致病微生物在麻醉操作中传播风险的研究

Research on transmission risk exposure of pathogenic microorganisms in anesthesia procedures

目的提高对麻醉操作中致病微生物传播风险的认识，以规范麻醉医生术中的无菌操作，从而降低术后感染的发生。方法选择45例全身麻醉患者，分别于麻醉诱导前（Time0）、麻醉后5分钟（Time1）及麻醉后2小时（Time2），对每一例手术患者使用的静脉三通旋塞阀、螺纹管接口、氧气流量调节钮、减压阀门表面、麻醉机呼出气入1：3、麻醉机呼吸回路氧气入口、麻醉车操作台面等术中易被污染的7个区域点进行细菌学监测。结果静脉三通旋塞阀随手术时间的延长污染程度增加，在Time0呈无菌状态，Timel的45例中84．4％有细菌生长，菌落数在12CFU／ml，Time2时各监测点菌落数在7～21CFU／ml，其中Time1组与Time0组、Time2组与Time0组相比，其差异具有统计学意义（P〈0．05）。其他监测点菌落数符合消毒技术规范要求。结论手术麻醉过程中，静脉三通旋塞阀极易造成污染，执行规范无菌操作能有效预防和降低患者手术后感染的风险。

Objective To raise risk exposure awareness for spreading pathogenic microorganisms in anesthesia procedures and normalize aseptic technique of anesthesiologists, thus minimizing postoperative infection. Methods Choose 45 cases of general anesthesia. Respectively before anesthesia induction （TimeO）, five minutes after induction （Time1） and two hours after anesthesia （Time2）, make bacteriological tests on seven spots vulnerable to contamination,including the three-way stopcock, screw- type hose coupling, oxygen flux knob, pressure-release valve surface, exhaled breath entry of the anesthesia machine, oxygen intake of the breathing loop of the anesthesia machine, and operating desktop of the anesthesia cart. Results Contamination risk exposure of the stopcock extends with the operative time. At Time 0, it is sterile; at Time 1, 84. 4%of the 45 cases are found with bacteria growth, with colony count of 1-2CFU/ml; at Time2, colony counts at various monitoring points range 7~21 CFU/ml, of which the differences between Time1 group and Time0, as well as Time2 and Time0 are statistically significant（P（0.05）. Colony counts at other monitoring points comply with the regulations. Conclusion Three-way stopcocks are highly vulnerable to contamination during operative anesthesia. Regular sterile operations can effectively prevent and lower postoperative infection of the patients.