新型冠状病毒肺炎疫情下耳鼻喉科护士应对气道护理风险的防控策略

Prevention and control strategies for ear nose and throat nurses to deal with the risk of airway care under coronavirus disease 2019

目的通过评估护士为佩戴气管套管患者进行气道护理时产生的细颗粒物2.5(PM2.5)、PM10和气溶胶粒子数的变化,为耳鼻喉科护理人员的职业防护提供参考依据。方法选取2020年3月16~19日,我院耳鼻喉科病区因各类咽喉部恶性肿瘤切除手术后呈气管切开或颈部气管造口状态,且均需佩戴气管套管的在院患者30例和同期住院非气管切开患者30例,采用空气质量检测仪实时监测患者所处环境的PM2.5、PM10、气溶胶粒子数。分别监测佩戴气管套管患者在安静状态下、吸痰、气道湿化、取放气管套管内套管时的数据以及非气管切开患者安静状态下的数据。分析相同环境下2类患者病房内PM和气溶胶密度,以及佩戴气管套管患者于不同护理操作状态下PM和气溶胶密度。结果在安静状态下,佩戴气管套管患者所处环境的气溶胶密度显著高于非气管切开患者(P<0.01)。佩戴气管套管患者在护士为其吸痰时的PM 2.5密度和气溶胶密度显著高于其他操作,护士为患者取放气管套管时的PM 10密度显著高于其他操作,差异均具有统计学意义(P<0.01)。结论耳鼻喉科护理人员为患者进行气道护理相关操作时直接暴露于高密度气溶胶粒子中,存在较高的职业暴露风险,应配备相应的防护装备降低职业暴露风险。

Objective To evaluate the changes in PM 2.5,PM 10 and aerosol density when nurses performed airway care for patients undergoing tracheotomy in order to provide references for the occupational protection of the otorhinolaryngological nurses.Methods From March 162020 to March 192020,30 patients in the Ear Nose and Throat ward underwent tracheotomy and 30 patients hospitalized during the same period without tracheotomy were selected.Air quality monitor was used to monitor density of PM 2.5,PM 10 and aerosol.Patients with tracheotomy were monitored under the quiet state,sputum aspiration,airway humidification,and inner tracheal tube removal.Non-tracheotomy patients were monitored in a quiet state.The differences of PM and aerosol densities in the wards wase compared between the two groups.The differences of PM and aerosol density of patients with tracheotomy under different nursing operations wase compared.Results In the quiet state,the aerosol density of patients with tracheotomy was significantly higher than non-tracheotomy patients(P<0.1).The PM 2.5 and aerosol density of patients undergoing tracheotomy during sputum aspiration were significantly higher than other nursing operations.The PM 10 density of inner tracheal tube removal was significantly higher than that of other operations(P<0.1).Conclusions Otolaryngology nurses are directly exposed to high-density aerosol particles when performing airway nursing operations for patients,which has a high occupational exposure risk.Therefore,corresponding protective equipment should be equipped to reduce the occupational exposure risk.