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超净手术关键区带菌颗粒物浓度控制机理研究

作者:完美论文网  来源:www.wmlunwen.com  发布时间:2019/10/31 9:21:23  

摘要:目前,各国手术室的建设已经达到了一定的水平,完全满足手术标准。但是,在现有严格的医疗防控措施下,手术感染事件依然存在。考虑到手术过程中医生的弯腰、医护人员的走动等会对气流产生一定的扰动作用,影响带菌粒子的分布,增大手术关键区患者伤口感染的风险。为此,本课题研究了超净手术室医生的弯腰、医护人员的行走及局部通风对粒子浓度分布的影响,以期能够降低手术感染率。

文中首先对实验室模型进行了模拟,并与实验结果作对比,验证了数学模型的正确性。采用标准- 模型模拟气流分布、动网格模拟人员行走、修改后的漂移通量模型模拟带菌粒子的分布。相关结论如下:

巡回护士以较低的速度0m/s和0.25m/s进出洁净区时会对手术关键区带菌粒子的分布产生轻微的影响,而以更快的速度0.5m/s和1m/s行走时会给病人的上表面和手术台部分区域带来污染;建议巡回护士应尽量以低于0.25m/s的速度行走,减少手术关键区的粒子浓度。

对超净手术室中人员静态情形与动态弯曲运动的研究发现:静态情形下层流系统可以使手术关键区的带菌粒子浓度低于10 cfu/m3;动态运动中手术关键区带菌粒子浓度超过规定要求的25倍左右。所以,认为外科医生的动态弯曲运动会使手术关键区带菌粒子浓度变大,增大患者伤口的感染风险。

针对超净手术室中人体处于直立与弯曲两种不同状态,本文提出了一种新型的局部通风方式,并研究了局部送风速度对手术关键区的速度场、粒子浓度场的影响。局部送风速度为0.15m/s时可以及时洗涤人员胸前滞留的粒子且对身后粒子扰动相对较小,满足手术关键区的洁净度要求;建议局部通风方式的最佳送风速度为0.15m/s。

At present, the construction of operatingrooms in various countries has reached a certain level, completely meeting thestandard of operation. However, with the existing strict medical controlmeasures, surgical infection still exists. Considering that the doctor'sbending and the walking of the medical staff will have a certain disturbance onthe air flow, affecting the distribution of the bacteria particles, andincreasing the risk of wound infection in patients in the key surgical area.For this reason, this study investigated the effects of the doctor's bending,walking of medical staff, and local ventilation on the particle concentrationdistribution, which hoping to reduce the surgical infection rate.

Firstly, the laboratory model was simulatedand compared with the experimental results to verify the correctness of themathematical model. The standard - model was used to simulate air flow, dynamicgrid to simulate personnel walking, and modified drift flux model to simulatethe distribution of carriers of bacteria. The relevant conclusions are asfollows:

The nurses entering and leaving the cleanarea at low speeds of 0 m/s and 0.25 m/s will have a slight impact on thedistribution of the bacteria in the critical surgical area. When walking atfaster speeds of 0.5m/s and 1m/s, it will contaminate parts of the operatingtable and the patient's upper surface; it is recommended that the travelingnurse should try to walk at a speed of less than 0.25m/s to reduce the criticalconcentration of particles in the operation room.

Studying of static conditions and dynamicbending motions in personnel in clean operating rooms found that: under staticconditions, the concentration of carrier particles in the critical area ofoperation is less than 10 cfu/m3 under the laminar flow system. In the dynamicmovement, the concentration of the bacteria in the key area of the operation isabout 25 times more than the required requirement. Therefore, it is believedthat the surgeon's dynamic bending movement will increase the concentration ofthe bacteria in the critical area of the operation and increase the risk ofinfection in the site of the patient's wound.

This paper presents a new type of localventilation method for the human body in an ultra-clean operating room in bothupright and curved states. The effect of local delivery speed on the velocityfield and particle concentration field in the critical surgical area isstudied. The results show that when the local air supply speed is 0.15m/s, theparticles trapped on the chest of the personnel can be washed in time and thedisturbance to the behind-body particles is relatively small, which meets thecleanliness requirements of the key surgical area. Based on the comprehensiveanalysis, it is recommended that the optimal air supply speed for this localventilation method be 0.15 m/s. The local ventilation method proposed in thepaper provides a new method for the purification of critical areas in theultra-clean ventilation operating room.

关键词:手术室;带菌颗粒物;人员行走;局部通风;数值计算

operating room; bacteria-carryingparticles; personnel walking; local ventilation; numerical calculation

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