摘要
目的观察并探讨改进头低足高“人字形”卧位在腹腔镜直肠癌前切除术中的应用效果。方法选取全麻下择期行腹腔镜直肠癌前切除术的患者108例，依据人院顺序采用随机数字表法分为观察组和对照组各54例。观察组采用改进头低足高“人字形”卧位，对照组采用常规的头低足高截石位。分别记录2组患者麻醉诱导后体位安置前3min、安置后3min的心率和平均动脉压并计算差值、恢复平卧位前3min、恢复平卧位后3min的心率和平均动脉压并计算差值；于麻醉诱导后体位安置前3min（T0）、气腹并头低足高位后3min（T1）、60min（T2）、120min（T3）、恢复水平卧位前3min（T4）、气腹解除恢复平卧位后3min（T5）、30min（T6）测量眼内压并记录；调查手术医生对于2种体位的满意度，并于术后24h、48h对患者进行随防，调查并记录患者肩部疼痛情况和下肢疼痛麻木情况。结果观察组体位摆放前后及体位恢复前后的心率差值分别为（2．11±0．92）、（-2．78±1．01）次／min，对照组分别为（5．98±2．98）、（-6．03±1．98）次/min，差异有统计学意义（t=9．111、-9．851，均P〈0．01）。观察组体位摆放前后及体位恢复前后的平均动脉压差值分别为（1．67±1．23）、（2．21±0．89）mmHg（1mmHg=0．133kPa），对照组分别为（7．20±2．30）、（6．41±1．87）mmHg，差异有统计学意义（t=15．512、14．811，P〈0．01）。在T0、T6两个时间点，2组患者眼压值比较差异无统计学意义（均P〉0．05），T1-T5的每个时间点观察组的平均眼压值分别为（13．64±1．66）、（16．56±1．82）、（19．78±1．70）、（21．00±1．71）、（18．53±1．77）mmHg，均低于对照组的（15．59±2．03）、（19．40±1．89）、（23．22±2．15）、（25．38±2．09）、（22．35±1．76）mmHg，差异有统计学意义（t=5．442-11．907，均P〈0．01）。各时间点差值2组比较有统计学意义（t=-3．461-13．449，均P〈0．01）。观察组肩部疼痛发生率及下肢疼痛发生率分别为9．26％（5／54）、7．41％（4／54），低于对照组的46．29％（25／54）、31．48％（17／54），差异有统计学意义（χ^2=17．778、9．755，P〈0.01）；观察组肩部疼痛及下肢疼痛评分分别为（1．38±0．38）、（2．02±0．34）分，低于对照组的（4．44±0．48）、（3．85±0．57）分，差异有统计学意义（t=36．761、20．162，P〈0．01）。手术医生对观察组体位的满意率为87．04％（47／54），高于对照组的55．56％（30／54），差异有统计学意义（r=5．119，P=0．024）。结论在满足手术暴露需要的基础上，改进“人字形”头低足高位较头低足高截石位能更好地维持心率血压稳定，有效减少患者术中眼压值的升高，减少了术后下肢和肩部疼痛的发生率，能提高手术患者的体位舒适度，有利于患者的手术安全。
Objective To explore the effects of modified herringbone-Trendelenburg position in the laparoscopic anterior resection for rectal cancer patients. Methods A total of 108 patients undergoing laparoscopic anterior resection were recruited and randomly assigned to observation group（54 cases） and control group （54 cases）. Patients in the observation group were positioned in modified herringbone-Trendelenburg position, while the patients in the control group were placed in conventional Trendelenburg position. The data of heart rate （HR）, mean arterial pressure （MAP） were recorded at 3 minutes before body position change and 3 minutes after body position change, 3 minutes before recover horizontal position and 3 minutes after recover horizontal position. Intraocular pressure （IOP） were measured at 3 minutes after general anesthesia in supine position （T0）, and 3 minutes after pneumoperitoneum while in the operation position （T1）, every 1 hour （T2 to T3）, 3 minutes before recover horizontal position at the end of pneumoperitoneum （T4）, 3 minutes after recover horizontal position （T5） and 30 minutes after recover horizontal position（T6）. Investigate the satisfaction of the surgeons regarding the surgical position of the patients.Followed up investigation at 24h and 48h after surgery were enforced to record the situation of the nain in the shoulder and postoperative complications of the lower limbs.Results The heart rate pre-and post the change of body position in observation group were （2.11±0.92）, （-2.78±1.01） beats/min respectively, while the control group were （5.98±2.98）, （-6.03±1.98） beats/min, the differences were statically significant （t=9.111,9.851, P 〈 0.01）.The mean arterial pressure pre-and post the change of body position in observation group were （1.67±1.23）, （2.21±0.89） mmHg（lmmHg= 0.133kPa） respectively, while the control group were （7.20±2.30）, （6.41±1.87）mmHg, the differences were statically significant（t=15.512, 14.811, P〈0.01）.The differences of intra-ocular pressure between 2 groups had no statistical significance at T0 and T6 （P 〉 0.05）. The intra-ocular pressure were （13.64±1.66）, （16.56±1.82）,（19.78±1.70）,（21.00±1.71）,（18.53±1.77）mmHg respectively from T1 to T5, lower than that of control group （15.59±2.03）,（19.40±1.89）, （23.22±2.15）, （25.38±2.09）, （22.35±1.76）mmHg, the differences were statically significant （t=5.442-11.907, P 〈 0.01）.The incidence of shoulder pain and low leg pain in observation group were 9.26% （5/54）, 7.41% （4/54） respectively, lower than that of control group 46.29% （25/54）,31.48%（17/54）, the differences were statically significant （t=1.7.778,9.755 ,P 〈 0.01）. The scores of shoulder pain and low leg pain in observation group were （1.38±0.38）, （2.02±0.34） points, lower than that of control group （4.44±0.48）, （3.85 ±0.57） points, the differences were statically significant （t=36.761, 20.162, P 〈 0.01）. The satisfaction rate of surgeons was 87.04% （47/54） in the observation group, higher than that in the control group 55.56% （30/54）, the difference was statically significant （X^2=5.119, P= 0.024）. Conclusion Modified herringbone-Trendelenburg position can maintain the circulatory system stability better without affecting the operation, reduce the elevation of lOP, effectively improve the comfort of the operation position of the patients,reduce the postoperative complications of the lower limbs and the incidence rate of the shoulder pain in the laparoseopie anterior resection for rectal cancer patients.
作者
柏艳芳
李凤姣
周怡
刘艳玲
Bai Yanfang;Li Fengliao;Zhou Yi;Liu Yanling(Department of Operating Room,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)
出处
《中国实用护理杂志》
2018年第29期2286-2291,共6页
Chinese Journal of Practical Nursing
基金
广东省医学科研基金立项课题（A2014249）
