国内密闭手术室暴露于电外科烟雾的相关风险因素分析

Analysis of the related risk factors of exposure to electrosurgical smoke in China's enclosing operating room

目的:分析密闭手术室暴露于电外科烟雾的相关风险因素,为医护人员安全保障措施制定提供参考。方法:对我院2015年10月~2016年5月在密闭手术室行电外科手术100台相关情况进行分析并对100台手术切割时关键工位PM2.5、PM10粒径的颗粒物进行监测。按照环境空气质量标准中颗粒物的限值标准判断颗粒物浓度是否合格。分析切割时关键工位不同粒径的颗粒物与患者体质量指数(BMI)、切割功率、凝血功率的Spearman相关系数。筛选影响密闭手术室暴露于电外科烟雾对室内颗粒物的影响因素及危险因素。结果:切割时关键工位的PM2.5和PM≤10颗粒物与手术操作者年资无相关性,与患者BMI指数呈负相关,与切割功率呈正相关,与凝血功率呈正相关。患者BMI、切割方式、凝血方式均为密闭手术室暴露于电外科烟雾颗粒物的影响因素,切割方式采用为纯切、混合切,凝血方式采用电灼和喷凝为密闭手术室暴露于电外科烟雾颗粒物的危险因素。结论:临床应针对切割和凝血方式的选择做好周全的颗粒物超标防护措施,确保医护人员的生命健康。

Objective：To analyze the related risk factors of exposure to electrosurgical smoke in enclosing operating room and to provide reference for the development of safety and security measures for health care workers.Methods：A total of 100 cases of electrosurgical operations in enclosing operating room of our hospital were analyzed from October 2015 to May 2016.The particulate matter of PM2.5 and PM10 in key positions during the surgical cutting in these 100 operations were monitored.According to the limits of particulate matter in ambient air quality standards, this research determined whether the concentration of particulate matter was acceptable.The Spearman correlation coefficient of particle sizes at different key positions during cutting and body mass index （BMI）, cutting power and coagulation power were analyzed, thus screening influencing factors and risk factors of exposure to electrosurgical smoke of enclosing operating rooms to indoor particulate matter.Results：PM2.5 and PM≤10 particles at the critical positions were not correlated with the age of the operation operator and it negatively correlated with the BMI index of the patient.It was positively correlated with the cutting power and positively correlated with the coagulation power.Patients＇ BMI, cutting methods and coagulation methods were the influencing factors for exposure of enclosing operating room to electrosurgical smoke.Risk factors for the exposure of enclosing operating room to electrosurgical smoke included the cutting methods such as pure cutting and mixed cutting as well as the coagulation methods by electro cautery and spray.Conclusion：Fine excessive particulate protective measures should be applied in the clinical operation regarding cutting methods and coagulation methods to ensure the life health of the workers.