医疗机构工作人员是否需要戴口罩?——基于最佳证据的论述  

Do medical staffs need to wear masks?-Arguments based on best evidence

作　　者：王云云 曹英娟[3] 傅荣[4] 傅侃达[5] 范仲凯 高维杰[7] 靳英辉 刘玉峰[8] 毛智 裴斌 戎萍[11] 施月仙 谭力铭 王芬[14] 王颖[15] 许大国 许庆安 谢文忠 肖政 杨简 杨启文[23] 杨志平[24] 周波 翟晓文[26] 张昀 钟燕军 朱小平 王行环[1,2] 顾晋 Yun-Yun WANG;Ying-Juan CAO;Rong FU;Kan-Da FU;Zhong-Kai FAN;Wei-Jie GAO;Ying-Hui JIN;Yu-Feng LIU;Zhi MAO;Bin PEI;Ping RONG;Yue-Xian SHI;Li-Ming TAN;Fen WANG;Ying WANG;Da-Guo XU;Qing-An XU;Wen-Zhong XIE;Zheng XIAO;Jian YANG;Qi-Wen YANG;Zhi-Ping YANG;Bo ZHOU;Xiao-Wen ZHAI;Yun ZHANG;Yan-Jun ZHONG;Xiao-Ping ZHU;Xing-Huan WANG;Jin GU(Center for Evidence-Based and Translational Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Center for Evidence-Based and Translational Medicine,Wuhan University,Wuhan 430071,China;Nursing Department,Qilu Hospital of Shandong University,Jinan 250012,China;Department of Internal Medicine,Gulou Hospital Affiliated to Medical College of Nanjing University,Nanjing 210008,China;Huaihe Hospital of Henan University,Kaifeng 475000,Henan Province,China;Department of Orthopedics,First Affiliated Hospital of Jinzhou Medical College,Jinzhou 121001,Liaoning Province,China;School of Nursing,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China;Department of Paediatric Internal Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Critical Medicine,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Evidence-Based Medicine Center,the first People’s Hospital of Xiangyang,Hubei University of Medicine,Xiangyang 442000,Hubei Province,China;Department of Pediatrics,First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China;School of Nursing,Peking University,Beijing 100191,China;The Second People's Hospital of Huaihua,Huaihua 418200,Hunan Province,China;Department of Obstetrics and Gynecology,First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of pharmacy,China Japan Union Hospital of Jilin University,Changchun 130033,China;Department of Quality Management,Zhujiang Hospital Affiliated to South Medical University,Guangzhou 510282,China;Department of Stomatology,School of Medicine,Jianghan University,Wuhan 430056,China;Stomatologica

机构地区：[1]武汉大学中南医院循证与转化医学中心,武汉430071 [2]武汉大学循证与转化医学中心,武汉430071 [3]山东大学齐鲁医院护理部,济南250012 [4]南京大学医学院附属鼓楼医院内科,南京210008 [5]河南大学淮河医院,河南开封475000 [6]锦州医科大学附属第一医院骨科,辽宁锦州121001 [7]天津中医药大学护理学院,天津301617 [8]郑州大学第一附属医院小儿内科,郑州450052 [9]中国人民解放军总医院第一医学中心重症医学科,北京100853 [10]湖北医药学院附属襄阳市第一人民医院循证医学中心,湖北襄阳441000 [11]天津中医药大学第一附属医院儿科,天津300381 [12]北京大学护理学院,北京100191 [13]怀化市第二人民医院,湖南怀化418200 [14]南昌大学第一附属医院妇产科,南昌330006 [15]吉林大学中日联谊医院药学部,长春130033 [16]南方医科大学珠江医院质量管理科,广州510282 [17]江汉大学医学院口腔系,武汉430056 [18]江汉大学口腔医院,武汉430022 [19]开封市医学科学研究所附属医院,河南开封475000 [20]遵义医科大学附属医院循证医学中心,贵州遵义536000 [21]三峡大学人民医院心血管内科,湖北宜昌443000 [22]三峡大学循证与转化医学研究所,湖北宜昌443003 [23]北京协和医院检验科,北京100730 [24]空军军医大学西京消化病医院,西安710032 [25]中国医科大学附属第一医院临床流行病学与循证医学教研室,沈阳110001 [26]复旦大学附属儿科医院血液科,上海201102 [27]兰州市口腔医院,兰州730000 [28]中南大学湘雅二医院重症医学科,长沙410011 [29]武汉大学中南医院医院质量与安全管理办公室,武汉430071 [30]北京大学首钢医院胃肠外科,北京100043

出　　处：《医学新知》2020年第2期124-138,共15页New Medicine

基　　金：国家自然科学基金面上项目(81570968);国家自然科学基金青年项目(81603496);中国博士后科学基金(2016M592985);山东省科技厅课题(2017GSP218001);山东省社科联人文社科课题(17-ND-SH-2);山东省医学伦理学学会课题(SYXLL-004);中国卫生经济学会及上海医学创新发展基金会项目(儿童疾病分级诊疗试点实践效果评价研究);湖北省第二届医学领军人才工程第一层次基金;湖北省新型肺炎应急科技攻关项目(2020FCA008)。

摘　　要：目的目前关于医疗机构工作人员是否需要戴口罩仍存在较大争议,本研究意在评价和总结针对这一问题的现有最佳证据,以期为临床医务工作人员使用口罩提供参考。方法计算机检索PubMed、Cochrane图书馆、Web of Science、CINAHL、中国知网、万方、维普、中国生物医学文献数据库,指南数据库平台及相关专业学会组织,检索时限为建库至2019年10月27日,以获取相关指南、专家共识、系统评价,应用国际公认的质量评价工具对纳入的证据进行质量评价,汇总现有证据对医疗机构人员是否需要戴口罩这一问题的相关推荐内容。结果共纳入35篇文献,其中6篇指南,27篇专家共识,2篇系统评价,证据质量整体较高。现有证据均推荐使用口罩作为个人防护措施之一,且与不使用呼吸防护设备相比,戴口罩在预防院内感染方面具有明显的优势,并根据不同的应用情景如手术区域、实验室区、产科等提出多项推荐意见。结论现有证据充分认可戴口罩作为个人防护措施之一在医疗机构中预防院内感染的重要作用。但本研究纳入的证据质量仍有一定的局限性。临床医务工作人员应当结合自身工作经验、临床实际情况等因素综合考虑,合理、规范使用口罩。Objective whether the medical staff need to wear masks or not is still controversial,the aim of this study is to evaluate and summarize the best evidence relevant to this topic in order to provide suggestions for the medical staff.Methods PubMed,Cochrane Library,web of science,CINAHL,CNKI,Wanfang,VIP,CBM,guideline databases and related professional societies were systematically searched from the inception of the database to 27 October 2019 in order to relevant guidelines,expert consensus and systematic reviews.The researchers assessed the quality of best evidence included using international recognized quality evaluation tools,and summarized the recommendations on whether the medical staff need to wear masks or not.Results 35 documents were included,including 6 guidelines,27 expert consensus,2 systematic reviews,and the overall quality of the evidence was higher.According to the evidence,masks were recommended as one of the personal protective measures,and wearing masks has obvious advantages in the prevention of nosocomial infection compared with the nonuse of respiratory protective equipment.The evidence also put forward a number of recommendations based on different clinical scenarios workplace such as operation area,laboratory area,obstetrics.Conclusion Wearing masks is well recognized by the existing best evidence to prevent nosocomial infection.However,the quality of the evidence still has certain limitations.The medical staff should use masks reasonably considering their experience,clinical settings,or other factors.

关 键 词：医疗机构 医务人员 口罩 最佳证据 临床证据 

分 类 号：R197.3[医药卫生—卫生事业管理]