朱萍 刘建芳 裘巧燕 沈敏

[摘要] 目的 研究中醫拔罐罐具的污染状况，分析不同皮肤状态下干式拔罐感染风险，并采用目测法进行效度分析，为进一步健全干罐临床应用制订、选择安全有效的消毒方法提供依据。 方法 随机选取我院中医诊疗室2018年10-11月90例患者完整皮肤拔罐后的罐具及罐斑皮肤各600份及痘、疖皮肤表面拔罐后罐具及罐斑皮肤60份，分别采用试纸法及胶体金法进行残留血测定，并对目测法与残留血测定结果进行比较。 结果 皮肤完整组拔罐后残留血阳性5份，为拔罐后出现水泡破损患者，阳性率为0.83%;痘、疖皮肤组拔罐后，残留血监测阳性36份，阳性率为60.00%，两组阳性率比较，差异有统计学意义（χ2=297.940，P<0.05）。皮肤完整组目测法和残留血测定评估结果一致。痘、疖皮肤组拔罐后，目测法阳性率为33.33%，残留血检测阳性率为60.00%，差异有统计学意义（χ2=11.380，P<0.05）。 结论 干式拔罐后出现水泡皮肤破损，感染风险最高;其次为痘、疖皮肤组。干式拔罐可通过不同皮肤状况评估结合目测法进行判断，以评估其感染风险并选择正确的消毒方法，保障中医诊疗安全。

[关键词] 中医拔罐;感染风险;目测法;效度分析

[中图分类号] R244          [文献标识码] B          [文章编号] 1673-9701（2021）06-0167-04

Infection risk analysis of traditional Chinese medicine cupping equipment under different skin conditions and the validity analysis of the visual inspection method on the infection risk of cupping equipment

ZHU Ping1   LIU Jianfang2   QIU Qiaoyan1   SHEN Min1

1.Department of Infection Management，the Second Affiliated Hospital of Zhejiang Chinese Medicine University，Hangzhou   310005， China; 2.Department of Nutrition，the Third Affiliated Hospital of Zhejiang Chinese Medicine University， Hangzhou   330106，China

[Abstract] Objective To study the contamination status of Chinese medicine cupping equipment， analyze the risk of dry cupping infection under different skin conditions， and use the visual method for validity analysis to provide a basis for further improving the clinical application of dry cupping and selecting safe and effective disinfection methods. Methods A total of 600 samples of cupping equipment and cupping scar skin were taken from 90 patients with intact skin cupping， and 60 samples of cupping equipment and cupping scar skin from acne and boil skin after cupping on the skin surface in our hospital′s Chinese medicine clinic from October to November 2018 were selected. The test paper method and the colloidal gold method were used to determine the residual blood. The results of the visual method and the residual blood measurement were compared. Results There were 5 cases of positive residual blood after cupping in the skin intact group， who were patients with blister breakage after cupping， and the positive rate was 0.83%. After cupping in the acne and furuncle skin group， the residual blood was positive in 36 cases， with a positive rate of 60.00%. There was signicant difference of the positive rate between the two groups （χ2=297.940， P<0.05）. The results of the visual inspection of the skin intact group were consistent with residual blood determination. After cupping in the acne furuncle skin group， the positive rate of the visual inspection was 33.33%， and the positive rate of residual blood detection was 60.00%. The difference between the two was statistically significant（χ2=11.380， P<0.05）. Conclusion The blisters and skin breakage after dry cupping have the highest risk of infection， followed by the acne and furuncle skin group. Dry cupping can be judged by evaluating different skin conditions combined with visual inspection to assess the risk of infection and choose the correct disinfection method， and to ensure the safety of Chinese medicine diagnosis and treatment.

[Key words] Chinese medicine cupping; Risk of infection; Visual inspection method; Validity analysis

拔罐疗法是以罐为工具，利用燃烧、抽吸等方法排除罐内空气，造成负压，使罐吸附于体表特定部位（患处、穴位），通过物理的刺激，形成局部充血或瘀血现象，从而达到防病治病、强壮身体为目的的一种治疗方法[1-3]。拔罐历史悠久，因其简便易学、疗效显著、适应证广，日益受到人们的重视和欢迎，在临床广泛应用[4-6]。但受传统中医思想的影响，人们一直以来对于中医拔罐技术感染风险重视不够，消毒意识淡漠，国内外学者对于罐具的感染风险评估研究极少[7]，薛世萍等[8]、钱海东等[9]认为罐具主要接触完整皮肤，为低度危险物品;而Nielsen等[10]、蒋景华等[11]则认为拔罐会造成皮下微小毛细血管破裂，有可能有肉眼不可见的血液外渗到皮肤导致感染风险，因此将其认定为中度危险物品。……