Objective: To study the clinical application effect of modified nasopharyngeal swab sampling for 2019 novel coronavirus nucleic acid detection. Methods: This study covered the period from January 14 to March 1, 2020.The supine position method and the protective face screen were used to collect nasopharyngeal swabs from February 24 onwards, before which, the nasopharyngeal swabs were collected by sitting position method. All the patients who were diagnosed with suspected/confirmed 2019 novel coronavirus infection were admitted from February 19 with the nasopharyngeal swabs collected outside the hospital before admission. (1) Thirty-four swabbing operators meeting the inclusion criteria of the study were recruited in this retrospective cohort study. They were grouped according to the collection method of nasopharyngeal swabs. Sixteen operators of Wuhan Taikang Tongji Hospital who applied the supine position method and the protective face screen were included in supine position method+ protective face screen group (15 males and 1 female, aged 34-49 years); 18 operators (12 from the First Affiliated Hospital of Army Medical University (the Third Military Medical University), 1 from Wuhan Jiangxia Mobile Cabin Hospital, 5 from the East District of People's Hospital of Wuhan University) who applied the traditional sitting position method were included in sitting position method group (2 males and 16 females, aged 25-49 years). In supine position method+ protective face screen group, when collecting sample, the patient lay flat and wore a special protective face screen for nasopharyngeal swab sampling, with neck slightly extending and face turning to the opposite side of the operator about 10°. The self-designed questionnaire was used to investigate the cooperation, the incidence of nausea, coughing, sneezing, and struggling of patients evaluated by the operators, the operation time for a single swab sample, the fear of operation and the perceived exposure risk of operators in the two groups. (2) Sixty-five patients (22 males and 43 females, aged 25-91 years) admitted to Wuhan Taikang Tongji Hospital who successively received the sitting position method and supine position method+ protective face screen for nasopharyngeal swabs sampling and with complete nucleic acid detection results were included. The positive rates of nucleic acid detection by the two sampling methods of nasopharyngeal swabs of the patients were statistically analyzed. (3) Forty-one patients who could express their feelings accurately were selected out of those 65 patients (12 males and 29 females, aged 27-83 years). The comfort of patients in the process of sampling by the two methods was investigated. (4) Thirty-four patients (10 males and 24 females, aged 25-83 years) with two or more consecutive negative results of nucleic acid detection of nasopharyngeal swabs by sitting position method were selected from the above 65 patients. The positive rate of nucleic acid detection of nasopharyngeal swab of patients by supine position method+ protective face screen, i. e. negative to positive rate was statistically analyzed. Data were statistically analyzed with t test, Wilcoxon signed rank test, and chi-square test. Results: (1) Compared with those of sitting position method group, the cooperation score of patients evaluated by the operators in supine position method+ protective face screen group was significantly higher (Z=-4.928, P<0.01), the incidence of nausea, choking cough, sneezing, and struggling of patients evaluated by the operators, and the fear of operation score and the perceived exposure risk score of operators in supine position method+ protective face screen group were significantly lower (Z=-5.071, -5.046, -4.095, -4.397, -4.174, -5.049, P<0.01), and the operation time for a single swab sample in supine position method+ protective face screen group was significantly longer (t=223.17, P<0.01). (2) The positive rate of nucleic acid detection of nasopharyngeal swabs by supine position method+ protective face screen was 60.00% (39/65), which was obviously higher than 41.54% (27/65) by sitting position method (χ(2)=4.432, P<0.05). (3) The comfort score of the 41 patients during nasopharyngeal swabs sampling by supine position method+ protective face screen was significantly higher than that by sitting position method (Z=-5.319, P<0.01). (4) Of the 34 patients with two or more consecutive negative results of nucleic acid detection of nasopharyngeal swabs by sitting position method, the rate of negative to positive of nucleic acid detection was 26.47% (9/34) after sampling by supine position method+ protective face screen. Conclusions: Compared with the traditional sitting position method, detection of 2019 novel coronavirus nucleic acids of nasopharyngeal swabs collected by supine method combined with protective face screen is worth promoting, because of its better comfort of patients, low exposure risk for operators, in addition to reducing in the false negative result to some extent, which may help reduce false recurrence of discharged patients.
目的： 探讨改良新型冠状病毒核酸检测鼻咽拭子采样方法的临床应用效果。 方法： 本研究涉及时间范围为2020年1月14日—3月1日，2月24日开始采用卧位法＋防护面屏采集鼻咽拭子，在此之前均采用坐位法采集鼻咽拭子。患者均为疑似/确诊新型冠状病毒感染患者，2月19日开始入院，之前在院外采集鼻咽拭子。(1)34名鼻咽拭子采集操作者符合本研究入选标准，对其进行回顾性队列研究。按鼻咽拭子采集方法分组，武汉泰康同济医院16名操作者(男15名、女1名，年龄34～49岁)采用卧位法配合防护面屏，纳入卧位法＋防护面屏组，采集标本时，患者平卧，佩戴鼻咽拭子采样专用防护面屏，颈部稍过伸，面部转向操作者对侧10°左右；18名操作者采用传统的坐位法，纳入坐位法组，其中陆军军医大学(第三军医大学)第一附属医院12名、武汉江夏方舱医院1名、武汉大学人民医院东院区5名，男2名、女16名，年龄25～49岁。自制问卷调查2组操作者自评患者配合度及恶心、呛咳、喷嚏、挣扎发生率，单次采样操作时间，对操作的恐惧感、自感暴露风险程度。(2)选择于武汉泰康同济医院先后接受坐位法、卧位法＋防护面屏采集鼻咽拭子且有完整核酸检测结果的65例患者(男22例、女43例，年龄25～91岁)，统计其分别采用2种方法采集鼻咽拭子的核酸检测阳性率。(3)选择(2)中的能准确表达自己感觉的41例患者(男12例、女29例，年龄27～83岁)，调查其在接受2种方法进行样本采集过程中的舒适度。(4)选择(2)中经坐位法采集鼻咽拭子核酸检测结果持续阴性(连续≥2次)患者34例(男10例、女24例，年龄25～83岁)，统计其经卧位法＋防护面屏采集鼻咽拭子的核酸检测阳性率，即阴性转阳性率。对数据行Wilcoxon符号秩检验、t检验、χ(2)检验。 结果： (1)卧位法＋防护面屏组操作者自评患者配合度评分显著高于坐位法组(Z＝－4.928，P<0.01)，操作者自评患者恶心、呛咳、喷嚏和挣扎发生率以及对操作的恐惧感和自感暴露风险程度评分显著低于坐位法组(Z＝－5.071、－5.046、－4.095、－4.397、－4.174、－5.049，P<0.01)，单次采样操作时间显著长于坐位法组(t＝223.17，P<0.01)。(2)65例患者经卧位法＋防护面屏采集鼻咽拭子的核酸检测阳性率为60.00%(39/65)，明显高于坐位法的41.54%(27/65)，χ(2)＝4.432，P<0.05。(3)41例患者经卧位法＋防护面屏采集鼻咽拭子的舒适度评分显著高于坐位法(Z＝－5.319，P<0.01)。(4)坐位法采集鼻咽拭子核酸检测持续阴性的34例患者，采用卧位法＋防护面屏采集鼻咽拭子后核酸检测阴性转阳性率为26.47%(9/34)。 结论： 相较于传统坐位法，采用卧位法联合防护面屏采集鼻咽拭子行新型冠状病毒核酸检测可显著改善患者舒适度，降低操作者的暴露风险，在一定程度上减少检测结果假阴性，可能有助于减少出院患者假性"复阳"现象，值得推广。.
Keywords: 2019 novel coronavirus; Comfort; Nasopharyngeal swab; Positive detection rate; Protective face screen; Safety; Sitting position method; Supine position method.