COVID-19 у медицинских работников (обзор литературы и собственные данные)

Введение. Медицинские работники — группа риска инфекции вирусом SARS-CoV-2. Вместе с тем многие аспекты профессионально обусловленной COVID-19 все ещё недостаточно изучены.

Цель исследования — провести краткий обзор и анализ научных данных о распространённости, особенностях клинико-лабораторных синдромов COVID-19 у медицинских работников. Оценить структуру пост-COVID синдрома у медицинских работников, наблюдающихся в крупной многопрофильной медицинской организации, имеющей в своём составе центр профпатологии. Представить современное состояние проблемы экспертизы связи COVID-19 с профессией и допуска к работе в условиях высокого риска инфекции SARS-CoV-2.

Материалы и методы. На первом этапе выполнен краткий обзор литературы по проблеме COVID-19 у медицинских работников, на втором — одноцентровое наблюдательное проспективное исследование реконвалесцентов COVID-19. Основную группу составили медицинские работники (n=203), группу сравнения — лица, не имеющие профессиональных рисков здоровью (n=156). Группы были сопоставимы по демографическим характеристикам. Стаж работы медицинского персонала составил 15 (5; 21) лет. Из участников основной группы в стационарах работали 20,2%, в амбулаторных учреждениях — 79,8%. Трое участников (1,5%) были сотрудниками специализированных COVID-госпиталей. Врачей было 25,6%, среднего медицинского персонала — 51,7%, младшего медицинского и технического персонала — 22,7%. Тяжёлую форму COVID-19 перенесли 25 (12,3%) человек, после ИВЛ — двое участников. Время наблюдения — 60 дней. Статистический анализ включал стандартные методы описательной статистики, определение взаимосвязей методом логистической регрессии. Уровень значимости р<0,05.

Результаты. Большая часть известных данных о COVID-19 у медицинских работников получена в кросс секционных исследованиях. Достаточно доказана возможность профессионального инфицирования. Риск, вероятно, зависит от выполняемой работы и выше в условиях прямого контакта медицинского персонала со взрослыми, потенциально инфицированными больными, но не в специализированном госпитале. Возможно, течение COVID-19 у медицинских работников отличается от общей популяции больных, в частности, есть данные о большей частоте слабости и миалгий. Исследований особенностей пост-COVID синдрома у медицинских работников в доступных источниках выявить не удалось.

По результатам собственного исследования, у медицинских работников, перенёсших COVID-19, была выше частота центральных нарушений терморегуляции, аритмий, сердечной недостаточности, панических атак и депрессии.

Выводы. Медицинские работники — группа риска COVID-19. Профессионально обусловленный пост-COVID синдром отличается частотой нарушений центральных механизмов терморегуляции и аритмий. COVID-19 у медицинских работников соответствует определению профессионального заболевания.

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