局部负压吸引对手术室烟雾PM2.5浓度的影响

Influence of local negative pressure suction on concentration of PM2.5 of operating room smoke

[目的]探讨局部负压吸引对手术室烟雾PM2.5浓度的影响。[方法]采用自主设计的问卷调查外科手术室100名医护人员对手术烟雾的认知及防护现状;在50例肝胆外科开腹手术中应用负压吸引装置,分别在吸引管开口距电刀笔头约1cm、5cm、10cm及20cm处进行吸引,利用智能PM2.5检测仪检测主刀医师口鼻处约5cm范围内的空气中PM2.5的浓度;观察20例左/右半肝切除术中,利用超声刀或高频电刀分离肝脏组织切割中的PM2.5浓度在局部负压吸引前后的变化。[结果]89%手术室医护人员接触手术烟雾会产生明显的不良反应,但仅10%的医护人员有较强的防护意识;负压吸引前,主刀医师口鼻附近PM2.5浓度为148.95μg/m3,吸引位置距离切割位置1cm、5cm、10cm及20cm时,PM2.5浓度分别为4.53μg/m3、28.08μg/m3、93.78μg/m3与129.76μg/m3;20例左/右半肝切除术中,超声刀切割肝脏组织产生的PM2.5浓度约为电刀切割的2倍,经距离切割处5cm负压吸引后,超声刀、电刀切割肝组织产生的PM2.5浓度分别减少了77%、79%。[结论]手术室医护人员对外科手术烟雾的认知水平和防护能力较低;局部负压吸引可明显降低手术烟雾中PM2.5的浓度,对医护人员有较强的保护作用;吸引管距离烟雾源头5cm时为手术中最佳的吸引位置。

Objective: To probe into the effect of local negative pressure suction on the concentration of PM2.5 in operating room smoke. Methods: A self designed questionnaire was used to investigate the cognition and protection status of surgical smoke among 100 medical staff in the operating room.In 50 cases of hepatobiliary surgery,negative pressure suction devices were used at the positions about 1 cm,5 cm,10 cm and 20 cm from the opening of the suction tube to the tip of the electric knife,and the intelligent PM2.5 detector was used to detect the concentration of PM2.5 in the air within about 5 cm from the nose and mouth of the surgeon.The changes of PM2.5 concentration were observed before and after local negative pressure suction during liver tissue cutting with ultrasonic knife or high frequency electric scalpel in 20 cases of left/right hepatectomy. Results: 89% of operating room staff exposed to surgical smoke would have obvious adverse reactions,but only 10% of the medical staff had a strong sense of protection.Before negative pressure suction,the PM2.5 concentration near the nose and mouth of the surgeon was 148.95 μg/m 3.When the suction position was 1 cm,5 cm,10 cm and 20 cm from the cutting position,the PM2.5 concentration was 4.53 μg/m 3,28.08 μg/m 3,93.78 μg/m 3 and 129.76 μg/m 3 respectively.In the 20 cases of left/right hepatectomy,the PM2.5 concentration generated by ultrasonic scalpel cutting liver tissue was about twice as high as that generated by electric scalpel cutting.After negative pressure suction at 5 cm away from the cutting,the PM2.5 concentration generated by ultrasonic scalpel and electric scalpel cutting liver tissue was reduced by 77% and 79%,respectively. Conclusion: The cognitive level and protective ability on surgical smoke among operating room staff were low.Local negative pressure suction can significantly reduce the concentration of PM2.5 in surgical smoke, which has a strong protective effect on medical staff.When the suction tube was 5 cm away from the smoke source,it was the best suction position during the operation.