不同浓度七氟烷在体外循环中应用对手术室环境的影响  

Effect of different concentrations of sevoflurane in cardiopulmonary bypass(CPB) on environmental pollution of operating room

作　　者：苏建林 李屹壁 阳子华 黄保堂 杨九光[3] 

机构地区：[1]广西桂林市人民医院麻醉科,桂林541002 [2]广西桂林市兴安县人民医院麻醉科 [3]中国医学科学院,北京协和医学院,阜外心血管病医院体外循环科

出　　处：《山西医科大学学报》2013年第6期486-489,共4页Journal of Shanxi Medical University

摘　　要：目的探讨不同浓度七氟烷在体外循环使用中对手术室不同位置的环境影响。方法择期CPB下双瓣置换术患者99例,ASAⅡ-Ⅲ级,心功能Ⅱ-Ⅲ级,在百级洁净层流手术室中,根据体外循环过程中吹入七氟烷浓度将患者分为3组:A组34例患者(2%七氟烷),B组33例患者(2.5%七氟烷),C组32例患者(3%七氟烷)。三组均在体外循环开始时吹入,并用中心负压吸引将七氟烷从氧合器排气口直接排至手术室外。在吹入七氟烷前(T0)、后15 min(T1)、30 min(T2)、45 min(T3)、60min(T4),分别统一使用专用气囊回收,在麻醉师(M)、巡回护士(X)、外科医师(S)、体外循环医师(T)、储血罐开口上方1 cm(R)和氧合器排气口(O)位置分别采集空气,检测空气样本中七氟烷浓度。结果在X和T位置:C组检测到七氟烷浓度并随着使用七氟烷时间延长逐渐增加(P<0.05),且在T4时检测七氟烷浓度接近手术室环境七氟烷安全浓度2×10-6;在A组和B组吹入七氟烷后各观察时点组内比较差异无统计学意义(P>0.05)。在M和S位置:C组和B组在T3、T4检测到七氟烷浓度,C组较B组七氟烷浓度高(P<0.05)。在X、T、R和O位置:在吹入七氟烷后相同观察时点检测到七氟烷浓度比较,C组最高,A组最低(均P<0.01)。结论体外循环中使用小于2.5%七氟烷不会造成手术室环境污染,当大于3%七氟烷长时间使用,可能在体外循环医师和巡回护士位置发生环境污染。Abstract： Objective To investigate the effect of different concentrations of sevoflurane on environmental pollution of operating room in cardiopulmonary bypass（CPB）.Methods Ninety-nine ASA Ⅱ or Ⅲ patients scheduled for mitral-aortic valve replacement were assigned into three groups according to the concentrations of sevoflurane in CPB：group A （n =34,2% sevoflurane） ; group B （n =33,2.5% sevoflurane） ; group C （n =32,3% sevoflurane）.Sevoflurane was blown into the oxygenator in three groups at the beginning of CPB,and was drawn out by central vacuum from the oxygenator air vent at the same time.The gas was collected by gasbag to detect the concentration of sevoflurane in several sites in the laminar flow operating room before the CPB,and 15,30,45,60 min after the sevoflurane was blown.The gas was collected in the sites：doctor of surgery （S）,anesthetist （M）,circulating nurse （X）,perfusionist （T）,1 cm above the reservoir（R）,the oxygenator air vent （O）.Results In group C,the concentration of sevoflurane was increased with the time of insufflating sevoflurane at X site and T site（P 〈0.05）,and the concentration of sevoflurane was nearly to the safe concertration of operating room （2 × 10-6） at T4 ; but there was no significant change in group A and group B.At T3 and T4,the concentrations of sevoflurane at M site and S site in group C were significantly higher than that in group B（P 〈0.05）.At X,T,R,and O sites,the concentrations of sevoflurane were the highest in group C and the lowest in group A （P 〈 0.01） at the same time.Conclusion When the concentration of sevoflurane is lower than 2.5% in CPB,there was no environmental pollution in the operation room.When the concentration of sevoflurane is higher than 3% in CPB and the time is more than 60 min,the environments at sites of the circulating nurses and perfusionists are polluted possibly.

关 键 词：七氟醚 体外循环 环境污染 

分 类 号：R614[医药卫生—麻醉学]