Department of Critical Care Medicine, Antwerp University Hospital, University of Antwerp, Belgium.
Toxicological Centre, University of Antwerp, Belgium.
Environ Int. 2015 Aug;81:64-72. doi: 10.1016/j.envint.2015.04.008. Epub 2015 May 4.
Critical care medicine has largely benefited from plastic-containing medical devices. However, bisphenol-A (BPA) and phthalates present in the plastics can leach from such devices. We hypothesized that intensive care unit (ICU) patients are exposed to BPA and phthalates through (plastic) medical devices. Serum (n = 118) and urine (n= 102) samples of adult ICU patients (n = 35) were analyzed for total BPA and phthalate metabolites (PMs). Our results showed that adult ICU patients are continuously exposed to phthalates, such as di(2-ethylhexyl)phthalate (DEHP), as well as to BPA, albeit to a lesser extent. This exposure resulted in detectable high serum and urinary levels in almost every patient and at every studied time point. Moreover, these levels were significantly higher than in controls or compared to referenced literature. The chronology of exposure was demonstrated: pre-operative urinary and serum levels of the DEHP metabolites were often below the detection limit. Plastic-containing medical devices were the main source of DEHP exposure: post-operative patients on hemofiltration, extracorporeal membrane oxygenation or both showed serum levels 100-or 1000-fold higher than the levels in the general population reported in the literature. The serum and some of the urinary levels of the DEHP metabolites are the highest ever reported in humans; some at biologically highly relevant concentrations of ≥ 10-50 μM. Despite the continuously tightening regulations, BPA and DEHP appear to be still present in (some) medical devices. Because patient safety is a concern in the ICU, further research into the (possibly toxic and clinical) effects of these chemicals released from medical devices is imperiously necessary.
重症监护医学在很大程度上受益于含有塑料的医疗器械。然而，塑料中存在的双酚 A (BPA) 和邻苯二甲酸酯会从这些设备中浸出。我们假设重症监护病房 (ICU) 患者通过 (塑料) 医疗器械接触到 BPA 和邻苯二甲酸酯。我们分析了 35 名成年 ICU 患者的血清 (n = 118) 和尿液 (n = 102) 样本，以检测总 BPA 和邻苯二甲酸酯代谢物 (PM)。我们的结果表明，成年 ICU 患者持续接触邻苯二甲酸酯，如邻苯二甲酸二 (2-乙基己基) 酯 (DEHP)，尽管接触程度较轻。这种接触导致几乎每个患者在每个研究时间点都检测到可检测的高血清和尿液水平。此外，这些水平明显高于对照组或参考文献中的水平。暴露的时间顺序得到了证明：术前尿液和血清中 DEHP 代谢物的水平经常低于检测限。含塑料的医疗器械是 DEHP 暴露的主要来源：接受血液滤过、体外膜氧合或两者兼有的术后患者的血清水平比文献中报道的一般人群高出 100 或 1000 倍。DEHP 代谢物的血清和一些尿液水平是迄今为止在人类中报告的最高水平；一些处于生物学上非常相关的浓度≥10-50 μM。尽管监管不断收紧，但 BPA 和 DEHP 似乎仍存在于 (某些) 医疗器械中。由于患者安全是 ICU 关注的问题，因此迫切需要进一步研究这些从医疗器械中释放的化学物质的 (可能有毒和临床) 影响。
