摘要
目的:为证实静脉用药调配中心(PIVAS)建立对于临床科室护理人员抗肿瘤药物(ADs)职业暴露防护方面的作用提供参考,并为制订ADs调配指南和职业暴露防护规范提供依据。方法:通过问卷调查和导出实验室检查指标数据等方式调查和对比分析我院PIVAS建立前后不同ADs接触频率的临床科室护理人员(A组为非暴露组,B组为低暴露组,C组为高暴露组)月经异常、不良生育结局、脱发及血液毒性、肝肾毒性等发生情况,并采用高效液相色谱法考察PIVAS环境中ADs[甲氨蝶呤(MTX)和5-氟尿嘧啶(5-FU)]残留情况。结果:PIVAS建立前共发放问卷160份,回收有效问卷151份,有效回收率为94.38%;PIVAS建立后共发放问卷150份,回收有效问卷144份,有效回收率为96.00%。问卷调查结果显示,PIVAS建立前,C组受访者月经周期异常、行经天数异常、痛经、自然流产、不孕、子代低出生体质量发生率和脱发症状严重程度均显著高于A组,差异均有统计学意义(P<0.05或P<0.01);C组受访者上述前6项情况发生率分别是A组的5.14、6.10、3.81、4.04、6.15、8.08倍。同时,B组受访者子代低出生体质量发生率和脱发症状严重程度也均显著高于A组,差异均有统计学意义(P<0.05或P<0.01);B组受访者前者发生率是A组的6.21倍。PIVAS建立后,C组受访者月经周期异常、行经天数异常、痛经、自然流产、不孕、子代低出生体质量发生率和脱发症状严重程度均较建立前显著降低,差异均有统计学意义(P<0.05);且C组受访者除脱发症状严重程度仍显著高于A组外,上述其他指标与A组比较差异均无统计学意义(P>0.05)。同时,B组受访者子代低出生体质量发生率和脱发症状严重程度与A组比较差异均无统计学意义(P>0.05)。实验室检查指标调查结果显示,PIVAS建立前,C组受访者白细胞计数、血小板计数均显著低于A组,肝功能异常发生率显著高于A组,差异均有统计学意义(P<0.05或P<0.01)。PIVAS建立后,C组受访者白细胞计数、血小板计数、红细胞计数和B组受访者血小板计数均较建立前显著升高,C组受访者肝功能异常发生率较建立前显著降低,差异均有统计学意义(P<0.05或P<0.01);且C组受访者上述指标与A组比较差异均无统计学意义(P>0.05),B组受访者血小板计数甚至已经显著高于A组(P<0.05)。PIVAS环境中ADs残留考察结果显示,PIVAS环境中不同物体表面均存在不同程度的MTX和5-FU残留,ADs残留量由高至低依次为生物安全柜台面、生物安全柜正下方地面、药筐、传递窗门把手、输液袋。结论:ADs接触频率较高的临床科室护理人员面临更高的相关健康风险,而通过建立PIVAS可以对临床科室护理人员的ADs职业暴露起到有效的防护作用,从而降低上述风险。同时,PIVAS环境中不同物体表面仍存在不同程度的ADs残留,并存在转运出PIVAS的可能,提示仍应提高对PIVAS环境中ADs残留引起的职业暴露风险的防护意识,需尽快制订统一的ADs调配指南和职业暴露防护规范以减少PIVAS和临床科室护理人员的相关职业暴露风险。
OBJECTIVE： To provide reference for confirming the protective effect of the establishment of PIVAS on antineoplastic drugs（ADs） occupational exposure to nursing staff in clinical departments, and to provide the basis for the formulation of ADs dispensing guideline and occupational exposure protection regulations. METHODS：By questionnaire survey and deriving data of lab examination index,the occurrence of abnormal menstruation,bad birth outcome,alopecia,blood toxicity,liver and renal toxicity in nursing staff of clinical departments with different ADs contact frequencies（non-exposure group as group A,low-exposure group as group B,high-exposure group as group C）were investigated and analyzed in our hospital before and after the establishment of PIVAS. The residual of ADs [methotrexate（MTX）and 5-Fluorouracil（5-FU）] in PIVAS environment were investigated by HPLC. RESULTS：A total of 160 questionnaires were sent out before the establishment of PIVAS,and 151 were effectively collected with effective recovery of 94.38%. After the establishment of PIVAS,150 questionnaires were sent out,and144 were effectively collected with effective recovery of 96.00%. Questionnaire results showed that the incidence of abnormal menstruation,abnormal menstruation period,dysmenorrhea,spontaneous abortion,infertility and offspring low birth weight,the severity of hair loss in group C were significantly higher than group A,with statistical significance（P〈0.05 or P〈0.01）. The incidence of above 6 conditions in group C were 5.14,6.10,3.81,4.04,6.15,8.08 times higher than in group A. At same time,the incidence of the offspring low birth weight and the severity of hair loss in group B were significantly higher than group A,with statistical significance（P〈0.05 or P〈0.01）;the incidence of the former in group B was 6.21 times higher than in group A. After the establishment of PIVAS,the incidence of abnormal menstruation,abnormal menstruation period,dysmenorrhea,spontaneous abortion,infertility and offspring low birth weight,the severity of hair loss were decreased significantly in group C,with statistical significance（P〈0.05）. The severity of hair loss in group C was significantly higher than group A,and there was no statistical significance in above indexes,compared with group A（P〉0.05）. At the same time,there was no statistical significance in the incidence of the offspring low birth weight and the severity of hair loss between group B and A（P〉0.05）. Results of lab examination index investigation showed that before the establishment of PIVAS,WBC and PLT of group C were significantly lower than group A,and the incidence of abnormal liver function was significantly higher than group A,with statistical significance（P〈0.05 or P〈0.01）. After the establishment PIVAS,WBC,PLT and RBC of group C,and PLT of group B were increased significantly compared to before the establishment PIVAS;the incidence of abnormal liver function in group C was decreased significantly compared to before the establishment PIVAS, with statistical significance（P〈0.05 or P〈0.01）. There was no statistical significance in above indexes between group C and A（P〉0.05）,and PLT of group B was even significantly higher than group A（P〈0.05）. Results of investigation of ADs residues in PIVAS environment showed that there were different degrees of MTX and 5-FU residue on the surface of different objects. The residues of ADs from high to low were biological safety cabinet worktops, the floor just below biological safety cabinet, transfer box, transfer window and door handle and infusion bags.CONCLUSIONS：Nursing staff of clinical department with high ADs contact frequency face higher relevant health risks. The establishment of PIVAS can effectively protect the ADs occupational exposure of nursing staff in clinical departments,thereby reducing the above risks. At the same time,there are still different degrees of ADs residues on the surface of different objects in the PIVAS environment, and transshipment out of PIVAS is possible. It is suggested that the awareness of protection against occupational exposure risk caused by ADs residues in PIVAS environment should be improved; unified guideline for ADs dispensing and occupational exposure protection regulations should be formulated as soon as possible,so as to reduce occupational exposure risk associated with ADs for nursing staff in PIVAS and clinical departments.
作者
孙妍
马骁驰
白荣
商庆辉
SUN Yan1, MA Xiaoehi2, BAI Rong3, SHANG Qinghui1(1.Hulunbuir Municipal People＇ s Hospital/Hulunbuir College of Clinical Medicine, Inner Mongolia University for Nationalities, Inner Mongolia Hulunbuir 021000, China; 2.College of Pharmacy, Dalian Medical University, Liaoning Dalian 116044, China; 3.Shanghai Dongfang Hospital, Shanghai 200120, Chin)
出处
《中国药房》
CAS
北大核心
2018年第6期739-745,共7页
China Pharmacy
基金
辽宁省优秀人才支持计划(No.LS2010059)
