个性化颈过伸体位对甲状腺切除术后体位综合征、循环呼吸功能及椎动脉血流动力学的影响  

Effects of Personalized Cervical Hyperextension Position on Postthyroidectomy Postural Syndrome,Circulatory and Respiratory Function and Vertebral Artery Hemodynamics

作　　者：刘佳 刘亚婷 LIU Jia;LIU Ya-ting(The Second Department of Surgery,Xuchang Hospital of Traditional Chinese Medicine,Xuchang 461000,China)

机构地区：[1]许昌市中医院外二科,河南许昌461000

出　　处：《实用临床医学（江西）》2022年第1期83-86,共4页Practical Clinical Medicine

摘　　要：目的探讨个性化颈过伸体位对甲状腺切除术后体位综合征、循环呼吸功能及椎动脉血流动力学的影响。方法选取许昌市中医院2018年7月至2020年7月收治的拟行甲状腺切除术患者109例,按随机数字表法分为2组:对照组54例予以常规手术体位,观察组55例予以个性化颈过伸体位。比较2组术后体位综合征(头、颈、背、肩部疼痛及恶心呕吐)发生率、体位改变前[气管插管后气腹前(T0)]后[体位改变后15 min(T1)]循环呼吸功能[心率(HR)、收缩压(SBP)、舒张压(DBP)、气道峰压(Ppeak)、呼吸末二氧化碳(P_(ET)CO_(2))]及椎动脉血流动力学[左右两侧血流量(Fv)、平均血流速度(Vm)、血流量变化(△Fv)和平均血流速度变化(△Vm)]。结果与对照组比较,观察组术后头、颈、背、肩部疼痛及恶心呕吐发生率均显著降低,差异有统计学意义(均P<0.05);与T0时比较,2组T1时HR、SBP、DBP、Ppeak、P_(ET)CO_(2)水平显著升高,且观察组升高幅度明显低于对照组;与T0时比较,2组T1时SpO_(2)水平显著降低,且观察组降低幅度明显低于对照组,差异有统计学意义(均P<0.05);与对照组比较,观察组术后左右两侧△Fv、△Vm水平均显著降低,差异有统计学意义(P<0.0001)。结论个性化颈过伸体位可改善甲状腺切除术患者的循环呼吸相关指标,调节椎动脉血流动力学水平,降低体位综合征的发生率。Objective To investigate the effects of individualized cervical hyperextension position on postthyroidectomy postural syndrome,circulatory and respiratory function and vertebral artery hemodynamics.Methods A total of 109 patients admitted to Xuchang Hospital of Traditional Chinese Medicine from July 2018 to July 2020 were randomly treated with thyroidectomy in either conventional surgical position(control group,54 cases)or individualized cervical hyperextension position(observation group,55 cases).The incidence of postural syndrome(head,neck,back and shoulder pain,nausea,and vomiting)was compared between the two groups.In addition,heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),peak airway pressure(Ppeak),end-tidal carbon dioxide tension(P_(ET)CO_(2)),left and right blood flow(Fv),mean blood flow velocity(Vm),change in blood flow(△Fv),and change in mean blood flow velocity(△Vm)were measured before position change(after endotracheal intubation and before pneumoperitoneum,T0)and 15 minutes after position change(T1).Results Compared with the control group,the incidence of postoperative head,neck,back and shoulder pain,nausea and vomiting and bilateral△Fv and△Vm markedly declined in the observation group(P<0.05 or P<0.0001).Compared with T0,the HR,SBP,DBP,Ppeak and P_(ET)CO_(2) increased and SpO_(2) decreased at T1 in both groups,and the changes in the observation group were more significant than those in the control group(P<0.05).Conclusion Personalized cervical hyperextension position can improve respiratory and circulatory parameters,regulate vertebral artery hemodynamics,and reduce the incidence of postural syndrome in patients undergoing thyroidectomy.

关 键 词：个性化颈过伸体位 甲状腺切除 循环呼吸功能 

分 类 号：R653[医药卫生—外科学]