医务人员职业接触抗肿瘤药物环境监测与健康危害的研究进展

摘要/Abstract

摘要： 抗肿瘤药物已证实会在空气和物体表面残留,环境监测技术揭示了残留污染的来源,是保护医务工作者免受职业暴露的潜在风险的必要组成部分。医务人员作为抗肿瘤药物接触的高危人群,可能会长期暴露,残留药物也可能会对医务人员造成潜在的职业危害。本文就国内外各类抗肿瘤药物常用的环境监测方法进行综述,指出周围环境存在一定程度的抗肿瘤药物污染,评估潜在的健康风险,并以此提出相关的防范建议,以期确保医务人员的健康安全。

关键词: 抗肿瘤药物, 环境监测, 职业防护, 职业暴露

Abstract: Antitumor drugs have been proven to remain in the air and on object surfaces,and environmental monitoring technology reveals the sources of residual pollution,which is a necessary component of protecting medical workers from potential occupational exposure risks. As a high-risk group of anti-tumor drug exposure,medical staff may be exposed to them for a long time,and residual drugs may also cause potential occupational harm to medical staff. This paper summarizes the environmental monitoring methods commonly used for various anti-tumor drugs at home and abroad,points out that there is a certain degree of pollution of anti-tumor drugs in the surrounding environment,evaluates the potential health risks,and puts forward relevant prevention suggestions,in order to ensure the health and safety of medical staff.

Key words: Anti-tumor drugs, Environmental monitoring, Occupational protection, Occupational exposure

中图分类号:

R181.3⁺4

张双飞, 成金桃, 袁梦, 黄小红. 医务人员职业接触抗肿瘤药物环境监测与健康危害的研究进展. [J]职业与健康, 2024, 40(13): 1862-1866.

ZHANG Shuangfei, CHENG Jintao, YUAN Meng, HUANG Xiaohong. Research progress on environmental monitoring and health hazards of occupational exposure to anti-tumor drugs of medical personnel. [J]OCCUPATION AND HEALTH, 2024, 40(13): 1862-1866.

参考文献

[1] BOBIN-DUBIGEON C,AMIAND M,PERCHERON C,et al.A new,validated wipe-sampling procedure coupled to LC-MS analysis for the simultaneous determination of 5-fluorouracil,doxorubicin and cyclo-
phosphamide in surface contamination[J].J Anal Toxicol,2013,7(7):433-439.
[2] 张曦文,李乐乐,江素鑫,等.环磷酰胺生殖毒性的研究进展[J].中国研究型医院,2018,5(1):27-32.
[3] CANAL-RAFFIN M,KHENNOUFA K,MARTINEZ B,et al.Highly sensitive LC-MS/MS methods for urinary biological monitoring of occupational exposure to cyclophosphamide,ifosfamide,and methotrexate antineoplastic drugs and routine application[J].J Chromatogr B Analyt Technol Biomed Life Sci,2016,1038(1):109-117.
[4] MORETTI M,BONFIGLIOLI R,FERETTI D,et al.A study protocol for the evaluation of occupational mutagenic/carcinogenic risks in subjects exposed to antineoplastic drugs:A multicentric project[J].BMC Public Health,2011,11:195.
[5] CONNOR T H,LAESON C C,POLOVICH M,et al.Reproductive health risks associated with occupational exposures to antineoplastic drugs in health care settings:a review of the evidence[J].J Occup Environ Med,2014,56(9):901-910.
[6] KAREDAL M,JONSSON R,WETTERLING M,et al.A quantitative LC-MS method to determine surface contamination of antineoplastic drugs by wipe sampling[J].J Occup Environ Hyg,2022,19(1):50-66.
[7] PORTILHA-CUNHA M F,RAMOS S,SILVA A M T,et al.An Improved LC-MS/MS Method for the Analysis of Thirteen Cytostatics on Workplace Surfaces[J].Pharmaceuticals(Basel),2021,14(8):754.
[8] CONNOR T H,MCDIARMID M A.Preventing occupational exposures to antineoplastic drugs in health care settings[J].CA Cancer J Clin,2006, 56(6):354-365.
[9] ROLAND C,CARON N,BUSSIERES J F.Multicenter study of environmental contamination with cyclophosphamide,ifosfamide,and methotrexate in 66 Canadian hospitals:A 2016 follow-up study[J].J Occup Environ Hyg,2017,14(8):661-669.
[10] 殷爽,刘丽.环境监测与生物监测在静脉药物配置中心抗肿瘤药物暴露评估中的应用研究[J].中国医学前沿杂志(电子版),2016, 8(6):119-123.
[11] MUCCI N,DUGHERI S,FARIOLI A,et al.Occupational exposure to antineoplastic drugs in hospital environments:Potential risk associated with contact with cyclophosphamide-and ifosfamide-contaminated surfaces[J].Med Pr,2020,71(5):519-529.
[12] 张晶晶,沈国荣,王人英,等.我国PIVAS抗肿瘤药物环境暴露卫生指导值的探索[J].中国药学杂志,2021,56(3):244-249.
[13] SOTTANI C,GRIGNANI E,CORNACCHIA M,et al.Occupational exposure assessment to antineoplastic drugs in nine italian hospital centers over a 5-year survey program[J].Int J Environ Res Public Health, 2022,19(14):8601.
[14] LESO V,SOTTANI C,SANTOCONO C,et al.Exposure to antineoplastic drugs in occupational settings:a systematic review of biological monitoring data[J].Int J Environ Res Public Health,2022,19(6):3737.
[15] MCDEVITT J J,LEES P S,MCDIARMID M A.Exposure of hospital pharmacists and nurses to antineoplastic agents[J].J Occup Med,1993, 35(1):57-60.
[16] JANES A,TANGUAY C,CARON N J,et al.Environmental contamination with cyclophosphamide,ifosfamide,and methotrexate:A study of 51 canadian centres[J].Can J Hosp Pharm,2015,68(4):279-289.
[17] SOTERIADES E S,ECONOMIDOU S C,TSIVITANIDOU A,et al.Environmental assessment of cytotoxic drugs in the oncology center of cyprus[J].PLoS One,2020,15(3):e0216098.
[18] CRUL M,SIMONS-SANDERS K.Carry-over of antineoplastic drug contamination in Dutch hospital pharmacies[J].J Oncol Pharm Pract,2018,24(7):483-489.
[19] 包建安,沈国荣,王仁英,等.多中心PIVAS对职业暴露的评估[J].中国医院药房杂志,2016,36(9):701-706.
[20] 李佳,黄小红.职业接触铂类抗肿瘤药物暴露风险与防护的研究进展[J].职业与健康,2022,38(2):271-275.
[21] 李佳,梅小红,黄小红,等.铂类抗肿瘤药物遗传毒性和生殖毒性的研究进展[J].职业卫生与应急救援,2022,40(2):242-246.
[22] CANEPARO A,MASSUCCO P,VAIRA M,et al.Contamination risk for operators performing semi-closed HIPEC procedure using cisplatin[J].Eur J Surg Oncol,2014,40(8):925-929.
[23] 林一然,梅小红,黄小红,等.诱导耦合等离子体质谱法测定职业环境中的铂基抗癌药物[J].中华劳动卫生与职业病杂志,2022, 40(12):950-951.
[24] 梅小红,张艳芳,林怡然,等.医护人员职业接触抗肿瘤药物的环境暴露评估[J].中国预防医学杂志,2022,23(11):845-850.
[25] VALERO-GARCIA S,GONZALEZ-HABA E,GORGAS-TORNER M Q,et al.Monitoring contamination of hazardous drug compounding surfaces at hospital pharmacy departments.A consensus Statement.Practice guidelines of the spanish society of hospital pharmacists(SEFH)[J].Farmacia Hospitalaria:Organo Oficial de Expresion Cientifica de la Sociedad Espanola de Farmacia Hospitalaria,2021,45(2):96-107.
[26] SMITH J P,SAMMONS D,ROBERTSON S,et al.Field evaluation of onsite near real-time monitors for surface contamination by 5-fluorouracil[J].J Oncol Pharm Pract,2019,25(5):1152-1159.
[27] KOLLER M,BOHLANDT A,HABERL C,et al.Environmental and biological monitoring on an oncology ward during a complete working week[J].Toxicol Lett,2018,298:158-163.
[28] 尹红梅. 某医院静脉用药调配中心工作人员抗肿瘤药物职业暴露评估研究[J].中国当代医药,2020,27(18):179-182.
[29] KARAMIi F,RANJBAR S,GHASEMI Y,et al.Analytical methodologies for determination of methotrexate and its metabolites in pharmaceutical,biological and environmental samples[J].J Pharm Anal,2019, 9(6):373-391.
[30] CHAN E S,CRONSTEIN B N.Methotrexate--how does it really work?[J].Nat Rev Rheumatol,2010,6(3):175-178.
[31] JERONIMO M,COLOMBO M,ASTRAKIANAKIS G,et al.A surface wipe sampling and LC-MS/MS method for the simultaneous detection of six antineoplastic drugs commonly handled by healthcare workers[J].Anal Bioanal Chem,2015,407(23):7083-7092.
[32] ASTRAKIANAKIS G,JERONIMO M,GRIFFITHS A,et al.The application of novel field measurement and field evaluation protocols for assessing health care workers' exposure risk to antineoplastic drugs[J].J Occup Environ Hyg,2020,17(9):373-382.
[33] PALAMINI M,GAGNE S,CARON N,et al.Cross-sectional evaluation of surface contamination with 9 antineoplastic drugs in 93 Canadian healthcare centers:2019 results[J].J Oncol Pharm Pract,2020,26(8):1921-1930.
[34] SAINT-LORANT G,VASSEUR M,ALLORGE D,et al,Odou P.Four-year follow-up of surface contamination by antineoplastic drugs in a compounding unit[J].Occup Environ Med,2023,80(3):146-153.
[35] MARTIN S,BEACH L.The adverse health effects of occupational exposure to hazardous drugs[J].Community Oncol,2005,5(2):397-400.
[36] VLANIS B G,VOLLMER W M,LABUHN K T,et al.Acute symptoms associated with antineoplastic drug handling among nurses[J].Cancer Nurs,1993,16(4):288-295.
[37] CALLAHAN A,AMES N J,MAINNING M L,et al.Factors Influencing Nurses' Use of Hazardous Drug Safe-Handling Precautions[J].OncolNurs Forum,2016,43(3):342-349.
[38] MOMENI M,ASKARIAN M,AZAD H,et al.Exposure to cytotoxic drugs threatens the health of staff in oncology wards[J].Russ Open Med J,2021,10(3):318.
[39] 郝梦琳,边原,朱九群,等.四川省医务人员抗肿瘤药职业暴露调查分析[J].中国药房,2020,31(8):1009-1014.
[40] 王凤,陈曾曾,闫永建.职业接触抗肿瘤药物对国内医务人员健康影响研究现状[J].中国职业医学,2016,43(5):615-617.
[41] PARK C.Reproductive toxic agents in work environments and related cases in Korea[J].Yeungnam Univ J Med,2020,37(1):22-31.
[42] SELEVAN S G,LINDBOHM M L,HORNUNG R W,et al.A study of occupational exposure to antineoplastic drugs and fetal loss in nurses[J].N Engl J Med,1985,313(19):1173-1178.
[43] NASSAN F L,CHAVARRO J E,JOHNSON C Y,et al.Prepregnancy handling of antineoplastic drugs and risk of miscarriage in female nurses[J].Ann Epidemiol,2021,53:95-102.e2.
[44] 江会. 西安市9所三甲医院护理人员抗肿瘤药物职业防护的流行病学研究[D].西安:第四军医大学,2006.
[45] 吴小燕,湛亚,文晓柯.湖南省育龄妇女生殖毒性药物合理使用调查分析[J].中国医药导刊,2021,23(8):598-602.
[46] 朱蕙,左瑶,高志彬,等.职业接触抗癌药遗传毒性损伤的Meta分析[J].公共卫生与预防医学,2017,28(4):87-89.
[47] GIANFREDI V,NUCCI D,FATIGONI C,et al.Extent of Primary DNA damage measured by the comet assay in health professionals exposed to antineoplastic drugs:A systematic review and meta-analysis[J].Int J Environ Res Public Health,2020,17(2):523.
[48] HUANG X H,GAO C X,CAI W Z,et al.Effect of occupational exposure to antineoplastic drugs on DNA damage in nurses:A cross-sectional study[J].Occup Environ Med,2022,79(4):253-258.
[49] 金力奋,何继亮,张美辩.抗肿瘤药接触对护士的遗传损伤[J].环境与健康杂志,2003,20(1):21-22,49.
[50] 何璇,王晓,戴惠珍,等.2018—2020年南京地区新型抗肿瘤药物利用分析[J].中国药物警戒,2021,18(8):725-730.
[51] 藕顺龙,罗静,王松,等.历年《新型抗肿瘤药物临床应用指导原则》概况与变迁[J].中国药房,2022,33(11):1392-1396.
[52] 刘家伟,孔维华,董子询,等.2021年《新型抗肿瘤药物临床应用指导原则》解读与思考[J].临床药物治疗杂志,2022,20(3):1-5.