中国支气管舒张试验实施现状和试验中药物及耗材消毒方法的调查分析  

Investigation and analysis of the implementation status of bronchodilator responsiveness testing in China and the disinfection methods of drugs and consumables in the test

作　　者：贺若曦[1] 李艳明[2] 陈露[1] 李勇[3] 于春艳 宋元林[4] 杨汀[5] He Ruoxi;Li Yanming;Chen Lu;Li Yong;Yu Chunyan;Song Yuanlin;Yang Ting(Department of Pulmonary and Critical Care Medicine,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Clinical Laboratory,Xiangya Hospital,Central South University,Changsha 410008,China;Department of Respiratory Diagnosis,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Pulmonary and Critical Care Medicine,China-Japan Friendship Hospital,National Center for Respiratory Medicine,National Clinical Research Center for Respiratory Diseases,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,State Key Laboratory of Respiratory Health and Multimorbidity,Beijing 100029,China)

机构地区：[1]中南大学湘雅医院呼吸与危重症医学科,长沙410008 [2]中南大学湘雅医院检验科,长沙410008 [3]中日友好医院呼吸诊察部,北京100029 [4]复旦大学附属中山医院呼吸与危重症医学科,上海200032 [5]中日友好医院呼吸中心呼吸与危重症医学科、国家呼吸医学中心、国家呼吸疾病临床研究中心、中国医学科学院呼吸病学研究院、呼吸和共病全国重点实验室,北京100029

出　　处：《国际呼吸杂志》2023年第12期1428-1435,共8页International Journal of Respiration

基　　金：中国医学科学院医学与健康科技创新工程(CIFMS)(2021-I2M-1-049);湖南省自然科学基金(2023JJ30882)。

摘　　要：目的在全国开展一项针对支气管舒张试验实施现状和试验中药物及耗材消毒方法的调查分析。方法本研究为横断面研究。采用问卷调查的方法,通过全国基层呼吸疾病防治联盟工作组对389家联盟医院采用问卷星进行问卷调查,并对常用消毒方法通过微生物培养和基因测序进行效果的验证。结果在参与调查的325家医院中,84.3%(274/325)的医院已开展支气管舒张试验。在已开展试验的274家医院中,67.9%(186/274)的医院采取的诊断标准为:吸入支气管舒张剂后,第1秒用力呼气容积和(或)用力肺活量增加≥12%,且≥200 ml。试验中91.6%(251/274)的医院采用直接或用储雾罐吸入沙丁胺醇气雾剂,其中93.6%(235/251)的医院该药物为重复使用。在使用储雾罐的92家医院中,62.0%(57/92)的医院储雾罐为重复使用。在酒精消毒后的沙丁胺醇气雾剂和储雾罐表面采样,通过基因测序方法检测到分枝杆菌和肺炎克雷伯杆菌;用含氯消毒液消毒后,未在其表面检测到致病菌。结论我国支气管舒张试验诊断标准和方法不一致,可能导致试验结果出现偏差。试验中常用的沙丁胺醇气雾剂以及储雾罐多为重复使用,为避免交叉感染,亟需寻找一种适合我国的消毒方法。Objective To carry out a nation-wide investigation and analysis of the implementation status of bronchodilator responsiveness(BDR)testing,and the disinfection methods of drugs and consumables in BDR testing.Methods This was a cross-sectional study.We conducted a questionnaire survey on QuestionStar in 389 alliance hospitals of the working group of the National Grassroots Alliance for the Prevention and Treatment of Respiratory Diseases,and verified the effectiveness of commonly used disinfection methods through microbial culture and gene sequencing.Results Among the 325 participated hospitals in the survey,84.3%(274/325)have carried out BDR testing.Of the 274 hospitals that have carried out the test,67.9%(186/274)adopted the diagnostic criteria,that is the post-bronchodilators forced expiratory volume in one second and/or forced vital capacity increased by≥12%and≥200 ml.In BDR testing,91.6%(251/274)of the hospitals adopted inhaling albuterol aerosol directly or with a spacer,and 93.6%(235/251)of the hospitals used the drug repeatedly.Of the 92 hospitals using spacers,62.0%(57/92)used spacers repeatedly.Mycobacteria and Klebsiella pneumoniae were detected by gene sequencing on the surface of albuterol aerosol and spacer after alcohol disinfection;no pathogenic bacteria were detected on the surface after disinfection with chlorine-containing disinfectant.Conclusions The diagnostic standards and methods of BDR testing in China are inconsistent,which may lead to deviations in the results.Most of the albuterol aerosols and spacers are reused.To avoid cross-infection in BDR testing,it is urgent to find a suitable disinfection method in China.

关 键 词：消毒 支气管舒张试验 支气管舒张剂 储雾罐 沙丁胺醇气雾剂 

分 类 号：R562.22[医药卫生—呼吸系统]