改良“Z字形”屈氏位对腹腔镜子宫内膜癌根治术患者血流动力学的影响  

Hemodynamic effect of the modified Z Trendelenburg position in patients undergoing laparoscopic radical surgery of endometrial carcinoma

作　　者：胡皓琳[1] 邱云[1] Hu Haolin;Qiu Yun(Department of Operating Room,the Central Hospital of Xiangyang,Xiangyang 441021,China)

机构地区：[1]湖北省襄阳市中心医院手术室,441021

出　　处：《中国实用护理杂志》2021年第7期511-516,共6页Chinese Journal of Practical Nursing

摘　　要：目的探讨改良"Z字形"屈氏位对腹腔镜子宫内膜癌根治术患者血流动力学的影响,为患者手术体位的选择提供参考。方法选取2017年4月至2019年4月在湖北省襄阳市中心医院行腹腔镜子宫内膜癌根治术的患者80例,按照随机数字表法分为试验组和对照组,每组40例。对照组采用常规头低足高截石位,试验组采用改良"Z字形"屈氏位。分别记录2组患者气腹前10 min(T_(0))、气腹即刻(T_(1))、气腹后5 min(T_(2))、气腹后10 min(T_(3))、气腹后30 min(T_(4))、气腹后60 min(T_(5))、恢复水平体位后1 min(T_(6))的心率、平均动脉压、中心静脉压、体循环阻力和心排出量,并于术后24 h对患者进行随访,采用视觉模拟量表(VAS)评价肩部和下肢疼痛程度。结果T_(0)~T_(6)时,2组患者心率、平均动脉压、体循环阻力和心排出量差异无统计学意义(均P>0.05)。T_(2)~T_(6)的每个时间点试验组的中心静脉压分别为(9.86±1.95)、(10.94±1.53)、(11.33±2.24)、(11.14±1.54)、(7.75±1.59)cmH_(2)O(1 cmH_(2)O=0.098 kPa),均低于对照组的(18.83±2.82)、(16.81±2.93)、(16.27±3.56)、(15.76±2.33)、(8.92±1.68)cmH_(2)O,差异有统计学意义(t值为3.057~15.736,均P<0.05)。试验组肩部疼痛和下肢疼痛VAS评分分别为(3.48±1.10)、(2.35±0.66)分,低于对照组的(4.16±1.32)、(2.99±1.02)分,差异有统计学意义(t值为2.404、3.228,P<0.05)。结论改良"Z字形"屈氏位能有效减少腹腔镜子宫内膜癌根治术患者术中血流动力学的波动幅度,降低术后下肢和肩部疼痛发生率,有利于患者手术安全。Objective To explore the hemodynamic effect of the modified Z Trendelenburg position in patients undergoing laparoscopic radical surgery of endometrial carcinoma,to provide a reference for the selection of the operative position of patients.Methods A total of 80 patients who undergoing laparoscopic radical surgery of endometrial carcinoma from April 2017 to April 2019 in the Central Hospital of Xiangyang were recruited and assigned to experiment group and control group by random digits table method with 40 cases in each group.Patients in the experiment group were positioned in modified Z Trendelenburg position,while the patients in the control group were placed in conventional Trendelenburg position.The data of heart rate,mean arterial pressure,central venous pressure,systemic circulation resistance,cardiac output were recorded at 10 minutes before pneumoperitoneum(T_(0)),pneumoperitoneum immediately(T_(1))and 5 minutes(T_(2)),10 minutes(T_(3)),30 minutes(T_(4)),60 minutes(T_(5))after pneumoperitoneum and 1 minute after recover horizontal position(T_(6)).Followed up investigation at 24 h after surgery,the degree of pain in the shoulder and the lower limbs were also recorded by Visual Analogue Scale(VAS).Results The differences of heart rate,mean arterial pressure,systemic circulation resistance and cardiac output between the two groups had no statistical significance at T_(0)to T_(6)(all P>0.05).The central venous pressure were(9.86±1.95),(10.94±1.53),(11.33±2.24),(11.14±1.54),(7.75±1.59)cmH_(2)O(1 cmH_(2)O=0.098 kPa)respectively from T_(2)to T_(6)in the experiment group,lower than that of control group(18.83±2.82),(16.81±2.93),(16.27±3.56),(15.76±2.33),(8.92±1.68)cmH_(2)O at the same time,the differences were statically significant(t values were 3.057-15.736,all P<0.05).The VAS scores of shoulder pain and low leg pain in experiment group were(3.48±1.10),(2.35±0.66)points,lower than that of control group(4.16±1.32),(2.99±1.02)points,the differences were statically significant(t values were 2.404,3.2

关 键 词：腹腔镜手术 子宫内膜癌 屈氏体位 血流动力学 

分 类 号：R473.73[医药卫生—护理学]