摘要
目的:分析高速动力系统对鼻内镜下经筛径路手术空气质量的影响,为手术室医护人员的术中防控提供建议。方法:选择2021年9月至11月在温州医科大学附属眼视光医院进行鼻内镜下经筛径路手术时的空气为研究对象。采用空气质量检测仪和空气微生物采样器,分别于手术划刀时、金刚砂磨钻在鼻内使用时、微动力刨削刀头在鼻内使用时、污染的高速动力系统在体外激活时以及停止使用高速动力系统10 min后,实时检测患者鼻孔、距患者鼻孔50 cm处、距患者鼻孔1.5 m处、手术室周边区产生的PM_(2.5)、PM_(10)和粒子数及浮游菌浓度变化并分析。结果:随着术中高速动力系统的使用,PM_(2.5)、PM_(10)及粒子数均呈现波动上升趋势,并在体外激活时达到峰值,颗粒物浓度从高到低依次为:污染的高速动力系统在体外激活时>微动力刨削刀头在鼻内使用时>金刚砂磨钻在鼻内使用时,差异有统计学意义(P<0.01)。不同采样位置之间的PM_(2.5)、PM_(10)及粒子数差异均有统计学意义(P<0.01),从高到低依次为:患者鼻孔>主刀口鼻>器械护士口鼻>手术室周边区。术中不同采样位置的浮游菌浓度均高于初始基线,差异有统计学意义(P<0.05)。结论:鼻内镜下经筛径路术中高速动力系统的使用会使手术室区域空气中颗粒物和细菌数增加,且随着不同使用模式和工作距离产生不同影响。术中医护人员应采取相应的防控措施,减少职业暴露,预防手术感染。
Objective:To analyze the impact of high-speed power systems on the air quality during endoscopic transluminal surgery,and to provide recommendations for intraoperative prevention and control for medical staff in the operating room.Methods:The air during nasal endoscopic transethmoid operation in Eye Hospital Affiliated to Wenzhou Medical University from September to November 2021 was selected as the study object.An air quality detector and an air microbiological sampler were used respectively to measure in real-time at the patient’s nostril level,the level at 50 cm from the patient’s nostril,the level at 1.5 m from the patient’s nostril,and the surrounding areas of the operating room during surgical incision,when the diamond grinding drill was used in the nose,when the micro power planer head was used in the nose,when contaminated high-speed power system was activated in vitro,and 10 minutes after discontinuation of high-speed power systems.The changes in PM_(2.5),PM_(10),particle count,and planktonic bacterial concentration generated at the above sampling points were analyzed.Results:With the use of intraoperative high-speed power systems,PM_(2.5),PM_(10),and particle count showed a fluctuating upward trend,reaching their peak during in vitro activation,and the concentration of particulate matter ranked in order from high to low as follows:when the contaminated high-speed power system activated outside the body,when the micro dynamic force cutting blade used inside the nose,and when the diamond grinding drill used inside the nose(P<0.01).The PM_(2.5)concentration,PM_(10)concentration and particle number at different sampling locations were statistically different(P<0.01),with the concentration ranking in order from high to low as follows:patient’s nostril>surgeon’s mouth and nose>instrument nurse’s mouth and nose>operating room’s surrounding area,showing significant difference(P<0.01).The concentration of planktonic bacteria from different sampling locations during surgery was higher than the baseline,with statistical difference(P<0.05).Conclusion:The use of high-speed power system during endoscopic transethmoidal approach will increase the number of particles and bacteria in the air of the operating room,and produce different effect with different using modes and from difference working distance.Nursing staff should take corresponding prevention and control measures to reduce occupational exposure and prevent from surgical infection.
作者
章菁菁
彭园园
黄美娜
李纯纯
梁希希
张佩华
陈燕燕
ZHANG Jingjing;PENG Yuanyuan;HUANG Meina;LI Chunchun;LIANG Xixi;ZHANG Peihua;CHEN Yanyan(Operating Centre,National Clinical Research Center for Ocular Diseases,Eye Hospital,Wenzhou Medical University,Wenzhou 325027,China)
出处
《温州医科大学学报》
CAS
2023年第10期819-824,共6页
Journal of Wenzhou Medical University
基金
温州市基础性科研项目(Y2020720)
温州医科大学附属眼视光医院护理专项课题(YNHL2202001)。
关键词
鼻内镜
高速动力系统
手术室
空气质量
气溶胶
职业暴露
nasal endoscope
high speed power system
operating room
air quality
aerosol
occupational exposure
