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目的 探讨护士职业接触抗癌药及其接触水平与不良生殖结局的关系。方法 对北京、天津、包头 2 4所医院 873名护士 10 2 1次妊娠情况进行了回顾性群组研究 ,接触组 (35 0名 ,433次妊娠 )孕前及孕期有明确抗癌药接触史 ,对照组 (5 2 3名 ,5 88次妊娠 )孕期及孕前均不接触抗癌药。应用暴露指数评估护士接触抗癌药的水平。结果 接触组自然流产率 (14.1% )、先天畸形率 (2 .82 % )及妊娠剧吐发生率 (18.9% )、妊娠贫血发生率 (10 .2 % )高于对照组 (分别为 8.3%、0 .76 %、12 .7%、5 .6 % ) ,差异有显著性 (P <0 .0 5 )。经Logistic回归分析 ,调整年龄、吸烟、饮酒等混杂因素后显示 ,接触抗癌药自然流产 (OR =2 .2 9,95 %CI=1.46～ 3.5 9)、先天畸形 (OR =3.6 3,95 %CI=1.0 7～ 12 .36 )及妊娠贫血 (OR =1.77,95 %CI=1.0 3～ 3.0 5 )的危险显著增加 (P <0 .0 1,P <0 .0 5 )。护士职业接触抗癌药的接触水平 -反应关系的趋势 χ2 检验 ,自然流产及先天畸形均随抗癌药接触水平的增加有增高的趋势 ,其 χ2 值分别为 3.86和 14.6 2 (P <0 .0 5 ,P <0 .0 0 1)。结论 护士职业接触抗癌药可导致妊娠并发症 (妊娠剧吐、妊娠贫血 )及不良妊娠结局 (自然流产、先天畸形 )的危险增加 ,其不良妊娠结局随抗癌药接触水平
Objective To explore the relationship between occupational exposure to anticancer drugs and their exposure level to adverse reproductive outcomes in nurses. Methods A retrospective cohort study was conducted on 1021 pregnancies among 873 nurses in 24 hospitals in Beijing, Tianjin and Baotou. The contact group (35 0 and 433 pregnancies) had a clear history of anticancer drug exposure before and during pregnancy, Control group (523, 5 88 pregnancies) were not exposed to anticancer drugs during pregnancy and before pregnancy. Application of exposure index to assess nurse exposure to anticancer drugs. Results The spontaneous abortion rate (14.1%), congenital malformation rate (2.82%) and the incidence of hyperemesis gravidarum (18.9%) in the exposure group were significantly higher than those in the control group (8.3% , 0 .76%, 12.7%, 5.6%), the difference was significant (P <0.05). Logistic regression analysis showed that the incidence of spontaneous abortion (OR = 2.29, 95% CI = 1.46 ~ 3.59), congenital malformation (OR = 3.6 3,95 % CI = 1.07 ~ 12.36) and anemia of pregnancy (OR = 1.77, 95% CI = 1.03 ~ 3.05) were significantly increased (P <0.01, P <0.05). Exposure to anticancer drug exposure in nurses - the trend of the response relationship The χ2 test, spontaneous abortion and congenital malformations tended to increase with increasing exposure to anticancer drugs, with χ2 values of 3.86 and 14.62, respectively (P <0. 0 5, P <0. 0 0 1). Conclusion Nurses’ occupational exposure to anticancer drugs may lead to an increased risk of complications of pregnancy (hyperemesis gravidarum, anemia of pregnancy) and unfavorable pregnancy outcomes (spontaneous abortion, congenital malformations), with adverse pregnancy outcomes associated with exposure to anticancer drugs