手術人員對於不同手術之電燒煙霧中揮發性有機物質暴露調查研究

The Exposure of Surgeons to Volatile Organic Compounds in Electrosurgical Smoke Resulted from Surgeries

鄭乃云(Nai-Yun Cheng)

指導教授 ： 黃耀輝

國立臺灣大學/公共衛生學院/職業醫學與工業衛生研究所/碩士(2016年)

https://doi.org/10.6342/NTU201603650

摘要

手術電刀的使用大幅提升手術效率及安全性，但操作時產生的電刀煙霧會對手術人員造成不適感，甚至不良健康影響。且手術過程中，手術人員僅配戴手術口罩，對於電刀煙霧中揮發性有機物質較無防護效果。本研究目的為探討手術類別、電刀種類、電刀使用時間等不同因素對於手術人員暴露於電刀煙霧中揮發性有機物質的影響程度。研究對象為北部某區域醫院手術室，共採集10場手術之電燒過程環境樣本及12位手術人員使用電刀前後之呼氣樣本，同時進行手術電刀使用後之自覺症狀調查，評估手術人員體內實際受電刀煙霧暴露情形，以及暴露與健康之間的關係。
研究結果發現手術人員呼氣樣本中可偵測到15種揮發性有機物質，其中sevoflurane、hexane、benzene、toluene、m/p-xylene、hexamethyldisiloxane等13種物質在手術電燒過程環境樣本中可被偵測到，兩種樣本所測得之有機物質具高度重複性，顯示呼氣樣本可反應手術電燒過程中揮發性有機物質暴露情形。另統計分析結果顯示，手術人員使用電刀時間較長者，其手術後呼氣樣本中Benzene濃度顯著增加(p = 0.031)。分別比較進行傳統手術與內視鏡手術方式，以及使用一般電刀與低溫電漿刀手術方式的手術人員，在手術後的呼氣結果顯示，傳統手術與使用一般電刀的手術人員在手術後呼氣樣本中hexane、benzene、toluene等多種揮發性有機物質的濃度相對較高。在自覺症狀中有咳嗽及呼吸不順症狀之手術人員在電刀煙霧暴露後呼氣中benzene濃度顯著高於無症狀者。另一方面，本研究亦發現手術過程中，手術人員暴露於手術室環境中麻醉劑sevoflurane最高濃度已超過應採取改善措施的二分之一容許濃度值(Action Level)。且當手術時間越長，手術人員呼氣樣本中sevoflurane濃度顯著增加(p = 0.011)。
本研究發現使用電刀時間、電刀種類及內視鏡手術均為手術人員暴露電刀煙霧中揮發性有機物質的影響因子，且手術人員普遍存在麻醉劑之暴露危害達到應採取改善措施之曝露程度。期望本研究成果可促使醫療院所重新重視手術電刀煙霧中揮發性有機物質以及麻醉劑對於手術人員的潛在暴露危害，並能依此研究成果進行必要暴露防護措施與通風換氣調整，以保障手術人員之職業健康權益。

關鍵字

電刀煙霧暴露 ； 揮發性有機物質 ； 麻醉劑 ； 呼氣採樣 ； 自覺症狀

並列摘要

Using electrosurgical units (EU) effectively improve the efficiency and safety of surgery. However, the resulted electrosurgical smoke could make surgeons and relevant health workers uncomfortable and even adverse health effects to them. Surgical mask is the usual personal protective equipment for surgeons and relevant health workers in the regular surgical procedures, which could not provide effective protection for volatile organic compounds (VOCs) in electrosurgical smoke. This study aimed to assess the exposure level of VOCs in electrosurgical smoke for surgeons and relevant health worker by surgical division, EU type and use time of EU. Area samples were collected from surgeries and breath samples were collected from surgeons and relevant health workers before and after surgical procedure in an area hospital located in northern Taiwan. This study also investigated the self-reported symptoms of surgeon and relevant health workers after each surgery in order to assess the relationship of electrosurgical smoke exposure and health effect.
Results showed that 15 VOCs were detected in breath samples. Among them, 13 VOCs were also found in area samples, such as sevoflurane, hexane, benzene, toluene, m/p-xylene and hexamethyldisiloxane etc. High compliance in VOC species between two types of samples implies that breath samples might reflect the exposure scenario of electrosurgical smoke during electrosurgical procedures. Benzene level in breath samples significantly increased for surgeons who experienced longer time for EU use (p = 0.031). Comparing the results of breath samples after surgery between traditional and endoscopy surgeries, samples of surgeons of traditional surgeries presented higher VOCs (benzene and toluene etc.) exposure level, while surgeons who used Pulsed Electron Avalanche Knife (PEAK) in surgical procedures showed lower exposure levels of VOCs (hexane and toluene etc.) in electrosurgical smoke than those surgeons who used electrocautery. In addition, the levels of benzene in breath samples after surgery were significantly higher among surgeons who reported cough and shortness of breath after surgical procedure. On the other hand, this study also found that the maximum level of sevoflurane, one kind of anesthetic gas, in the operating room already exceeded the action level and warranted immediate measures to lower this kind of exposure. Besides, sevoflurane in breath samples of surgeons also significantly increased as the surgical time lasted longer (p = 0.011).
This study illustrated that use time of EU, type of EU and endoscopic surgery were the factors which effected the exposure level of VOCs in electrosurgical smoke and exposure to attention-requiring anesthetic gas level were common for surgeons and relevant health workers. It’s expected that our findings would urge the hospitals to adopt the necessary exposure prevention measure and adequate ventilation system in operating room in order to protect the health of surgeons and relevant health workers.

並列關鍵字

electrosurgical smoke exposure ； volatile organic compound ； anesthetic ； breath sampling ； self-reported symptom

參考文獻

中華民國醫師公會全國聯合會：2014年台灣地區執業醫師、醫療機構統計。

黃百粲、莊文吉、蔡雪嬌：手術室中雷射與電刀燻煙的暴露調查。中華職業醫學雜誌 1998; 5: 139-146。

廖祐伶、陳叡瑜：手術房區域醫護人員麻醉廢氣暴露評估。臺北醫學大學公共衛生學系碩士論文 2006。

林冠宇：偵測呼出氣體中所含揮發性有機物作為指標在環境衛生上的應用-可行性探討。國立台灣大學公共衛生學院環境衛生研究所碩士論文2004。

Allen CJ, Jones NL, Killian KJ. Alveolar gas exchange during exercise: a single-breath analysis. J Appl Physiol Respir Environ Exerc Physiol 1984; 57: 1704-1709.