手术室吸入性麻醉剂暴露情况调查及其对医护人员应激水平的影响  

Investigation on exposure of inhalation anesthetics in operating room and its influence on stress level of medical staff

作　　者：李丹 任俊桥 李婷 巩固 LI Dan;REN Junqiao;LI Ting;GONG Gu(Department of Anesthesiology,General Hospital of Western Theater,Chengdu,Sichuan 610000,China)

机构地区：[1]西部战区总医院麻醉科,四川成都610000

出　　处：《国际检验医学杂志》2021年第11期1338-1341,1345,共5页International Journal of Laboratory Medicine

摘　　要：目的对雅安地区医疗机构手术室人员七氟醚职业暴露情况进行调查,并分析七氟醚暴露对医护人员健康的影响。方法使用红外光声分析仪及多点采样器对雅安5家医院的100例手术室医护人员(暴露组)的七氟醚个人暴露进行定量检测,同时选择100例非手术室医护人员为对照组,采集医护人员血液及尿液标本,检测七氟醚及其代谢物、过氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)等指标水平,利用Western blot检测外周血中组蛋白H2AX磷酸化(γH2AX)水平。结果在检测区测得的七氟醚浓度普遍偏低。在暴露组100份标本中,环境中七氟醚暴露量均低于美国国家职业安全卫生研究所制订的限值2.0 ppm,只有9份标本超过0.5 ppm。麻醉师比手术医生、器械护士、麻醉护士、巡回护士暴露在七氟醚中的风险更高,不同岗位的医护人员环境中七氟醚暴露量比较,差异有统计学意义(P<0.05)。相关性分析显示,环境中七氟醚暴露量与尿液中七氟醚排泄量呈正相关(r=0.49,P<0.01);环境中七氟醚暴露量与尿液中氢氟烷排泄量呈正相关(r=0.52,P<0.01);尿液中七氟醚排泄量与尿液中氢氟烷排泄量呈正相关(r=0.27,P=0.006)。与对照组比较,暴露组医护人员外周血的SOD、GSH-Px水平明显降低(P<0.05),MDA水平明显升高(P<0.05)。Western blot检测显示,暴露组、对照组的γH2AX/GAPDH比值分别为1.13±0.21、0.27±0.04,2组差异有统计学意义(P<0.05)。结论雅安地区医院的手术室仍然存在七氟醚暴露的职业危害问题,并对医护人员有一定的伤害,有必要尽快制订更详细的策略进行预防。Objective To investigate the occupational exposure of sevoflurane in the operating room of medical institutions in Ya′an area,and to analyze the impact of sevoflurane exposure on the health of medical staff.Methods Infrared photoacoustic analyzer and multipoint sampler were used to quantitatively detect the personal exposure to sevoflurane of 100 medical staff in operating rooms(exposed group)of 5 hospitals in Ya′an area,and 100 medical staff in non-surgical departments were selected as control group.Blood and urine samples were collected,the levels of sevoflurane and its metabolites,superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),malondialdehyde(MDA)and other indicators were detected,the level ofγH2AX in peripheral blood was detected by Western blot.Results The concentration of sevoflurane in the detection area was generally low.Among the 100 samples in exposed group,the average concentration of sevoflurane in environmental water was 2.0 ppm lower than the limit set by the National Occupational Safety and Health Commission,and only 9 samples exceeded 0.5 ppm.Anesthesiologists had a higher risk of exposure to sevoflurane than surgeons,instrument nurses,anesthesia nurses or itinerant nurses,there was significant difference in sevoflurane exposure among medical staff in different positions(P<0.05).Correlation analysis showed that there was a positive correlation between sevoflurane exposure in environment and sevoflurane excretion in urine(r=0.49,P<0.01);there was a positive correlation between sevoflurane exposure in environment and urinary hydrofurane excretion(r=0.52,P<0.01);there was a positive correlation between sevoflurane excretion in urine and urinary hydrofurane excretion(r=0.27,P=0.006).Compared with the control group,the levels of SOD and GSH-Px in the exposed group were significantly lower(P<0.05),and the levels of MDA were significantly higher(P<0.05).Western blot showed that the ratio ofγH2AX/GAPDH in the exposure group and the control group was 1.13±0.21 and 0.27±0.04,respectively,a

关 键 词：七氟醚 职业暴露 氧化应激 手术室 

分 类 号：R614[医药卫生—麻醉学]