摘要
目的探讨不同体位对腹腔镜手术患者呼吸循环功能及术后不适症状发生的影响。方法选择腹腔镜手术不同体位患者120例，其中术中头高足低位组、头低足高位组、侧卧位组患者各40例。监测手术开始气腹前5min（T1）、气腹后10min（T2）及关闭气腹后5min（T3），患者心率（HR）、收缩压（SBP）、舒张压（DBP）、血氧饱和度（SpO2）、呼吸末二氧化碳分压（PETCO2）及气道峰压（Ppeak）各参数值的变化。术后随访患者不适症状的发生率。结果3组患者术中不同时间的SBP和DBP水平差异均有统计学意义（SBP：F值分别为40．39，31．03，19．03；DBP：F值分别为33．44，17．86，11．79；P均〈0．01）。T2时间的SBP和DBP水平均高于T1时间，差异有统计学意义（P〈0．01），L时间的SBP和DBP水平均低于T2时间，差异有统计学意义（P〈0．01）。3组患者T：和T3时间HR的变化均比T1时间增加，但差异无统计学意义（P〉0．05）。SpO：的前后3次测量值变化较小，差异无统计学意义（P〉0．05）。头高足低位组患者T2时间P础水平高于T1时间；T3时间Ppeak吐水平高于T2时间，差异有统计学意义（P〈0．01）；头低足高位组患者T2、L时间P谳水平均高于T1时间，差异有统计学意义（P〈0．01）。3组患者T2、T3时间PET，CO2水平均高于T1时间，差异有统计学意义（P〈0．01）。侧卧位组患者不同时间的Ppak水平差异无统计学意义（P〉0．05）。3组不同手术体位患者气腹前后各指标变化差值，组间比较差异均无统计学意义（P〉0．05）。术后头高足低位、头低足高位、侧卧位3组不适症状发生率分别为15．0％，42．5％，15．0％，头低足高位组患者术后肩部不适症状的发生率明显高于其他两组，差异有统计学意义（x2=17．1，P〈0．01）。结论腹腔镜手术不同体位和气腹压力对患者的呼吸及循环功能均有影响，不同手术体位对患者术后不适症状的发生有影响。
Objective To investigate the effect of different laparoscopic surgical positions on respiratory and circulatory functions, and postoperative symptoms of patients. Methods Totals of 120 consecutive cases with different laparoscopic surgery positions were included and were divided into three groups with 40 cases each group ： reverse trendelenhurg position group, trendelenhurg position group, and were lateral position group. Heart rate ,blood pressure, oxygen saturation, end-tidal carbon dioxide partial pressure, and peak airway pressure （ Preak ） were collected at three time points ： 5 rains before the start of surgery pneumoperitoneum （T1 ）, 10 mins after pneumoperitoneum （T2 ） and 5 rains after the end of pneumoperitoneum （ T3 ）. Postoperative symptoms were recorded as following up. Results In three groups, respectively, the differences in systolic blood pressure, diastolic blood pressure and respiratory carbon dioxide partial pressure （PEr CO2 ） were statistically significant （P 〈 0.05 ）. The blood pressure of T3 was significantly lower than that of T2 （P 〈 0.01 ）. The level of SBP and DBP of were significantly higher than that of T3 and T1 （P 〈 0.01 ）. No significant difference was detected in the heart rate change, and SpO2 of T2, T3 and Tt （P 〉 0.05 ）. In reverse trendelenburg position group,the level of Ppeak of T2 was significantly higher than that of Tt ,while lower than that of T3 （P 〈0.01 ）. In trendelenburg position group, the levels of Ppeak of T2 and T3 were significantly higher than that of Tl （ P 〈 0. 01 ）. No significant difference was found in the levels of Ppeak of lateral position group （ P 〉 0.05 ）. And no significant difference was found in the incidence of abdominal discomfort symptoms between three groups （ P 〉 0.05 ）. The incidence of discomfortable symptoms of reverse trendelenburg position group, trendelenburg position group and lateral position group, respectively was 15.0%, 42.5%, 15.0%, and the incidence of shoulder pain after surgery of trendelenburg position group was significantly higher than that of other groups （P 〈 0. 01 ）. Conclusions Pneumoperitoneum pressure and different positions can affect both the respiratory and circulation function of patients that undergoing laparoscopic surgery. And positions may affect the incidence of postoperative shoulder pain.
出处
《中华现代护理杂志》
2012年第28期3356-3360,共5页
Chinese Journal of Modern Nursing
关键词
腹腔镜
手术体位
呼吸循环功能
影响因素
Laparoscopy
Surgical position
Respiratory and circulatory functions
Influencing factor
