外科手术烟雾中可吸入颗粒物(PM10)浓度变化的原因分析  

Analysis of the changes of PM10 concentration in surgical smoke

作　　者：穆莉[1] 王琤[1] 黄丽文[1] 姜鲁平 Mu Li;Wang Zheng;Huang Liwen;Jiang Luping(Operation Room,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院中心手术室,北京100034

出　　处：《中华现代护理杂志》2019年第4期444-447,共4页Chinese Journal of Modern Nursing

基　　金：2015年北京大学第一医院护理院级课题.

摘　　要：目的探讨不同手术方式及手术步骤下手术室内的可吸入颗粒物(PM10)浓度变化及其影响因素。方法2016年6?—8月采用便利抽样法选择某医院的常规普外科开放手术23例和腔镜手术10例。应用P-5型数字粉尘仪监测术中PM10浓度变化,测量位置为层流送风天花装置区域内(即术中外科医生口鼻处等高的位置,手术切口上方垂直距离为50 cm)或层流送风天花装置区域外(巡回护士工作区域)。记录并分析手术过程中不同的手术方式(开放手术、腔镜手术)和手术步骤(患者入室、消毒皮肤、术野暴露、组织分离、切口关闭、手术结束)对PM10浓度变化的影响。结果33例手术中不同手术步骤下PM10浓度均符合国家环境空气质量检测标准,6个手术步骤中PM10的浓度平均为(14.21±3.86)μg/m3。开放手术和腔镜手术相比,两组患者入室、消毒皮肤、术野暴露、组织分离、切口关闭、手术结束时PM10浓度比较差异有统计学意义(U/t值为-4.45、10.37、7.52、4.90、8.08、-4.39;P<0.05)。是否使用高频电刀比较,两组患者入室、消毒皮肤、术野暴露、组织分离、切口关闭、手术结束时PM10浓度比较差异有统计学意义(U/t值为-4.51、7.22、6.96、5.24、8.60、-4.36;P<0.05)。结论外科手术过程中PM10的浓度符合国家标准,环境空气质量等级良好以上;外科手术烟雾中PM10浓度变化与手术方式和高频电刀的使用相关。Objective To investigate the changes of inhalable particulate matter(PM10)concentration in operating room and its influencing factors under different surgical methods and procedures.Methods From June to August 2016,23 cases of open surgery and 10 cases of laparoscopic surgery in a hospital were selected by convenience sampling method.The change of PM10 concentration during operation was monitored by P-5 digital dust meter.The measuring position was in the area of laminar air supply ceiling device(the position of the surgeon's mouth and nose is equal,and the vertical distance above the incision is 50 cm)or outside the area of the laminar air supply ceiling device(working area of itinerant nurses).The effects of different surgical methods(open surgery and endoscopic surgery)and surgical procedures(patient admission,disinfection of skin,exposure of surgical field,tissue separation,incision closure and end of operation)on the concentration of PM10 were recorded and analyzed.Results The concentration of PM10 in 33 surgeries with different surgical procedures met the national ambient air quality standards.The average PM10 concentration of the 6 surgical procedures was(14.21±3.86)μg/m3.Comparing between open surgery and laparoscopic surgery,there were significant differences in PM10 concentration between the two groups in terms of admission,disinfection of skin,field exposure,tissue separation,incision closure and end of operation(U/t=-4.45,10.37,7.52,4.90,8.08,-4.39;P<0.05).There were significant differences in PM10 concentration in patients whether to use high frequency electric knife or not in terms of admission,disinfection of skin,field exposure,tissue separation,incision closure and end of operation(U/t=-4.51,7.22,6.96,5.24,8.60,-4.36;P<0.05).Conclusions The concentration of PM10 in the whole surgical process complies with national standards.The change of PM10 concentration during surgery is related to different surgical methods and the use of high frequency electric knife.

关 键 词：外科手术 烟雾 PM10 浓度 空气质量 手术方式 手术步骤 高频电刀 

分 类 号：R472.3[医药卫生—护理学]