新型内镜口鼻屏蔽罩在上消化道内镜检查中减少气溶胶传播的研究

Reduction of aerosol transmission in upper gastrointestinal endoscopy by using a novel endoscopic oronasal shield

摘要:

目的 评估内镜口鼻屏蔽罩在减少上消化道内镜检查中气溶胶传播的效果。方法 纳入2023年12月至2024年2月在拉萨市人民医院行无痛上消化道内镜检查的患者，应用SAS 9.4统计软件，按1∶1的比例生成随机编码，将患者随机分为内镜口鼻屏蔽罩组和对照组。使用六通道（0.3、0.5、1.0、2.5、5.0、10.0 μm）颗粒计数器测量气溶胶颗粒。主要结局是内镜检查前后医师面部位置气溶胶颗粒水平的变化，次要结局是口鼻屏蔽罩的安全性。结果 研究纳入100例患者，两组各50例，两组基线特征相似。口鼻屏蔽罩组及对照组操作时间分别为（7.8±3.9）min和（8.1±4.2）min，差异无统计学意义（t=0.500，P=0.615）。内镜口鼻屏蔽罩组在0.3 μm［（57.87±19.26）×104/L比（203.32±18.33）×104/L，t=4.295，P<0.001］、0.5 μm［（19.36±3.60）×104/L比（64.61±12.67）×104/L，t=4.949，P<0.001］、1.0 μm［（15.31±4.42）×104/L比（54.11±9.12）×104/L，t=4.507，P<0.001］、2.5 μm［（7.38±2.90）×104/L比（23.33±5.17）×104/L，t=3.723，P<0.001］粒径增加的气溶胶颗粒数显著少于对照组。两组在常见不良反应（咳嗽、呃逆、低氧饱和度等）方面差异均无统计学意义（P>0.05）。结论 使用内镜口鼻屏蔽罩安全，不延长操作时间，并能有效减少气溶胶生成，有助于降低内镜中心的气溶胶暴露风险。

Abstract:

Objective To evaluate the effectiveness of a novel endoscopic oronasal shields in reducing aerosol transmission during upper gastrointestinal endoscopy. Methods Patients undergoing sedated upper gastrointestinal endoscopy at Lhasa People''s Hospital (December 2023-February 2024) were randomized 1∶1 via SAS 9.4 to shield or control groups. A six-channel particle counter (0.3, 0.5, 1.0, 2.5, 5.0, 10.0 µm) measured aerosol particles. The primary outcome was pre-/post-procedure aerosol variation at the endoscopist''s facial position. The secondary outcome was device safety. Results The study enrolled 100 patients (50 per group) with comparable baseline characteristics. Procedure duration showed no significant difference (7.8±3.9 min VS 8.1±4.2 min, t=0.500, P=0.615). The oronasal shield group demonstrated significantly reduced aerosol increases at 0.3 μm [(57.87±19.26)×10⁴/L VS (203.32±18.33)×10⁴/L, t=4.295, P<0.001], 0.5 μm [(19.36±3.60)×10⁴/L VS (64.61±12.67)×10⁴/L, t=4.949, P<0.001], 1.0 μm [(15.31±4.42)×10⁴/L VS (54.11±9.12)×10⁴/L, t=4.507, P<0.001], and 2.5 μm [(7.38±2.90)×10⁴/L VS (23.33±5.17)×10⁴/L, t=3.723, P<0.001]. Adverse event rates (cough, hiccups, hypoxemia, etc.) showed no significant differences (P>0.05). Conclusion Endoscopic oronasal shields safely reduce aerosol generation without prolonging procedure time, potentially mitigating exposure risks in endoscopy centers.