臺灣博碩士論文加值系統

過去極少研究探討人體組織在不同的電燒條件下之揮發性有機化合物成份和濃度變化，以及手術室醫護人員尿液中甲苯和二甲苯代謝物濃度分佈，因此本研究利用瞬間採樣法收集乳房手術與耳鼻喉手術中使用不同種類電刀處理人體組織時產生的手術煙霧，再以氣相層析質譜儀分析87種揮發性有機化合物濃度；另外收集80位手術室醫護人員尿液檢體，以高效液相層析串聯式質譜儀分析尿液中馬尿酸、鄰/間/對－甲基馬尿酸與肌酐酸濃度。在乳房手術方面，結果顯示電燒刀處理乳腺組織時產生的總揮發性有機化合物濃度顯著高於其他組織如脂肪組織、腫瘤組織及皮膚組織，且可發現一級致癌物中的苯、1,3-丁二烯及氯乙烯，上述結果均高於電漿刀處理上述人體組織的結果。在耳鼻喉科手術方面，以二氧化碳雷射刀電燒口腔黏膜組織時產生總揮發性有機化合物濃度變化與使用電燒刀電燒顱顏脂肪組織的結果不同。不論使用何種電刀處理組織，在手術煙霧中均可發現高濃度的甲醇，且電燒皮膚組織時使用≥27.5瓦的電燒功率會產生高濃度的總揮發性有機化合物。此外，本研究發現行政護理師尿液中測得的馬尿酸、鄰－甲基馬尿酸、間－甲基馬尿酸和對－甲基馬尿酸濃度最高，麻醉護理師次之，而外科醫師最低，且發現醫護人員分組、性別、年齡、工作年資與搭公車習慣會影響尿液中鄰/間/對－甲基馬尿酸濃度變化。本研究的結論顯示電燒刀處理乳腺組織時會產生高濃度的總揮發性有機化合物與甲醇，而電刀種類與電燒功率會影響手術煙霧中的總揮發性有機化合物濃度；另外手術室內的外科醫師、麻醉師與行政護理師的尿液中馬尿酸和甲基馬尿酸之濃度分佈不同。

Limited studies have investigated the compositions and concentrations of volatile organic compounds (VOCs) from human tissues at different electrocautery conditions, as well as the concentration distribution of urinary metabolites of toluene and xylene in health care personnel of the operating room. This study used the grab sampling to collect the surgical smoke generated from breast and otorhinolaryngology surgery with different types of electrosurgical units, and then the 87 VOCs concentrations were analyzed using gas chromatography-mass spectrometry. The 80 urinary samples were collected from health care personnel of the operating room and then analyzed the concentrations of hippuric acid, o-/m-/p-methylhippuric acids, and creatinine using ultra-performance liquid chromatography tandem mass spectrometry. In the breast surgery, the analytical results shows that the total VOCs concentrations in the surgical smoke from mammary glands using conventional electrosurgical knives were significantly higher than those from adipose, tumor, and subcutaneous tissues. The International Agency for Research on Cancer’s group 1 carcinogens including benzene, 1,3-butadiene, and vinyl chloride were also found in the surgical smoke generated from breast and otorhinolaryngology surgery. Above results using conventional electrosurgical knives were higher than those using pulsed electron avalanche knives. In otolaryngology surgery, the total VOCs concentrations in the surgical smoke from oral mucosa using a carbon dioxide laser scalpel differed from adipose tissue using an electrosurgical knife. High level of methanol was found in the surgical smoke from human tissues with types of electrosurgical units. The electrical power of ≥27.5 watts used for skin tissue produced high concentration of total VOCs. Additionally, the administrative nurses had the highest levels of urinary hippuric acid and o-/m-/p-methylhippuric acids, followed by the nurse anesthetists and surgeons. Also, some factors such as the group of health care personnel, gender, age, working years, and habit of taking bus would affect the concentrations of urinary o-/m-/p-methylhippuric acids. This study concluded that high concentrations of total VOCs and methanol were detected in the surgical smoke from mammary glands using conventional electrosurgical knives. The types of electrosurgical units and electrical power of electrosurgery machine would affect total VOCs concentrations in surgical smoke. The study also found the levels of urinary hippuric acid and o-/m-/p-methylhippuric acids were significantly different among administrative nurses, nurse anesthetists, and surgeons.

目 錄
指導教授推薦書...................................................
口試委員會審定書.................................................
誌謝............................................................iii
中文摘要........................................................iv
英文摘要........................................................v
第一章 前言.....................................................1
第一節 研究背景...................................................1
第二節 研究目的...................................................2
第二章 文獻回顧..................................................3
第一節 手術煙霧的產生機制..........................................3
第二節 影響手術煙霧組成成份之因素...................................4
第三節 手術煙霧暴露的潛在健康風險...................................6
第四節 手術煙霧暴露與其代謝物之關係.................................9
第三章 材料與方法................................................15
第一部份研究：手術煙霧成份與濃度分析................................15
第一節 手術煙霧採樣...............................................15
第二節 手術煙霧中揮發性有機化合物成份與濃度分析......................16
第三節 統計分析...................................................19
第二部份研究：手術室醫護人員與行政護理人員尿液代謝物成份與濃度分析....20
第一節 手術室醫護人員與行政護理人員尿液檢體收集與濃度分析............20
第二節 研究問卷收集...............................................21
第三節 統計分析...................................................21
第四章 研究結果..................................................24
第一部份研究：手術煙霧成份與濃度分析................................24
第一節 整形外科手術煙霧成份與濃度分佈變化...........................24
第二節 耳鼻喉科手術煙霧成份與濃度分佈變化...........................29
第二部份研究：手術室醫護人員與行政護理人員尿液代謝物成份與濃度分析....58
第五章 討論.....................................................66
第一部份研究：手術煙霧成份與濃度分析................................66
第二部份研究：手術室醫護人員與行政護理人員尿液代謝物成份與濃度分析....71
第六章 結論與建議................................................73
參考文獻.........................................................74


表目錄
表一、手術煙霧中87種揮發性有機化合物種類...........................17
表二、電燒刀在不同電燒功率下產生的手術煙霧中87種總揮發性有機化合物濃度分佈..............................................................57
表三、手術室內醫療人員與行政人員之個人基本資料與生活特性.............62
表四、個人基本特性和生活型態對於手術室醫護人員尿液中的馬尿酸與鄰/間/對－甲基馬尿酸濃度之影響性.........................................65


圖目錄
圖一、綜合文獻流程圖..............................................13
圖二、研究架構圖..................................................14
圖三、材料方法流程圖..............................................23
圖四、應用氣相層析質譜儀分析87種揮發性有機化合物之質譜層析圖..........33
圖五、執行手術前消毒皮膚時背景空氣樣本之揮發性有機化合物濃度分佈......34
圖六、乳房手術使用不同電刀種類產生的手術煙霧中87種總揮發性有機化合濃度分佈變化...........................................................35
圖七、乳房手術使用不同電刀種類產生的手術煙霧中12種總揮發性有機化合物濃度分佈變化.........................................................36
圖八、乳房手術使用電燒刀電燒皮膚組織產生的手術煙霧中87種揮發性有機化合物種類分佈.........................................................37
圖九、乳房手術使用電燒刀電燒脂肪組織產生的手術煙霧中87種揮發性有機化合物種類分佈.........................................................38
圖十、乳房手術使用電燒刀處理乳腺組織產生的87種揮發性有機化合物種類分佈...............................................................39
圖十一、乳房手術使用電燒刀電燒腫瘤組織產生的手術煙霧中87種揮發性有機化合物種類分佈.......................................................40
圖十二、乳房手術使用電漿刀電燒脂肪組織產生的手術煙霧中87種揮發性有機化合物種類分佈.......................................................41
圖十三、乳房手術使用電漿刀電燒乳腺組織產生的手術煙霧中87種揮發性有機化合物種類...........................................................42
圖十四、乳房手術使用不同電刀種類產生的手術煙霧中一級致癌物質濃度分佈變化 ................................................................43
圖十五、乳房手術使用不同電刀種類產生的手術煙霧中2A級致癌物質濃度分佈變化 ................................................................44
圖十六、乳房手術使用不同電刀種類產生的手術煙霧2B級致癌物質濃度分佈變化 ................................................................45
圖十七、乳房手術使用不同電刀種類產生的手術煙霧中三級致癌物質濃度分佈變化 ................................................................46
圖十八、耳鼻喉科使用不同電刀種類產生的手術煙霧中87種總揮發性有機化合物濃度分佈變化.......................................................47
圖十九、耳鼻喉科使用不同電刀種類產生的手術煙霧中12種總揮發性有機化合物濃度分佈變化.......................................................48
圖二十、耳鼻喉科手術使用電燒刀電燒表皮組織產生的手術煙霧中87種揮發性有機化合物種類分佈....................................................49
圖二十一、耳鼻喉科手術使用電燒刀電燒脂肪組織產生的手術煙霧中87種揮發性有機化合物種類分佈..................................................50
圖二十二、耳鼻喉科手術使用電燒刀電燒舌根組織產生的手術煙霧中87種揮發性有機化合物種類分佈..................................................51
圖二十三、耳鼻喉科手術使用二氧化碳雷射刀電燒口腔黏膜組織產生的手術煙霧中87種揮發性有機化合物種類分佈.......................................52
圖二十四、耳鼻喉科手術使用不同電刀種類產生的手術煙霧中一級致癌物質濃度分佈變化...........................................................53
圖二十五、耳鼻喉科手術使用不同電刀種類產生的手術煙霧中2A級致癌物質濃度分佈變化...........................................................54
圖二十六、耳鼻喉科手術使用不同電刀種類產生的手術煙霧中2B級致癌物質濃度分佈變化...........................................................55
圖二十七、耳鼻喉科手術使用不同電刀種類產生的手術煙霧中三級致癌物質濃度分佈變化...........................................................56
圖二十八、尿液中馬尿酸、鄰/間/對－甲基馬尿酸及肌酐酸濃度分析之質譜層析圖...............................................................61
圖二十九、手術室內醫護人員和行政護理人員尿液中馬尿酸及鄰/間/對－甲基馬尿酸濃度分佈.......................................................64

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