手术室中麻醉气体的暴露及医护人员非致癌风险评估

Exposure to anesthetic gases in the operating rooms and assessment of non-carcinogenic risk among health care workers.

作者信息

Kiani Fatemeh, Jorfi Sahand, Soltani Farhad, Ghanbari Saeed, Rezaee Ramin, Mohammadi Mohammad Javad

机构信息

Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

出版信息

Toxicol Rep. 2023 Jun 10;11:1-8. doi: 10.1016/j.toxrep.2023.06.007. eCollection 2023 Dec.

Abstract

Health care workers employed operating room in hospital and health centers are unavoidably exposed to inhaling toxic gases, including isoflurane and sevoflurane. Chronic contact with these gases increases the risk of spontaneous abortion, congenital anomalies and cancers. Risk assessment is an important tool in predicting the possible risk to personnel's health. Therefore, this study was conducted with the aim of determining the concentration of isoflurane and sevoflurane gas in the air of the operating room and estimating the non-carcinogenic risk caused by them. In this descriptive-cross-sectional study, according to the occupational method (OSHA 103), 23 samples (isoflurane and sevoflurane) were collected in the air of operating rooms of four selected hospitals in Ahvaz city by using SKC sampling pumps and sorbent tube (Anasorb 747). The samples were determined by used to gas chromatography with a flame ionization detector (GC/FID). Statistical analysis, including the Kruskal-Wallis test, was used to compare the average concentration of anesthetic gases, and the one-sample t-test was used to compare the average with the standard level. In all analyses, the significance level was 0.05, which was performed by SPSS version 22 software. Result of this study showed that the average concentration of isoflurane in private and general hospitals were 23.636 and 17.575 ppm, respectively. Also, the average level of sevoflurane were 1.58 and 7.804 ppm. According to the results the mean amount of anesthetic gases was within the range recommended by Iran's Occupational and Environmental Health Center and the permissible threshold limit provided by ACGIH. In addition, non-cancer risks from occupational exposure to isoflurane and sevoflurane in selected private and general hospitals were acceptable (HQ < 1). Although the results show that overall occupational exposure to anesthetic gases is less than acceptable but long-term exposure to anesthetic gases may endanger the health of operating room staffs. Therefore, it is recommended to implement some technical controls, including regular inspection of ventilation systems, the use of advanced ventilation systems with high cleaning power, continuous control of anesthesia devices in terms of leakage, and periodic training of related staff.

摘要

受雇于医院和健康中心手术室的医护人员不可避免地会接触并吸入有毒气体,包括异氟烷和七氟烷。长期接触这些气体会增加自然流产、先天性畸形和患癌的风险。风险评估是预测对人员健康可能风险的一项重要工具。因此,本研究旨在测定手术室空气中异氟烷和七氟烷气体的浓度,并估算它们所造成的非致癌风险。在这项描述性横断面研究中,根据职业方法(OSHA 103),使用SKC采样泵和吸附管(Anasorb 747),在阿瓦士市四家选定医院的手术室空气中采集了23个样本(异氟烷和七氟烷)。通过使用带有火焰离子化检测器的气相色谱法(GC/FID)对样本进行测定。统计分析,包括Kruskal-Wallis检验,用于比较麻醉气体的平均浓度,单样本t检验用于将平均值与标准水平进行比较。在所有分析中,显著性水平为0.05,由SPSS 22版软件执行。本研究结果表明,私立医院和综合医院中异氟烷的平均浓度分别为23.636 ppm和17.575 ppm。此外,七氟烷的平均水平分别为1.58 ppm和7.804 ppm。根据结果,麻醉气体的平均含量在伊朗职业与环境卫生中心推荐的范围内以及美国政府工业卫生学家会议规定的允许阈值范围内。此外,在选定的私立医院和综合医院中,职业接触异氟烷和七氟烷的非癌症风险是可接受的(危害商数<1)。虽然结果表明总体上职业接触麻醉气体的情况低于可接受水平,但长期接触麻醉气体可能会危及手术室工作人员的健康。因此,建议实施一些技术控制措施,包括定期检查通风系统、使用具有高净化能力的先进通风系统、持续控制麻醉设备的泄漏情况以及定期培训相关工作人员。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bfef/10285040/39f42a17ec01/ga1.jpg

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