手术室电外科烟雾防护初探

Preliminary study on effective protection distance of surgical smoke in the operating theatre

目的探讨手术室环境下电外科烟雾防护措施。方法选取择期全麻下行甲状腺或乳腺手术患者150例,参照随机数字表法分成C组、S1组和S2组,各50例。C组未采用吸引器清除烟雾,S1组和S2组采用吸引器清除烟雾,其吸引负压设置分别为300、500 mm Hg。分别在手术开始使用高频电刀后5 min和10 min,实时测量离电刀头10、20、30、40 cm垂直距离的PM2.5值。另外选取外科手术医生50名,测量手术过程中外科医生鼻尖到电刀头的直线距离。结果 3组的PM2.5值均随测量距离的增加而降低(χ~2=148.824,χ~2=137.016,χ~2=145.296,P<0.01),S1组和S2组在10、20、30、40 cm处测得PM2.5值均低于C组(P<0.05),且S2组测的PM2.5的值低于S1组(P<0.05)。男性医生的直线距离为(30.51±10.30)cm,女性医生的直线距离为(29.10±9.81)cm,男女之间差异无统计学意义(P>0.05)。结论在百级层流净化手术室中,利用吸引负压为500 mm Hg的吸引器动态吸引,其PM2.5的浓度在距离电刀头30 cm处危害较小,且符合外科医生执行手术操作的距离。

Objective To explore the the effective protection distance of electrosurgical smoke in the operating theatre. Methods Totally 150 patients undergoing thyroid or breast surgeries under elective general anesthesia were included and randomly divided into a non-aspirator group（ group C）,an aspirator attraction 300 mm Hg group（ group S1）,and an aspirator attraction 500 mm Hg group（ group S2）,with 50 cases in each group. At the same time,50 surgical surgeons were selected to measure the PM2. 5 values at 10,20,30,and 40 cm vertical distances of the electric knife head in real time,5 min and 10 min after the high-frequency knife was used.In addition,the straight-line distance from the surgeon＇s nose to the electric cutter head during the procedure was measured. Results With the increase of measurement distance,the PM2. 5 value was significantly reduced（ χ^2= 148. 824,χ^2= 137. 016,χ^2= 145. 296,P〈0. 01）. The PM2. 5 values of group S1 and group S2 were significantly lower than that of group C at 10,20,30,and 40 cm vertical distances（ P〈0. 05）,and the PM2. 5 value of group S2 were lower than that the S1 group at 10,20,30,and 40 cm vertical distances（ P〈0. 05）. The straight line distance from the surgeon＇s nose to the electric cutter head was not significantly different between male and female doctors（P〈0. 05）. Conclusion In the class 100 laminar flowpurification operating theatre,using of power 500 mm Hg attraction and keeping surgeons from the tip of electric knife more than 30 cm,can effectively prevent the harm of electrosurgical smoke.