【罂粟摘要】食道-胃-十二指肠镜检查中气溶胶产生源事件的识别
食道-胃-十二指肠镜检查中气溶胶产生源事件的识别
贵州医科大学 高鸿教授课题组
翻译：安丽 编辑：佟睿 审校：曹莹
确定在意识清醒的患者中，食道-胃-十二指肠镜检查(OGD)是否产生气溶胶水平升高，并确定其来源。
对接受OGD的患者在超净环境中进行的一项一项前瞻性的环境气溶胶监测研究。在离患者口腔20厘米处使用光学粒度仪进行采样。OGD期间的气溶胶水平与受试者的潮式呼吸和自主咳嗽进行比较。
招募了接受减肥手术的患者进行评估(平均体重指数44，平均年龄40岁，n=15)。剧院中较低的背景粒子浓度(3 L−1)可以通过潮式呼吸检测气溶胶产生(平均粒子浓度为118 L−1)。OGD期间的气溶胶记录显示平均粒子数浓度为595 L−1，范围较宽(3-4320 L−1)。产生生物气溶胶的事件，即咳嗽或打嗝是常见的。60%的内窥镜检查诱发咳嗽，其峰值浓度和采样颗粒总数高于患者参考自主咳嗽(11 710 vs 2320 L−1和780 vs 191颗粒，n=9, p=0.008)。有咳嗽的内窥镜比潮式呼吸产生更高水平的气溶胶，而那些没有咳嗽的与背景没有区别。打嗝还会产生更高的气溶胶浓度，与自主咳嗽时记录的浓度类似。除非引起咳嗽，否则内窥镜的插入和取出不会产生气溶胶。
OGD期间引起的咳嗽是气溶胶水平升高的主要来源，因此，OGD应被视为产生呼吸道气溶胶的高风险操作。对于有感染COVID-19或其他呼吸道病原体风险的患者，进行氧疗时应使用空气传播的个人防护设备并采取适当的预防措施。
Gregson FKA, et al. Gut 2021;0:1–8. doi:10.1136/gutjnl-2021-324588
Identification of the source events for aerosol generation during oesophago-gastro-duodenoscopy
ABSTRACT
Objective To determine if oesophago-gastroduodenoscopy (OGD) generates increased levels of aerosol in conscious patients and identify the source events.
Design A prospective, environmental aerosol monitoring study, undertaken in an ultraclean environment, on patients undergoing OGD. Sampling was performed 20 cm away from the patient’s mouth using an optical particle sizer. Aerosol levels during OGD were compared with tidal breathing and voluntary coughs within subject.
Results Patients undergoing bariatric surgical assessment were recruited (mean body mass index 44 and mean age 40 years, n=15). A low background particle concentration in theatres (3 L −1) enabled detection of aerosol generation by tidal breathing (mean particle concentration 118 L −1). Aerosol recording during OGD showed an average particle number concentration of 595 L −1 with a wide range(3–4320 L −1). Bioaerosol-generating events, namely, coughing or burping, were common. Coughing was evoked in 60% of the endoscopies, with a greater peak concentration and a greater total number of sampled particles than the patient’s reference voluntary coughs (11 710 vs 2320 L −1 and 780 vs 191 particles, n=9 and p=0.008). Endoscopies with coughs generated a higher level of aerosol than tidal breathing, whereas those without coughs were not different to the background. Burps also generated increased aerosol concentration, similar to those recorded during voluntary coughs. The insertion and removal of the endoscope were not aerosol generating unless a cough was triggered.
Conclusion Coughing evoked during OGD is the main source of the increased aerosol levels, and therefore, OGD should be regarded as a procedure with high risk of producing respiratory aerosols. OGD should be conducted with airborne personal protective equipment and appropriate precautions in those patients who are at risk of having COVID-19 or other respiratory pathogens.
您的每个点赞、在看，都是对我们莫大的支持！