开放手术中术野暴露时手术烟雾中细颗粒物(PM2.5)浓度变化的影响因素分析

Analysis of influencing factors on the concentration change of fine particulate matter(PM2.5)in surgical smoke during surgical field exposure in open surgeries

目的探讨开放手术中术野暴露时手术烟雾中细颗粒物(PM2.5)浓度变化和影响因素。方法选择2017年5—8月北京大学第一医院手术室普通外科124例开放手术,采用JC-M9粉尘检测仪对层流区域内外、距手术切口50 cm处的PM2.5浓度进行测量。应用自制问卷收集患者一般资料、电刀功率、使用时间、PM2.5浓度(最大即刻值),分析PM2.5浓度变化的影响因素。结果124例患者使用高频电刀进行术野暴露时,电刀功率范围为30~60 W,术野暴露时的PM2.5浓度最高值为3972μg/m3,最低为0,平均浓度为(130.17±408.36)μg/m3,中位数为18.00μg/m3。单因素分析显示,不同测量位置、性别、年龄和腰围患者PM2.5浓度差异有统计学意义(Z值分别为-7.33、-3.04、6.60、-2.08;P<0.05)。线性回归分析显示,是否在层流区域内、患者腰围是术野暴露时PM2.5浓度变化的影响因素(P<0.05)。结论开放手术中术野暴露时,在层流区域内测量的PM2.5浓度高于层流区域外的浓度,腰围正常的患者较腰围超标人群的PM2.5浓度高。手术室医护人员术前应评估手术部位和患者一般资料,术中保持有效的负压吸引、保持手术间封闭负压状态,提高医护人员对手术烟雾的防护意识。

Objective To investigate the changes and influencing factors of fine particulate matter(PM2.5)concentration in surgical smoke during surgical field exposure in open surgeries.Methods From May to August 2017,124 cases of open surgery in the Operating Room of the First Hospital of Peking University were selected.The concentration of PM2.5 inside and outside the laminar flow area and 50 cm from the incision was measured by JC-M9 dust detector.The general data,power of electrosurgical scalpel,use time and PM2.5 concentration(maximum immediate value)were collected by self-made questionnaire,and the influencing factors of PM2.5 concentration were analyzed.Results When 124 patients were exposed to high frequency electrosurgical knife,the power range of electrosurgical knife was 30-60 W,the highest concentration of PM2.5 was 3972μg/m3,the lowest was 0,the average concentration was(130.17±408.36)μg/m3,the median was 18.00μg/m3.Univariate analysis showed that the differences of PM2.5 concentration were statistically significant(Z=-7.33,-3.04,-6.60,-2.08;P<0.05).Linear regression analysis showed that whether in the laminar flow area and the waist circumference of patients were the influencing factors of PM2.5 concentration change during the field exposure(P<0.05).Conclusions The PM2.5 concentration measured in laminar flow area was higher than that outside laminar flow area,and the PM2.5 concentration of patients with normal waist circumference was higher than that of people with excessive waist circumference.Before the operation,the medical staff in the operating room should evaluate the operation site and the general information of the patients,maintain the effective negative pressure suction during the operation,keep the closed negative pressure state in the operating room,and improve the protection awareness of the medical staff to the operation smoke.