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  • 學位論文

不同手術保溫裝置對於手術區域菌落污染的影響

The impact of different warming devices on bacteria contamination in surgical field

指導教授 : 葉力森
共同指導教授 : 葉光勝(Kuang-Sheng Yeh)

摘要


麻醉中的病患由於代謝減緩而產熱較少,且麻醉造成之血管擴張會使得體熱從身體中心區域流向周邊循環,進而以輻射的形式散失在周遭環境中,因此麻醉中的病患往往因為產熱與散熱無法平衡而出現體溫下降之情形。低體溫會降低體內代謝作用,延緩藥物(包括麻醉藥物)的代謝而增加其作用之時間。即使體溫輕微的下降(36 ℃)也會降低病患對感染的抵抗力,而增加手術傷口感染的機會。 有鑑於此,不論人醫或獸醫均積極嘗試用各種方式來維持麻醉中病患的體溫。這些方式包括藉由主動加溫提供病患額外的熱源,或是以被動保溫的方式減少熱量散失(例如以反射性材質減少輻射熱散失或以絕緣性材質減少傳導熱流失)。而使用氣毯做為術中保溫,能有效避免低體溫的狀況發生,故氣毯保溫已被醫學界廣泛運用在保溫上面。但氣毯主機放置的地方往往低於手術台平面,且位於手術台層流出風系統有效範圍之外,故其吹入術區的氣體是否乾淨、能達到手術層級的要求是有疑慮的。此外,與其他的保溫裝置相比,氣毯吹入術區的氣體會經過未經消毒的病人體表,是否會將體表菌叢吹入術區也是值得探討之處。而研究顯示氣毯裝置的管線確實有藏汙納垢的可能。 共57隻手術病例納入本研究。在同一手術病例,若第二次手術區域採樣菌落數(CFU)大於第一次手術區域採樣菌落數,則認定為手術區域受到汙染。在收集保溫裝置類型、畜種、手術類型、傷口分類、手術室、刷手人員數量、窗巾種類、窗巾層數、窗巾固定方式之數據後,以卡方檢定(Chi-Square)進行統計分析。 結論發現手術時使用汽毯保暖裝置並不會增加手術區域汙染的機會,也不會增加手術後傷口感染的風險,僅有醫師的不同會造成手術區域汙染率有統計上的差異。不過礙於實驗設計的限制,日後更大規模、更加統一病例類型的實驗評估手術區落菌狀況,再做更進一步分析是必要的。

並列摘要


Increasing heat loss and reducing heat production are the main causes for anesthetic hypothermia. Patients with low body temperature are found associated with unwanted and potentially life-threatening complications. These consequences include decreased resistance to surgical wound infections, and higher chance of developing surgical site infection. Various passive insulators and active warming systems are available for use intraoperatively. Forced-aie warmer, a hot air blowing warming system is proven to be able to prevent anesthetic hypothermia and suggested to be introduced during anesthesia by human medical guidline. In arthroplasty and neurosurgery, stricktly surgical environment sterile level is required. Concerns are raised about forced-air warmer might bring skin bacteria flora into sterile surgical site and cause surgical site infection. The purpose of this study is to investigate the relationships between two different active warming devices and the surgical field contaminations rates. A total of 57 surgery cases were included in the study. Type of warming device, species, surgical wound category, operation room, numbers of scrub-in personnel, surgical drape type, surgical drape secure method, and surgeon who performed the surgery were recorded. Chi-Square test was used to test the differences between surgical field contamination rate on each category with the statistical significance level set at 5% (p = 0.05). According to the study, using force-air warming device was not associated with elevating surgical site contamination rate. But there were significant differences in different surgeons and their surgical site contamination rate. Revealing that personnel factor might contribute to surgical site contamination more than environmental factors.

參考文獻


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