目的 探索我国静脉用药调配中心(PIVAS)抗肿瘤药物(ADs)环境暴露卫生指导值(HGVs),为快速识别ADs环境暴露级别并实施科学防控提供依据。方法 监测数据来自全国10家医疗机构PIVAS的物体表面擦拭样本,利用UPLC-MS/MS测定样本中环磷酰胺(CP)与阿糖胞苷(CAR)的浓度。结果 共计收集到417例监测样本,CP与CAR的检出率高达84.65%与88.73%,且各家医院暴露水平差异较大,CP中位值为0～6.90 ng·cm-2,CAR中位值为0.04～1.92 ng·cm-2。若按国外推荐的90th百分位浓度设置我国ADs环境监测预警HGVs,CP的预警HGVs为20.75 ng·cm-2,远高于其他国家报道。结论 我国PIVAS中ADs环境暴露较国外严重, HGVs的引入为医疗机构快速识别ADs暴露级别并实施分级防控提供了科学依据,基于我国的暴露现状,建议以75th和90th百分位浓度为我国ADs职业暴露防控设置两道预警线。
Abstract
OBJECTIVE To explore the hygienic guidance values (HGVs) of environmental exposure of antineoplastic drugs in Chinese PIVAS, which provide a basis data for the rapid identification of the environmental exposure level of ADs and the implementation of scientific prevention and control. METHODS The monitoring wipe samples were obtained from PIVAS from ten Chinese medical institutions, and the concentrations of cyclophosphamide (CP) and cytarabine (CAR) in the wipe samples were determined by UPLC-MS/MS. RESULTS A total of 417 monitoring samples were collected, and the detection rate of CP and CAR was as high as 84.65% and 88.73%, and the exposure level of each hospital was significantly different, with the median value of CP ranging from 0 to 6.90 ng·cm-2 and the median value of CAR ranging from 0.04 to 1.92 ng·cm-2. The detection rate and exposure of ADs in each region of PIVAS were high, and the maximum detection amount existed in the general control area. If the environmental monitoring warning HGVs in our country was set according to the 90th percentil concentration recommended by foreign countries, the HGVs of CP was 20.75 ng·cm-2, which was far higher than that reported by other countries. CONCLUSION The environmental exposure of ADs in Chinese PIVAS seemed to be more serious than that in other countries. The introduction of HGVs provides a scientific basis for medical institutions to quickly identify the level of ADs exposure and implement classified prevention and control. Based on the current situation of exposure in China, it is suggested to set up two warning lines for the prevention and control of ADs occupational exposure in China with the concentration of 75th and 90th percentiles.
关键词
抗肿瘤药物 /
职业暴露 /
环境监测 /
卫生指导值 /
静脉用药调配中心
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Key words
antineoplastic drug /
occupational exposure /
the environmental monitoring /
hygienic guidance value /
PIVAS
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中图分类号：
R954
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参考文献
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脚注
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基金
苏州市科技计划项目(民生科技)资助(SS2019041)
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