佩戴口罩的生理代谢和临床后果-系统评价与荟萃分析及综合评估。

Physio-metabolic and clinical consequences of wearing face masks-Systematic review with meta-analysis and comprehensive evaluation.

机构信息

Orthopaedic and Trauma Surgery, Clinical Medicine, Private Practice, Düsseldorf, Germany.

Department of Psychology, Fachhochschule für Oekonomie und Management (FOM) University of Applied Sciences, Siegen, Germany.

出版信息

Front Public Health. 2023 Apr 5;11:1125150. doi: 10.3389/fpubh.2023.1125150. eCollection 2023.

BACKGROUND

As face masks became mandatory in most countries during the COVID-19 pandemic, adverse effects require substantiated investigation.

METHODS

A systematic review of 2,168 studies on adverse medical mask effects yielded 54 publications for synthesis and 37 studies for meta-analysis (on = 8,641, = 2,482, = 6,159, age = 34.8 ± 12.5). The median trial duration was only 18 min (IQR = 50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes.

RESULTS

We found significant effects in both medical surgical and N95 masks, with a greater impact of the second. These effects included decreased SpO (overall Standard Mean Difference, SMD = -0.24, 95% CI = -0.38 to -0.11, < 0.001) and minute ventilation (SMD = -0.72, 95% CI = -0.99 to -0.46, < 0.001), simultaneous increased in blood-CO (SMD = +0.64, 95% CI = 0.31-0.96, < 0.001), heart rate (N95: SMD = +0.22, 95% CI = 0.03-0.41, = 0.02), systolic blood pressure (surgical: SMD = +0.21, 95% CI = 0.03-0.39, = 0.02), skin temperature (overall SMD = +0.80 95% CI = 0.23-1.38, = 0.006) and humidity (SMD +2.24, 95% CI = 1.32-3.17, < 0.001). Effects on exertion (overall SMD = +0.9, surgical = +0.63, N95 = +1.19), discomfort (SMD = +1.16), dyspnoea (SMD = +1.46), heat (SMD = +0.70), and humidity (SMD = +0.9) were significant in = 373 with a robust relationship to mask wearing ( < 0.006 to < 0.001). Pooled symptom prevalence ( = 8,128) was significant for: headache (62%, < 0.001), acne (38%, < 0.001), skin irritation (36%, < 0.001), dyspnoea (33%, < 0.001), heat (26%, < 0.001), itching (26%, < 0.001), voice disorder (23%, < 0.03), and dizziness (5%, = 0.01).

DISCUSSION

Masks interfered with O-uptake and CO-release and compromised respiratory compensation. Though evaluated wearing durations are shorter than daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES) and down-stream physio-metabolic disfunctions. MIES can have long-term clinical consequences, especially for vulnerable groups. So far, several mask related symptoms may have been misinterpreted as long COVID-19 symptoms. In any case, the possible MIES contrasts with the WHO definition of health.

CONCLUSION

Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions. In the absence of strong empirical evidence of effectiveness, mask wearing should not be mandated let alone enforced by law.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021256694, identifier: PROSPERO 2021 CRD42021256694.

背景

在 COVID-19 大流行期间，大多数国家都强制要求佩戴口罩，因此需要对口罩的不良反应进行实质性调查。

方法

对 2168 项有关医疗口罩不良反应的研究进行系统综述，得出 54 篇用于综合分析的出版物和 37 篇用于荟萃分析的研究（纳入 8641 人，2482 人，6159 人，年龄 34.8 ± 12.5）。我们对口罩引起的生理代谢和临床结果的综合评估的中位试验持续时间仅为 18 分钟（IQR = 50）。

结果

我们发现医疗手术口罩和 N95 口罩都有显著影响，后者的影响更大。这些影响包括 SpO 显著下降（总体标准均数差，SMD = -0.24，95%置信区间 = -0.38 至 -0.11， < 0.001）和分钟通气量显著减少（SMD = -0.72，95%置信区间 = -0.99 至 -0.46， < 0.001），同时血液中的 CO 显著增加（SMD = +0.64，95%置信区间 = 0.31-0.96， < 0.001），心率（N95：SMD = +0.22，95%置信区间 = 0.03-0.41， = 0.02），收缩压（手术口罩：SMD = +0.21，95%置信区间 = 0.03-0.39， = 0.02），皮肤温度（总体 SMD = +0.80 95%置信区间 = 0.23-1.38， = 0.006）和湿度（SMD +2.24，95%置信区间 = 1.32-3.17， < 0.001）。在纳入 373 人的 = 373 项研究中，在佩戴口罩方面具有稳健关系的结果表明，疲劳（SMD = +0.9，手术口罩：SMD = +0.63，N95 = +1.19）、不适（SMD = +1.16）、呼吸困难（SMD = +1.46）、热（SMD = +0.70）和湿度（SMD = +0.9）的影响显著（ < 0.006 至 < 0.001）。汇总症状发生率（ = 8128）显著的是：头痛（62%， < 0.001）、痤疮（38%， < 0.001）、皮肤刺激（36%， < 0.001）、呼吸困难（33%， < 0.001）、热（26%， < 0.001）、瘙痒（26%， < 0.001）、声音障碍（23%， < 0.03）和头晕（5%， = 0.01）。

讨论

口罩干扰了 O 的摄取和 CO 的释放，并损害了呼吸代偿。尽管评估的佩戴时间比日常/长时间使用短，但结果独立验证了口罩引起的疲劳综合征（MIES）和下游生理代谢功能障碍。MIES 可能会产生长期的临床后果，特别是对弱势群体。到目前为止，一些与口罩相关的症状可能被误解为长期 COVID-19 症状。在任何情况下，可能的 MIES 与世界卫生组织对健康的定义相矛盾。