茜Zhu Tao, Li Qian

(1)、医院由专人配置含氯消毒液（消毒液的浓度分为：1，500mg/L浓度，主要用于普通患者；2，1000mg/L浓度，主要用于疑似或者确诊新冠状肺炎患者；3，2000mg/L的含氯消毒液，主要用于擦拭沾有血液的表面）;

(2)、消毒（擦拭）对象包括：麻醉机、药品车、体外循环机、所有电源线（包括心电图电源线、氧饱和度电源线、袖带）等所有设备、物品表面;

(3)、消毒（擦拭）的时间和频率：每天早晨手术开始前，每台手术结束后，每天手术结束后;

(4)、麻醉科所属的每个PACU的设备、消毒频率、消毒浓度与手术间一致;

(5)、麻醉科尽量采用一次性使用耗材，重复使用的耗材均交由医院中心供应室统一消毒。

(1)、T he hospital will be equipped with a chlorine-based disinfectant (the concentration of disinfectant is divided into two categories: concertation of 500mg / L, mainly used for ordinary patients; concertation of 2000mg / L, mainly used for patients with confirmed or suspected COVID-19 infection and used to wipe bloody surfaces).

(2)、 Objects and equipment that need sterilization include: anesthesia machines, drug carts, extracorporeal circulation machines, all power cords (including electrocardiogram power cords, oxygen saturation power cords, cuffs) and surfaces of other equipment and items.

(3)、Timing and frequency of sterilization: every morning before the first surgery, after each surgery, and every day after all surgeries.

(4)、The equipment, disinfection frequency, and disinfectant concentration of each PACU in the Department of Anesthesiology must be consistent with those in the operating room.

(5)、It is the best to use the Single use disposable medical consumables in the Department of Anesthesiology in the special time. Medical consumables that need to be reused should be collectively sterilized by the central supply of the hospital.

7、对于新冠状肺炎手术患者术毕麻醉机内部回路如何消毒？

How to sterilize the internal breathing circuit of the anesthesia machine after surgery？

朱涛，李茜Zhu Tao, Li Qian

术毕麻醉机内部回路如何消毒：

(1)、麻醉机内部消毒目前还没有很好的方法和确切的结论，目前主要使用循环风机消毒，但是在我国并不普及。确诊或疑似患者应该是在负压手术室，采用专用的麻醉机进行麻醉，并使用大于每分通气量的新鲜气流量进行麻醉；

(2)、疫情期间所有手术患者的麻醉机呼吸系统耗材均应一次性使用。特别要提醒的是，呼吸滤器能够降低病毒向麻醉机内部管道的播散，每位患者均应使用呼吸滤器，并且是一次性使用，呼吸滤器应该安放在气管导管和螺纹管之间，同时起到保护患者和设备的作用。目前在华西我们在螺纹管近患者端和近麻醉机端都安放呼吸滤器。

(1)、There is no perfect method and exact conclusion for the sterilization of internal circulation of the anesthesia machine. At present, the circulation fan is mainly used for disinfection, but it is not popular in China. The confirmed or suspected COVID-19 patients should be anesthetized in a negative pressure operating room with a dedicated anesthesia machine and ventilated with a fresh air flow greater than the minute ventilation.

(2)、During the epidemic, all consumables related to respiratory system of the surgical patients should be disposable. In particular, since the breathing filter can reduce the spread of the virus to the internal circulation of the anesthesia machine,the disposable breathing filter should be used for every patient.  Placing the breathing filter between the endotracheal tube and the Y-piece will protect the patient and the anesthesia machine from contamination. Currently in West China hospital, both the inspiratory port and the expiratory port are supplied with filters.

8、在麻醉门诊病人很多时怎样实现手卫生？

How to achieve hand hygiene when there are many patients in anesthesia clinics?

朱涛，李茜Zhu Tao, Li Qian

(1)、即便门诊病人多，也要严格按照手卫生指征执行手卫生，特别是“接触病人前”、“接触病人后”；

(2)、手卫生揉搓时间不少于15秒；

(3)、特别注意戴手套不能代替手卫生，脱掉手套后也应进行手卫生。

(1)、 Even if there are many outpatients, hand hygiene should be strictly implemented according to hand hygiene indications, especially before and after contacting with patients.

(2)、Hand washing and rubbing time must be more than 15 seconds.

(3)、Wearing gloves can not replace the need for hand hygiene. Hand washing is also mandatory after removing gloves.

新冠肺炎疫情防控专家答疑平台第六期——学科建设与科室管理篇

（专家意见仅供参考）

COVID-19 prevention and control experts Q&A platform (6)—Disciplineconstruction and department management (Expert’s opinion is for reference only)

1、在这场战疫中，麻醉科发挥了怎样的价值，还能做些什么？

During the epidemic of COVID-19, what value have Anesthesiologists played and what else can we do in the future?

米卫东，刘艳红Mi Weidong, Liu Yanhong

自疫情暴发以来，全国的麻醉科医务人员，也包括麻醉科下属的重症监护室的医生和护士，冲锋在前，勇挑重担。根据我们的统计目前奋战在疫情一线的医护人员中有来自102家医院的734名麻醉科医生护士，他们充分发挥本学科在重症患者的监护治疗，应激与脏器功能调控、气道通气管理等方面的优势，携手兄弟科室的同道们与病毒奋勇搏斗。现在各省市复工在即，医院手术也开始逐渐展开，这就要求我们这个作为全员枢纽和平台的科室，更加严密地做好防控，同时，逐渐铺开手术相关业务。这对维护社会和谐稳定，至关重要。在疫或区工作的麻醉科医生分别工作在定点医院的手术室、ICU病房、急诊科、发热门诊，方舱医院等，承担着感染患者的常规治疗、危重病患者的救治、感染患者及普通患者的急诊手术麻醉、呼吸功能衰竭患者的气管插管等危险度极高的医疗护理操作。需要根据传染性疾病的特点来判断具体能做哪些工作。以新型冠状病毒感染为例，该病主要侵袭呼吸道，也包括消化系统、心血管、肾功能等其他脏器的损害，在尚没有特效治疗药物的情况下，患者的救治基本都是依靠支持对症治疗，这与地震等引起的主要以外伤为主的灾害事件有所不同。对此麻醉科能做的工作，首先应充分发挥麻醉科医师擅长的应激与呼吸、循环等重要脏器功能的支持与调控技术，积极参与危重症患者的监护与治疗；其次，应全力保障感染病例因紧急病情，如急性肠梗阻，急性阑尾炎，剖宫产，颅脑外伤等须立即行急诊手术时的围术期管理；此外，在危重患者有创气道的建立方面麻醉科可一如以往地发挥所长，起到指导作用。

Since the outbreak of COVID-19, at least 734 anesthesia care providers from 102 hospitals have served in the front line of the epidemic in Wuhan, Hubei Province, China, according to our data. We still have a lot of colleagues fighting with virus in their own jobs all around the country. Anesthesia providers have played a critical role in urgent and emergent surgeries of patients suspected or confirmed of COVID-19, in which cases risks of exposure to the new coronavirus of anesthesia care providers were very high. At the same time, care providers from the Department of Anesthesiology, including anesthesiologists and intensive care physicians, have also been involved in treatment of critically ill patients in ICU, tracheal intubation and airway management of the mechanically ventilated patients who were confirmed of COVID-19 infection.

Although the epidemic is still far from being controlled and need further prevention, how to gradually and safely resume daily work will be our next priority. We need to establish scientific prevention and control process for routine surgeries and ensure safety of surgical patients, health care providers and the public in the process of surgery and anesthesia. In addition, we should continuously take our responsibility in the establishment and management of invasive airway, and treatment of critically ill patients.

2、新疫情下的成功防疫案例中给我们哪些启示？

What implications can we get from the successful perioperative management of patients with COVID-19?

邓小明，卞金俊Deng Xiaoming, Bian Jinjun

气管插管及气道相关操作，是可能导致麻醉科医护人员发生新型冠状病毒感染的重要途径，也是当前做好自身防护的关键。从武汉等地相关医院手术麻醉的成功防疫案例中，有下面几点启示。第一，要充分认识到新型冠状病毒的感染风险，做好三级防护措施的训练和演练，必须考核过关方可进行此类患者的麻醉及围术期管理工作。谨记，防护装备的脱卸过程，甚至比穿戴还要重要。脱卸过程不当，脱卸后的防护服处理不当，有导致感染的重要风险。第二，基于科室现有条件，调动知识储备和经验，来完善疑似或确诊新型冠状病毒肺炎患者的麻醉处理。主动学习，借鉴武汉等地相关医疗单位处置此类患者的手术麻醉经验（相关网站或期刊）。

Medical staff caring for patients with COVID-19 are at high risk of contracting the infection. Bag-valve-mask ventilation, and tracheal intubation are of particularly high risk for anesthesiologists perioperatively. Self-protection is the key to prevent possible contagious to COVID-19. As we know, many cases with COVID-19 received anesthesia and surgical procedures uneventfully, and here is what we learned. Firstly, the risk of the COVID-19 infection should be fully recognized, and third-level protective measures should be educated and trained. Medical staff who provide anesthesia and perioperative services for patients with COVID-19 confirmed or suspected must be strictly evaluated and pass relevant test before healthcare. It should be noted that the removal of self-protective equipment is even more important than donning them. Improper removal process and handling of protective clothing after removal pose risks of infection. Second, in now available condition,, all anesthesia care providers  should be prepared with knowledge and experience, in order to improve the quality of perioperative management of patients with COVID-19 confirmed or suspected. Last but not least, learn the experience from colleagues from  Wuhan and update yourself through reading the latest articles from relevant websites and journals.

3、疫情期间科主任应该做些什么？

What should the director of the department do during the epidemic?

李天佐，王云Li Tianzuo, Wang Yun

2020年2月14日，中华医学会麻醉学分会和中国医师协会麻醉学医师分会已经联合发出《给全国麻醉科主任的一封信》。总结起来，主要有以下几点：疫情期间麻醉科主任应保持高度的政治站位，树立大局意识，诸事以抗疫为先，建立麻醉科感染防控体系，考前指挥，对手术病人和不同岗位区域进行分类管理，切实做好员工防护，保障物资供应，做好员工培训和心理疏导，抗疫复工两手硬，妥善安排正常诊疗，做好疫情期间各类文档管理等。

  On February 14, 2020, Chinese Society of Anesthesiology and Chinese Association of Anesthesiologists jointly send a letter to the Director of the Department of National Anesthesiology. In summary, the main points can be concluded as follows: during the epidemic period, the director of the department of anesthesiology should maintain a high political stand and establish a sense of the overall situation. All matters should be given priority to resist the epidemic, establish an infection prevention and control system, command before assessment, carry out classified management of surgical patients and different post areas, earnestly do a good job in staff protection, ensure material supply, do a good job in staff training and psychological counseling, and take tough measures in the two tasks of anti-epidemic and resumption of work, make proper arrangements for normal diagnosis and treatment, and manage all kinds of documents during the epidemic.

4、新冠肺炎疫情下，科室组织管理如何开展？

With the epidemic of COVID-19, how to carry out the organization and management of the department?

李天佐，王云 Li Tianzuo, Wang Yun

麻醉科应成立疫情防控领导小组，由科主任任组长，领导科室疫情期间的防控管理工作。科室领导小组应在原科室制度体系的基础上，结合各上级文件精神，制定针对疫情防控的具体实施细则，同时确保执行医院各项决策，把科室工作融入到医院一盘棋的格局中去。全面管理科室各类人员（本院职工、进修生、研究生、规培生、实习生）的返京、隔离和身体健康情况。概括而言，就是管好自己的人，看好自己的门，做好自己的事，并以此发挥管理职能。

The department of anesthesiology should set up a leading group for epidemic prevention and control, headed by the director of the department, to lead the prevention and control management of the department during the epidemic. The department leading group should formulate specific implementation rules for epidemic prevention and control on the basis of the original department system and combined with the guidance of central government policy documents, and meanwhile ensure the implementation of various decisions of the hospital and integrate the work of the department into the overall pattern of the hospital. Fully manage the staff return to Beijing, quarantine and physical health of all kinds of personnel in the department (hospital staff, intern students, graduate students). In a nutshell, it is to take good care of their own staff, watch their own doors, take their own business, and play their management functions.

5、逐步复工阶段，麻醉科室工作该如何开展？

At the stage of gradual work resumption, how should the department of anesthesia carry out the work?

李天佐，王云Li Tianzuo, Wang Yun

第一、做好员工，尤其是一线工作的员工心理抚慰和思想沟通工作，进一步加强科室凝聚力。第二、做好疫情工作记录和归档，忠实记录科史。第三、展开病例讨论，总结经验教训，进一步完善科室应急方案和流程。第四、积极完成善后工作，帮助困难员工解决问题。第五、在医院统一领导下，逐步恢复正常医疗、教学和科研工作。

First, do a good job in psychological comfort and emotional communication among staff, especially those front-line workers, and further strengthen the team cohesion. Second, make good recording and filing the epidemic situation and faithfully record the history of the epidemic. Third, carry out case discussion, sum up experiences and lessons, and further improve the emergency plan and process of the department. Fourth, actively complete the aftermath work to help employees in need to solve problems. Fifth, under the unified leadership of the hospital, gradually restore normal medical, teaching and scientific research work.

6、基层医院如何做好疫情期间工作？

How can grass-roots hospitals do a good job during the epidemic?

李天佐，王云 Li Tianzuo, Wang Yun

第一、建立牢固的科室疫情防控体系。应包括：员工自身防护、手术室环境及设备防护、手术患者筛查、麻醉实施、患者术后管理及各种应急预案等。第二、强调手术病人分类管理（正常、可能正常、疑似、确诊/急诊、择期等），针对不同类型病人建立麻醉手术防护方案和流程。麻醉科和手术室按不同岗位和区域进行管理。第三、展开和做好全员培训工作。通过网络、视频和微信等手段组织员工学习各级学术组织发布的麻醉相关专家共识和经验；通过模拟培训等手段保障员工切实掌握防护手段和麻醉流程。第四、鼓舞士气，树立信心，发挥党员先锋模范作用。

Firstly, establish a solid epidemic prevention and control system in departments. It should include: self-protection of staff, environment and equipment protection of operation room, screening of surgical patients, implementation of anesthesia, postoperative management of patients and various emergency plans, etc. Secondly, emphasize the classified management of surgical patients (normal, possible normal, suspected, confirmed / emergency, elective, etc.), and establish anesthetic surgery protection programs and procedures for different types of patients. The department of anesthesiology and the operation room should be managed according to different positions and regions. Thirdly, launch and do a good job in staff training. Through the Internet, video, wechat and other means to organize staffs to study the ideas and experience of anesthesia experts by academic organizations at all levels; through simulation training and other means to ensure that staffs effectively master the protective measures and anesthesia process. Fourthly, boost morale, build confidence, and give full play to the exemplary vanguard role of party members.

7、麻醉医生该如何参与隔离病房及重症治疗？

How to participate the treatment in isolation wards and ICU for anesthesiologists?

王东信，彭宇明Wang Dongxin,Peng Yuming

"首先麻醉医生应当认真学习《新型冠状病毒感染的肺炎诊疗方案（试行第六版）》，熟悉新型冠状病毒的诊断标准、分型及最新治疗方案。对患者进行生命体征监测及呼吸支持，对需要进行有创机械通气的患者由麻醉医生完成气管插管，并参与机械通气患者的镇静和肌松治疗，避免人机对抗，对重症患者进行循环支持治疗。

插管医生需佩戴N95防护口罩、护目镜或面屏防护，一次性防护服，双层手套，两层湿纱布将患者口鼻盖住+面罩吸氧，插管时给予充分肌松，尽量使用可视喉镜。麻醉医生应熟悉并掌握自身防护、新冠重症患者插管流程，以及插管后工具的处理及消毒工作。对重症患者镇静给药时需谨慎，警惕插管过程循环的波动。"        

Firstly, anesthesiologists should learn the guideline of “Diagnosis and Treatment Plan of COVID-19 (Trial 6th Edition)”, and be familiar with diagnostic criteria, classification and the latest treatment for COVID-19. Anesthesiologist should participate in monitoring vital signs and respiratory and circulatory support therapy for critically ill patients. In addition, anesthesiologists should perform endotracheal intubation and participate in sedation and muscle relaxation to avoid man-machine confrontation in patients who need invasive mechanical ventilation.

Anesthesiologists need to wear N95 masks, goggles or face screen protection, disposable protective clothing and double gloves while intubating. Before intubation, the patient's mouth and nose is covered with two layers of wet gauze. Patients inhale oxygen with a mask, receive full muscle relaxation and endotracheal intubation through visual laryngoscope as much as possible. Anesthesiologists should know well of and master the self-protection, the intubation procedure, as well as the disinfection of implement and machine after intubation. Be cautious of administering sedatives for severe patients and to prevent the circulation fluctuation during intubation.

新冠肺炎疫情防控专家答疑平台第七期——心理呵护与人文关爱篇

（专家意见仅供参考）

COVID-19 prevention and control experts Q&A platform (7)—psychological counseling and humanistic care(Expert’s opinion is for reference only)

1、疫情之下，如何帮助患者消除恐惧心理，提高精神状态，增强免疫力，加快病情康复？

Under the epidemic, which procedures should be performed to help patients fight against disease and speed up recovery?

马虹，曹学照Ma  Hong，Cao Xuezhao

疫情是一场重大危机，危机之下每个人都可能出现焦虑、恐惧、易怒，心跳加快、血压升高、缺乏食欲、失眠等。这些都是正常的，但过度应激是有害的。医护人员应理解并帮助患者了解出现的应激反应，告知患者深呼吸以及转移注意力来缓解压力。如果上述症状无法缓解，患者要主动寻求专业人员的帮助。要强调隔离手段是为更好地观察治疗，也是在保护亲人，鼓励患者联络亲朋好友和同事，获得社会的支持鼓励。提倡健康作息，适当开展室内活动如锻炼、伸展、散步等。

The novel coronavirus disease is a crisis, under which patients are at high risk of post-traumatic stress disorder and other negative emotional, behavioral and mental health outcomes. Medical experts should help patients develop a better understanding of their responses to the disease and how it impacts their feelings, behaviors and relationships, teach them how to process stress management such as taking a deep breath and diverting attention. If emotional distress and behavior problems cannot be relieved, the patient should actively seek Medical specialists for help. Frontline health-care workers can help them to deal with the emotion swings, and encourage them to communicate with families and friends online or distract their attention. Healthy lifestyle and properly indoor exercise such as stretching, walking and so on are promoted as well.

2、关注抗疫一线的医护人员的身心状况及新冠患者的精神状态，如何做好麻醉医护的心理疏导来面对疫情期间的工作和心理压力？

What can we do for Anesthesiologist to face the work and psychological pressure during the epidemic?

马虹，曹学照 Ma Hong，Cao Xuezhao

医护人员在积极抗疫时，也要重视心理防疫。疾病突发，防护物资紧缺，作为一线抗疫的医护人员们更担心自己感染的可能，难免产生紧张焦虑情绪。为此，我们要落实培训，做到科学防护。同时鼓励一线人员改善自己对疫情的认知，不悲观、不放弃，把危机作为成长的契机。另外我们只关注权威科学信息。院内可以积极宣传疫苗研制进度、不断增加的治愈人数、医患共同努力抗击疫情的感人故事以及“一方有难，八方支援”正能量的事迹，为一线战士们助威。

The frontline health-care workers are working day and night to fight with the rampaging virus, no matter how exhausted they are or how dangerous it is. Because of complicated work procedures, high-intensity and high-risk work settings, they have a lower level of psychological status, which is manifested by mental disorder, stress disorder, and sleep disorder. We need to pay attention to the mental health of frontline medical staff in the epidemic, and provide guarantees to the medical staff to maintain a healthy working status. Enhanced support and training systemically could reduce burnout and stress. Hospital-based interventions to support staff may also promote adaptive coping. Improving work and rest conditions and providing professional psychological counseling can be beneficial as well. More importantly, the hospital can actively publicize the progress of vaccine development, the increasing number of people who have been cured, the touching story of doctors and patients working together to fight the epidemic, and the positive story of "when disaster struck, help came from all sides".

3、如何做好麻醉医护的心理疏导来面对疫情过后开展工作中的担忧和心理压力？

What we should do to improve psychological status of Anesthesiologists to face the psychological pressure of working after the epidemic?

马虹，曹学照 Ma Hong,Cao Xuezhao

疫情创造了一个“小假期”，鼓励医护人员充分利用来改善夫妻关系、亲子关系、朋友关系，积极面对疫情带来的改变，努力实现自我超越，增强应对困境的能力。保持健康的生活作息，保障身心健康，为返回岗位做好准备。应组织医护人员健康体检。组建心理救援专家组和医疗队，为实施心理危机干预的工作人员提供专业培训与督导，提供多种形式的专业心理危机干预服务；组建心理援助热线队伍，充分发挥现有心理援助热线和平台的作用，提供在线心理支持、援助服务。

The epidemic created a "small vacation" for Anesthesiologists. They are supposed to make full use of it to make a more harmonious marriage and improve the parental and friendship, actively face the changes brought about by the disaster, and strive to achieve self-implement and strengthen the ability to cope with difficulties. Maintaining a healthy lifestyle and protecting physical and mental health are important for healthy providers to go back to work. Available psychological therapies for prevention of negative physiological and mental problems exposed to trauma are necessary. Firstly，Physical examinations for medical staff should be organized. Then establish a psychological rescue expert team that can provide professional training and supervision for staff who carry out psychological crisis counseling. Secondly, setting up a psychological assistance hot-line team to make full use of existing lines and platforms. Lastly, create various approaches of professional psychological intervention services.

4、如何确保医生的合理工作和休息时间，现有条件下如何提高自身免疫力？

How to ensure balance reasonable working and rest time and improve doctor's immunity under existing conditions?

张宗泽，杨丽芳Zhang Zongze,Yang Lifang

目前疫情防控工作到了关键阶段，一批又一批医疗队员驰援湖北，减轻一线压力，但他们也面临着工作任务重、感染风险高、工作和休息条件有限、心理压力大等困难，结合国务院联防联控机制此前召开的新闻发布会，向大家介绍如何确保医生的合理工作和休息时间。首先，改造医生办公室、值班室和休息室，营造优质的休息和放松的环境，为医务人员提供良好后勤服务，保障医务人员充足的睡眠和饮食，另外可征用医院周边的酒店作为医务人员休息场所，以满足一线医务人员单人单间休息条件，确保每位医务人员具有充足的休息时间；其次，合理的工作安排，在保障防疫工作正常运行和人力资源有限的前提下，各科室集中人员，统一调配，实行医护人员轮岗/轮休制度，科学、合理、灵活安排医生的工作时间和工作内容，落实好交接班和特殊情况下的备班制度，以确保充足的休息；最后，避免长时间高强度工作，一线医务人员出现身体或心理不适时，及时停止工作并积极进行治疗。

现有条件下如何提高自身免疫力：首先，疫情当前，医护人员冲在第一线，身心的压力都比普通人大，一方面要保证充足的睡眠和营养，进行合适的锻炼，避免非战斗性减员；另一方面，进行适当的心理干预和心里疏导，保持积极的心态，多跟同事家人沟通互相支持相互鼓励；其次，可以适当使用增强免疫力的药物来提高免疫力。"

At present, epidemic prevention and control of COVID-19 is at a critical stage, batches of medical teams rushed to Hubei province to relieve the working pressure of front-line. They are facing heavy working tasks, high risk of infection, limited working and rest conditions, and high psychological pressure. Combined with Press Conference of Joint Prevention and Control Mechanism of the State Council, some suggestions about how to ensure the reasonable time of work and rest for doctors will be introduced. Firstly,it is necessary to redecorate the doctor's office, duty room and rest room to create a high-quality working environment and relaxed rest environment,and provide strong logistic service to ensure adequate sleep and diet medical staff. In addition, possible specific measures include requisitioning the hotels around the hospital to satisfy the single room rest condition, ensuring each one's sufficient rest time.Secondly,to ensure the normal operation of epidemic prevention, the work arrangement should be reasonable under the conditions of limited human resources. All departments should centralize personnel and allocate them uniformly, establish a system of rest rotation, arrange each one's working time and content scientifically, reasonably and flexibly, implement shift handover system and preparation system suitable for special circumstance to ensure adequate rest. Finally, avoiding working long hours work with high intensity, the front-line medical staff should stop working in time and accept treatment once they have physical or psychological problems.

How to improve their immunity under the existing conditions: First of all, front-line medical personnel are facing greater physical and mental stress than the ordinary. On the one hand, everyone should ensure adequate sleep and nutrition, and carry out appropriate exercise to avoid non-combat reduction. On the other hand, appropriate psychological intervention and counseling are necessary for the medical workers,they can also try to maintain a positive attitude by enhance communication with colleagues and family members.Secondly,immune-enhancing drugs can be  used to improve their immunity appropriately.

5、疫情下，工作和家庭安全该如何兼顾？医务工作者工作之外的休息时间，如何避免在家中交叉感染？

How to balance work and family safety under epidemic? How can medical workers avoid cross-infection at home during their rest time outside of work?

张宗泽，杨丽芳Zhang Zongze,Yang Lifang

(1)、对家人普及新冠肺炎相关知识及防护措施，加强自我防护和对疾病的早期识别，出现症状及早就诊；

(2)、医务人员要提高自身对新冠肺炎防治知识的掌控，在工作中，严格执行消毒隔离、手卫生和相应防护措施，正确穿脱防护物品，减少职业暴露，避免院内感染，离开医院前需先洗澡，并对随身物品做好消除处理，换干净的衣服后离院，若工作中出现职业暴露或可疑感染，要及时汇报医院相关部门进行相关检查并尽早隔离；

(3)、家庭条件允许时，可以跟家人分住两处或自己住在一个单独的房间，不能出现只“隔”不“离”；

(4)、在家入门处设立“缓冲区”，在此再次对自身衣服鞋子进行消毒等措施，并建议放在室外；

(5)、注意经常开窗通风。

(1) 、Popularizing knowledge and protective measures of NCP for family

members,strengthening self-protection and early recognition of the disease , and seeking treatment for the symptoms as soon as possible.

(2) 、Medical staff should improve their knowledge of the prevention and

treatment of NCP. They should inform disinfection and quarantine and corresponding protective measures strictly.Also,they should wear and take off protective goods correctly, reduce occupational exposure and avoid infection in hospital.Then,they should take a shower and disinfect their belongings and change their clothes for clean ones before leaving the hospital,only by doing so,can they leave the hospital.If occupational exposure or suspected infection at work, they should report to relevant departments of the hospital for inspection and isolation as soon as possible.

(3) 、Sharing two different rooms with other family members or living in a

separate room by oneself if family conditions permitted.

(4) 、Setting up a "buffer zone" at the entrance of the home, and disinfecting

clothes and shoes again, then putting them outdoor.

(5) 、Opening windows frequently and maintaining the good ventilation.

6、医护工作者下班回家后如何处理可以保证家人的安全问题？

How do medical workers do to ensure the safety of their families when they back home from work?

张宗泽，杨丽芳Zhang Zongze,Yang Lifang

首先，医护工作者上班期间注意自我防护，下班后用肥皂水全面洗脸洗手，注意鼻孔，颈部、外耳道等处，能在医院安排的住宿点住宿最佳，如果医院没有安排住宿，也建议尽量自己住一个房间；其次，进门前用消毒液再次对衣物进行消毒，换鞋、换外衣外裤后进门；自己的随身物品放置在自己房间固定的地方，并每天进行消毒擦拭；每日可使用消毒液对房间进行全面打扫，开窗通风30min以上，门把手、台面、手机、钥匙等频繁接触的地方，用消毒湿巾多次擦拭或使用紫外线进行消毒；换下的衣物用热水或消毒液浸泡半小时后再洗；所有家人都要做好手卫生；最后，减少不必要的外出。

Firstly, medical workers should pay attention to self-protection during work, wash face and hands with soap thoroughly after work, especially nostril, neck and external auditory canal. It is best to stay at the accommodation arranged by the hospital, if not, it is also suggested to live in a room by themselves. Secondly, disinfecting the shoes and clothes again before entering the door then taking them off. Putting your personal belongings in a fixed place in your room, and disinfecting them every day. Cleaning the room with disinfectant thoroughly every day and opening windows to strengthen the air circulation for more than 30min. Disinfecting with ultraviolet light or disinfectant for door handle, table top, mobile phone and key, the changed clothes should be soaked in hot water for half an hour before washing.All the family members should do well in hand hygiene. Finally, reducing unnecessary outings.

7、麻醉医生及其亲属由于工作原因感染后，医院和相关部门给予怎样的援助？

How do the hospital and related departments provide assistance once anesthesiologists and their relatives were infected due to work?

张宗泽，杨丽芳Zhang Zongze,Yang Lifang

麻醉科医务人员应接受医院感控方面培训，严格执行标准预防，根据感染风险级别采取相应隔离和防护措施，以避免病毒传播。麻醉医生及其亲属不幸由于工作原因感染后，首先应立即上报医院相关部门，对其密切接触者进行隔离观察，医院和相关部门应为医务人员救治和工伤认定开放“绿色通道”，确保医务人员及时就医，做好医务人员的后勤保障工作，消除其后顾之忧，并对医务人员和亲属进行积极地心理疏导，减轻其心理压力，按照规定给与相应补助，对表现突出的个人及时做出奖励和表彰，为做好疫情防控工作增强信心和凝聚力。

Anesthesiologists should receive training about infection control in hospital,and implement standard precautions strictly.Taking appropriate isolation and protection measures according to the level of infection risk to avoid the spread of the virus. When anesthesiologists and their relatives are infected unfortunately during the work, they should report to the hospital departments firstly and close contacts should be placed under isolation and medical observation. Additionally, hospital and relevant departments should establish a "green channel" for treatment and work-related injury identification of infected medical staff to ensure their timely medical treatment. At the same time, logistic support for medical staff should be provided to eliminate their worries. If necessary,psychological counseling should be carried out for the medical staff and their relatives to reduce their mental pressure.Finally, rewarding and commending outstanding individuals timely according to the related regulations so that enhancing confidence and cohesion of medical staff for the prevention and control of epidemic situation.

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