影响手术室电外科烟雾浓度的危险因素及医护人员职业暴露与防护情况  

Risk factors of electrosurgical smog concentration in operation room and analysis on occupational exposure and protection of medical staff

作　　者：许珏 辛丽雅[1] XU Jue;XIN Li-ya(Operation Room,Wuxi Hospital of Traditional Chinese Medicine,Wuxi Jiangsu,214071,China)

机构地区：[1]无锡市中医院手术室,江苏无锡214071

出　　处：《职业与健康》2018年第18期2458-2461,2468,共5页Occupation and Health

摘　　要：目的了解手术室电外科烟雾浓度的影响因素及医护人员职业暴露与防护情况。方法连续收集95台于密闭手术室行电外科手术的患者资料,分析手术室电外科烟雾浓度的影响因素。同时,纳入手术室及非手术科室医护人员共138名,根据有无外科烟雾暴露,分为烟雾暴露组与对照组,分析医护人员职业暴露及防护情况。结果 (1)95台手术中,47台手术空气颗粒物浓度不合格,不合格率为49.5%。单因素分析结果显示,患者体质指数(BMI)、手术切割方式、凝血方式是影响手术室颗粒物浓度的主要危险因素(P<0.05)。(2)多因素logistic分析结果显示,随着患者BMI升高,手术室颗粒物浓度不合格风险显著增加。同时,切割时采用混合切、凝血时采用电灼凝是影响手术室颗粒物浓度不合格的独立性危险因素。(3)与对照组相比,烟雾暴露组人员的血清总胆固醇水平、低密度脂蛋白(LDL)水平、LDL比例、血红蛋白水平、红细胞比积及尿酸明显较高,高密度脂蛋白(HDL)比例显著较低,差异均有统计学意义(均P<0.05)。(4)与对照组人员相比,烟雾暴露组人员仅在烟雾来源、对机体影响及防护依从性方面得分高于对照组,其余方面两组人员得分差异无统计学意义(P>0.05)。医护人员对手术烟雾防护措施执行力较差,约29.0%(18/62)的医护人员几乎不采取防护措施,61.3%(38/62)的人员未能采取有效措施,仅有9.7%(6/62)的医护人员采取了有效措施。结论电外科烟雾对医护人员身体健康有明显影响,但从业人员相关的认知水平、防护意识差。手术时若采用混合切割、电灼凝血,更应做好颗粒物浓度超标的防护措施,保证医护人员的身体健康。[Objective]To investigate the influencing factors of electrosurgical smog concentration in operation room,analyze the occupational exposure and protection of medical staff. [Methods] The data of patients undergoing electrosurgical operation in closed operation room from 95 operations were collected to analyze the influencing factors of electrosurgical smog concentration in operation room. At the same time,totally 138 operation room and non-operating department medical workers were divided into smog exposure group and control group according to surgical smog exposure,to analyze the occupational exposure and protection of medical staff. [Results]（1） In the 95 operations,the concentration of air particles was unqualified in 47 operations and the unqualified rate was 49.5%. Univariate analysis showed that patient＇s BMI,surgical incision mode and coagulation mode were the main risk factors of particle concentration in operation room（P〈0.05）.（2） Multivariate logistic analysis showed that the risk of unqualified particulate matter in operation room increased significantly with the increase of patient＇s BMI. Meanwhile,mixed cutting and electrocautery were the independent risk factor of particle concentration in operation room.（3） Compared with the control group,the serum total cholesterol level,low density lipoprotein（LDL） level,LDL ratio,hemoglobin level,hematocrit and uric acid increased significantly in the exposure group,while the high density lipoprotein（HDL） ratio decreased significantly,and the differences were statistically significant（all P〈0.05）.（4）The scores of smog source,the influence on the body and the compliance of the protection among medical workers in the exposure group were higher than those among medical workers in the control group,and there were no statistically significant differences in other aspects between two groups（P〉0.05）. Medical staff had poor execution of operative smog protection measures. About 29.0%（18/62） of medical staff almost didn�

关 键 词：手术室 电外科烟雾 危险因素 

分 类 号：R134[医药卫生—劳动卫生]