过氧乙酸空气消毒对人群健康不良影响的研究

发布时间：2018-05-15 01:18

本文选题：过氧乙酸 + 空气消毒　；参考：《华中科技大学》2006年硕士论文

【摘要】： 目的了解在SARS爆发流行期间大规模使用过氧乙酸空气消毒之后,对人群健康产生的潜在不良影响,为今后过氧乙酸的安全使用提供依据。方法经医学伦理委员会同意之后,招募29名志愿者,按照卫生部疾病控制司二OO三年四月二日发布的《各种污染对象的常用消毒方法(试行)》标准喷洒过氧乙酸进行室内空气消毒,在喷洒结束后开门窗透气。受试者于透气30分钟后进入消毒场所,暴露于消毒后气体。每天暴露两次,连续暴露两天。受试者分别在试验前、接触消毒剂一次、两次和脱离暴露一周后分别抽取5毫升,共四次20毫升的外周静脉血,检测血常规、肝功能、肾功能、IgE、组胺、血清SOD、MDA和外周血淋巴细胞DNA损伤(彗星试验)等指标,并且在第三次抽血和最后一次抽血后对志愿者不良反应进行量表调查。其中IgE的检测使用的是ELISA双抗夹心法,组胺的检测使用荧光法,SOD的检测则使用的羟胺法,MDA则使用的硫代巴比妥酸(TBA)法,DNA损伤的检测使用的是单细胞凝胶电泳法。量表的设计主要根据过氧乙酸空气消毒后,对接触者皮肤、眼部、呼吸道和消化道黏膜产生刺激而设计的。具体的指标包含:呼吸道刺激症状、消化道刺激症状、咽部刺激症状、皮肤刺激症状等。各项指标按照程度的不同,从低到高依次为:无、轻微、一般、较重(能忍受)、严重(无法忍受)。另设一栏填写其他的不适反应。通过对所测指标和调查量表的分析,综合评价过氧乙酸空气消毒对人群不良健康的影响,从而提出相应的建议和采取措施,以减轻或避免这种不良反应。结果人群接触消毒剂后,29人未有人出现皮肤红斑、斑疹、丘疹、水肿和紫绀。但观均感到不同程度的不适,所有的志愿者在进入消毒剂喷洒后的试验室均感觉到程度不等的异味,伴有其他各种轻微不适:呼吸道刺激感17人;咳嗽8人;1人气喘、呼吸困难和胸闷6人;眼部疼痛、流泪11人,其中两人出现畏光和红肿;消化道(胃腹部)不适7人。休息一周后,无人出现异常和不适。血常规中,除白细胞和单核细胞外,其他指标均无明显异常改变(P0.05)。白细胞计数有增多的趋势(P0.05),单核细胞计数也有增大的趋势(P0.01);脱离接触消毒剂一周后,白细胞回复到接触前水平,而单核细胞则持续增高。SOD早期受到抑制活性减小,接触消毒剂一天后期活性增加(P0.01),此后则一直稳定在同一水平;MDA的浓度随着接触时间的延长而增加(P0.01);彗星试验显示过氧乙酸可致DNA损伤。脱离接触消毒剂一周后,SOD活性恢复到接触前水平,而血清MDA水平和DNA损伤外虽然有所恢复,但是仍然没有恢复到接触前水平。在本次实验条件下,肝、肾功能和免疫指标则未见明显异常改变。结论按照卫生部的院感控制指导使用过氧乙酸进行空气消毒,暴露人群会出现多种主观不适症状,会致一过性炎症反应(白细胞和单核细胞计数上升),引起接触人群血清脂质过氧化的改变,并致DNA损伤。脱离暴露一周之后,各种不良反应基本消失,仅单核细胞、MDA和DNA改变仍未完全恢复到接触前水平。对此采取的预防措施主要有:(1)有人在场时不易进行过氧乙酸喷洒消毒;(2)在保证消毒效果的前提下,尽可能降低过氧乙酸消毒时的浓度和消毒次数;(3)在喷洒消毒剂并密闭作用30min后,应开门窗透气,加快过氧乙酸的稀释和分解;(4)过氧乙酸得家庭使用尤其要谨慎;(5)对有既往过敏体质的人应做好防护;(6)做好消毒人员的防护工作。
[Abstract]:Objective to understand the potential adverse effects of peroxy acetic acid on the health of the population after the large-scale use of peracetic acid air during the outbreak of SARS outbreak, and to provide a basis for the safe use of peracetic acid in the future.
Methods after the consent of the medical ethics committee, 29 volunteers were recruited to disinfect indoor air in accordance with the common disinfection methods (trial run) > standard spraying peracetic acid, which was released by the Department of disease control and Disease Control Department of the Ministry of health of the Department of disease control, two OO, three years, April 2nd, and open doors and windows after the spray ended. The subjects entered the disinfectant after 30 minutes of air permeability. The sites were exposed to the sterilized gas after exposure for two times a day for two days. The subjects were exposed to a disinfectant once, two times and 5 milliliters after one week of exposure, and four times of 20 ml of peripheral venous blood respectively. The blood routine, liver function, renal function, IgE, histamine, serum SOD, MDA, and peripheral blood lymphocyte DNA damage were detected. (comet test) and other indicators, and a scale survey of adverse reactions to volunteers after third blood pumping and final blood extraction. The test used for IgE was ELISA double anti sandwich, histamine detection and use of fluorescence, SOD assay using hydroxylamine method, MDA used thiobarbituric acid (TBA), DNA damage detection and use. It was designed by single cell gel electrophoresis. The design of the scale was designed to stimulate the skin, eye, respiratory, and digestive tract mucosa of the contact person after disinfection of peracetic acid air. Specific indicators included respiratory irritation symptoms, digestive irritation symptoms, pharynx irritation symptoms, skin irritation symptoms, and so on. Different, from low to high in turn: No, slight, general, heavy (tolerable), serious (intolerable). Another column fill in other discomfort reactions. Through the analysis of the measured index and survey scale, the effect of peracetic acid air disinfection on the bad health of the population is evaluated and the corresponding suggestions and measures are put forward to reduce or avoid. Avoid this adverse reaction.
Results there was no skin erythema, rash, papules, edema, and cyanosis in 29 people after exposure to the disinfectant. But all of them felt different degrees of discomfort. All the volunteers in the test room after the disinfectant sprayed all felt different degrees of odor, with other light and micro discomfort, respiratory irritation of 17 people, 8 people coughing and 1 asthma, 6 people with dyspnea and chest distress, 11 people with eye pain and tears, two of them were photophobia and redness, and 7 were discomfort in the digestive tract (stomach and abdomen). No abnormality and discomfort occurred after a week of rest. In the blood routine, there were no obvious abnormal changes (P0.05) except for leukocytes and mononuclear cells. The trend of white blood cell count increased (P0.05), mononuclear thin The cell count also has an increasing trend (P0.01). After a week of disengagement disinfectant, the leukocytes revert to the pre contact level, while the mononuclear cells continue to increase in the early stage of.SOD, and the activity of the contact disinfectant increases (P0.01) in the later day (P0.01), and then has been stable at the same level, and the concentration of MDA increases with the prolongation of the contact time. Addition (P0.01); comet test showed that peroxy acetic acid could cause DNA damage. After a week, the activity of SOD recovered to the level of pre contact, while the serum MDA level and DNA damage recovered, but still did not recover to the pre contact level. In this experiment, the liver, renal function and immune index were not obviously abnormal.
Conclusion the use of peracetic acid for air disinfection according to the hospital sense control of the Ministry of health, the exposed population will have a variety of subjective discomfort symptoms, causing an excessive inflammatory response (the increase of leukocyte and monocyte count), causing changes in serum lipid peroxidation in the contact population and causing DNA damage. Only mononuclear cells, only monocytes, MDA and DNA changes are still not fully restored to pre contact level. The main preventive measures are: (1) when someone is present, peroxy acetic acid spraying is not easy to be carried out; (2) the concentration and disinfection times of peracetic acid are reduced as much as possible under the premise of ensuring the disinfection effect; (3) the disinfectant is sprinkled and dense. After closing the 30min, we should open doors and windows to breathe in, speed up the dilution and decomposition of peroxy acetic acid; (4) the peracetic acid should be used with caution in family use; (5) people who have previously allergic constitution should be well protected; (6) do a good job for the protection of the disinfectant.

【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R187

【参考文献】