自制防护服在重症呼吸道传染性疾病患者气管插管时的应用

Application of self-made protective clothing in tracheal intubation for patients with severe respiratory infectious diseases

目的探讨自制防护服在呼吸道传染性疾病气管插管时的临床应用。方法用带袖套的成人型号塑料雨衣和护目镜自制简易防护服。采用前瞻性随机对照研究方法,选择2018年1月1日至2020年3月31日在甘肃省中医药大学第三附属医院重症医学科住院需行气管插管治疗的重症呼吸系统传染性疾病患者,按随机数字表法分为两组,对照组医务人员穿戴标准防护服者,试验组医务人员穿戴自制防护服进行气管插管操作。比较两组防护服穿戴时间、操作者感染率、防护服成本的差异;行气管插管前用锥虫蓝稀释液喷洒患者口腔,于穿自制防护服前及气管插管结束脱掉自制防护服后对操作医师全身进行荧光拍照,以评估自制防护服的抗渗透性。结果共入选86例患者,试验组46例患者中甲型H1N1流感病毒感染28例,乙型流感病毒感染11例,腺病毒感染7例;对照组40例患者中甲型H1N1流感病毒感染15例,乙型流感病毒感染10例,腺病毒感染10例,病原菌不明确5例,两组患者呼吸道病原学结果差异无统计学意义(χ^(2)=3.789,P=0.435)。对照组穿戴防护服时间约为试验组的11.6倍(min:22.23±1.45比1.86±0.24,χ^(2)=19.023,P<0.001)。标准防护服每套成本是自制防护服的12.5倍(元/套:500比40)。荧光拍照显示,气管插管后操作者全身均未染色,说明防护服抗渗透性较好,达到了防护效果。且试验组和对照组操作者均未出现感染。结论与标准防护服相比,自制防护服穿戴时间短、成本低,且具有等效隔离效果,值得临床推广。

Objective To explore the effect of self-made protective clothing in tracheal intubation for the patients with respiratory infectious diseases.Methods Self-made protective clothing were made by adult model plastic raincoat with sleeve lets and goggles.A prospective randomized controlled study was conducted.Patients with severe respiratory infectious diseases who needed tracheal intubation admitted to the department of intensive medicine of the Third Affiliated Hospital of Gansu University of Chinese Medicine from January 1st 2018 to March 31st 2020 were enrolled.According to the random number table method,they were divided into two groups.The control group was wearing standard protective clothing,while the test group was wearing self-made protective clothing for endotracheal intubation.The wearing time,infection rate of operators and costs of protective clothing were compared between the two groups.The patients were sprayed with trypanosome blue diluent before tracheal intubation,and the whole body of the operator was photographed with fluorescence before wearing self-made protective clothing and after doing tracheal intubation to take off the self-made protective clothing,in order to evaluate the permeability resistance of self-made protective clothing.Results A total of 86 patients were enrolled.There were 46 cases in the test group,included 28 cases of influenza A(H1N1)virus infection,11 cases of influenza B virus infection and 7 cases of adenovirus infection.There were 40 cases in the control group,included 15 cases of H1N1 virus infection,10 cases of influenza B virus infection,10 cases of adenovirus infection and 5 cases of unknown pathogen.There was no significant difference in respiratory etiology between the two groups(χ^(2)=3.789,P=0.435).The wearing protective clothing time of the control group was 11.6 times than that of the test group(minutes:22.23±1.45 vs.1.86±0.24,χ^(2)=19.023,P<0.001).The cost of standard protective clothing was 12.5 times than that of self-made protective clothing(Yuan/set:500 vs.40).Fluorescent photography showed that the whole body of the operator was not stained after tracheal intubation,indicating that the protective clothing had good anti permeability and achieved the protective effect.There was no operator infection in the test group and the control group.Conclusion Self-made protective clothing has short wearing time,low cost and equivalent isolation effect compared with standard protective clothing,which is worthy of clinical promotion.