腰椎手术中体位变化对不同体重指数患者中心静脉压的影响  

Effects of postural changes on central venous pressure in patients with different body mass index during lumbar spine surgery

作　　者：倪丽亚[1] 常永青[1] 马宇[1] 

机构地区：[1]第二军医大学附属长海医院麻醉科

出　　处：《临床外科杂志》2015年第8期616-618,共3页Journal of Clinical Surgery

摘　　要：目的观察腰椎手术中仰卧位、俯卧位对不同体重指数患者中心静脉压的影响，为手术中输液提供指导。方法腰椎手术患者48例，根据体重指数（body mass index，BMI）将48例患者分成正常体重组（N组）[BMI为（18．5—24．9）kg／m2]和超重组（O组）（BMI〉25．0kg／m2）。每组根据手术床不同分为Jackson手术床组和普通手术床加腰桥组，ASAⅠ～Ⅱ级。观察并记录麻醉诱导后仰卧位、俯卧位10分钟各时间点中心静脉压（central venous pressure，CVP）。采用容量控制机械通气模式，无呼气末正压。结果仰卧位，正常体重组与超重组间CVP比较，差异无统计学意义（P〉0．05），俯卧位两组间比较差异有统计学意义（P〈0．05）。各组组内仰卧位、俯卧位CVP比较，差异有统计学意义（P〈0．01）。结论俯卧位与仰卧位相比较，超重组CVP变化更明显，其中Jackson手术床组俯卧位下CVP降低，超重组下降更明显，普通手术床加腰桥组俯卧位下CVP增高，超重组升高更明显。Objective To observe the effects of supine or prone position on central venous pressure in patients with different body mass index（BMI） during lumbar spine surgery and provide guidance for intraoperative infusion. Methods A total of 48 cases of lumbar spine surgery were selected. According to the BMI,patients were randomly divided into the Group N（ BMI = 18.5-24.9 kg/m2） and Group O （ BMI 〉 25.0 kg/m2 ）. According to different operating tables, each group was divided into two sub- groups：the group with common operating table plus waist bridge and the group with Jackson operating table. After anesthesia induction,the patients（ ASA Ⅰ -Ⅱ grade）were placed in supine or prone for ten minutes and the central venous pressure（CVP） was observed and recorded. Volume controlled ventilation was used without PEEP. Results In the supine position, there was significant difference in CVP between Group N and O（P 〉 0.05 ）. In the prone position,the differences in CVP were significant between Group N and O （ P 〈 0.05 ）. The differences in CVP between different position were significant （ P 〈 0.01 ）. Conclusion After the comparison of prone position and supine position, the CVP obviously changed in the overweight group. Jackson operating table had a reduced CVP in prone position and overweight patients had a lower level of CVP. Ordinary operating table plus waist bridge had an increased CVP, overweight patients had a higher level of CVP.

关 键 词：体重指数 中心静脉压 俯卧位 腰椎手术 Jackson手术床 

分 类 号：R687.3[医药卫生—骨科学]