直肠癌经腹前切除手术中体位改变对血流动力学的影响  

Influence of position change on hemodynamics of patients in anterior resection of rectal cancer surgery

作　　者：孙萍 刘俊如 张宇星 汪俊芳 李宏军 王领 严爱龙 陈继贵 

机构地区：[1]武汉市第八医院手术室,430010 [2]武汉市第八医院肛肠外科,430010 [3]武汉市第八医院麻醉科,430010 [4]武汉市第八医院护理部,430010

出　　处：《中华护理杂志》2011年第5期480-482,共3页Chinese Journal of Nursing

基　　金：武汉市科技局创新体系与环境建设基金资助项目(编号:2006003108-04);武汉市科技局发展引导类计划项目(编号:200860923435)

摘　　要：目的探讨直肠癌经腹前切除术(Dixon)患者采用单、双侧下肢截石位时体位变换对患者血流动力学的影响。方法 2009年1月至2010年4月在我院行直肠癌经腹前切除术的手术患者32例,随机分为试验组和对照组。试验组采用一侧下肢抬高、另一侧下肢平放的单侧下肢截石位;对照组采用双下肢均抬高的改良截石位。分别记录两组在手术前后不同体位、不同时段收缩压、舒张压、平均动脉压、心率、中心静脉压,对两组数据进行重复测量资料的方差分析。结果两组测量指标均有随时间变化趋势,随时间变化的差异有统计学意义,组间差异无统计学意义。时间因素与分组的交互作用检验结果显示,心率和舒张压两项的差异无统计学意义,组间与时间因素的交互作用对收缩压、平均动脉压、中心静脉压的影响有统计学意义,试验组收缩压、平均动脉压、中心静脉压变化较对照组变化平缓。结论直肠癌经腹腔前切除术应用单侧下肢截石位可减轻患者血压、中心静脉压的波动程度,对患者的血流动力学影响较小。Objective To investigate the hemodynamics influence of position change,lithotomy position with left side leg extended vs.lithotomy position,in anterior resection of rectal cancer surgery.Methods Thirty-two patients who underwent anterior resection of rectal cancer were randomly assigned to two groups taking different positions in the surgery： lithotomy position with left side leg extended vs.lithotomy position.The systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,heart rate（HR）,and central venous pressure（CVP） were recorded before and after surgery when the patient was changed from supine to lithotomy position or reverse.Results Repeated measures ANOVA showed a significant main effect of time and interaction between time and group,while no significant main effect of group.Simple effect analysis showed that the fluctuations of SBP,MAP and CVP were milder in patients taking lithotomy position with left side leg extended than those in patients taking lithotomy position.Conclusion Application of lithotomy position with left side leg extended in anterior resection of rectal cancer surgery can smooth the fluctuations of blood pressure and central venous pressure,and has less influence on hemodynamics.

关 键 词：直肠肿瘤 结直肠外科手术 体位 血流动力学 

分 类 号：R735.37[医药卫生—肿瘤]