中华现代护理杂志
中華現代護理雜誌
중화현대호리잡지
CHINESE JOURNAL OF MODERN NURSING
2014年
4期
471-474
,共4页
胃肿瘤%腹腔镜%下肢%体位%血流动力学
胃腫瘤%腹腔鏡%下肢%體位%血流動力學
위종류%복강경%하지%체위%혈류동역학
Gastric cancer%Laparoscope%Lower extremity%Posture%Hemodynamics
目的：比较截石位与下肢水平位两种不同体位对行老年腹腔镜下胃癌根治术患者血流动力学及体位相关并发症的影响。方法根据手术时间进行编号分组，观察组44例（单号），对照组40例（双号），对照组常规采用截石位摆放下肢，观察组采用平卧位水平摆放下肢。记录两组体位安置前、安置即刻、安置3 min、体位恢复前、恢复即刻、恢复3 min BP、HR、中心静脉压（ CVP）的变化及术后24，48 h患者并发症发生率。结果两组体位安置前SBP、DBP、HR和CVP波动差异无统计学意义（P＞0．05），体位安置即刻观察组患者的SBP、DBP、HR和CVP分别为（118．60±10．25）mmHg，（75．21±5．67）mmHg，（75．44±6．88）次/min，（8．16±1．08） cmH2O，明显优于对照组的（143．90±9．52） mmHg，（94．06±6．19）mmHg，（97．05±6．78）次/min，（10．94±1．19） cmH2O，差异有统计学意义（t 分别为-2．445，-2．360，-2．685，-2．482；P＜0．05）。体位安置后3 min，观察组患者的SBP、DBP、HR和CVP分别为（130．20±9．53）mmHg，（74．86±5．01）mmHg，（81．24±13．19）次/min，（7．44±1．69）cmH2O，明显优于对照组的（140．96±6．79）mmHg，（95．02±7．92）mmHg，（95．80±9．91）次/min，（10．62±0．98）cmH2O，差异有统计学意义（ t分别为-2．630，-2．419，-0．889，-2．429；P＜0．05）。观察组体位恢复前、体位恢复即刻SBP、DBP、CVP稳定情况明显优于对照组，差异具有统计学意义（t分别为-2．542，-2．345，-2．551；2．790，-2．362，-2．569；P＜0．05），而HR差异无统计学意义（t分别为-0．909，-0．953；P＞0．05）；两组在体位恢复3 min后SBP、DBP、HR和CVP变化差异无统计学意义（ P＞0．05）。观察组患者出现非切口疼痛5例，麻木2例；对照组发生非切口疼痛21例，麻木27例，两组术后并发症比较差异有统计学意义（χ2分别为14．590，36．735；P＜0．05）。结论对老年患者采用下肢水平仰卧体位有助于满足手术医生和麻醉医生的手术需要，最大限度维持呼吸循环系统稳定和平衡，降低被迫性体位对肢体神经血管压迫损伤，提高手术安全性及手术效果，增进患者舒适感。
目的：比較截石位與下肢水平位兩種不同體位對行老年腹腔鏡下胃癌根治術患者血流動力學及體位相關併髮癥的影響。方法根據手術時間進行編號分組，觀察組44例（單號），對照組40例（雙號），對照組常規採用截石位襬放下肢，觀察組採用平臥位水平襬放下肢。記錄兩組體位安置前、安置即刻、安置3 min、體位恢複前、恢複即刻、恢複3 min BP、HR、中心靜脈壓（ CVP）的變化及術後24，48 h患者併髮癥髮生率。結果兩組體位安置前SBP、DBP、HR和CVP波動差異無統計學意義（P＞0．05），體位安置即刻觀察組患者的SBP、DBP、HR和CVP分彆為（118．60±10．25）mmHg，（75．21±5．67）mmHg，（75．44±6．88）次/min，（8．16±1．08） cmH2O，明顯優于對照組的（143．90±9．52） mmHg，（94．06±6．19）mmHg，（97．05±6．78）次/min，（10．94±1．19） cmH2O，差異有統計學意義（t 分彆為-2．445，-2．360，-2．685，-2．482；P＜0．05）。體位安置後3 min，觀察組患者的SBP、DBP、HR和CVP分彆為（130．20±9．53）mmHg，（74．86±5．01）mmHg，（81．24±13．19）次/min，（7．44±1．69）cmH2O，明顯優于對照組的（140．96±6．79）mmHg，（95．02±7．92）mmHg，（95．80±9．91）次/min，（10．62±0．98）cmH2O，差異有統計學意義（ t分彆為-2．630，-2．419，-0．889，-2．429；P＜0．05）。觀察組體位恢複前、體位恢複即刻SBP、DBP、CVP穩定情況明顯優于對照組，差異具有統計學意義（t分彆為-2．542，-2．345，-2．551；2．790，-2．362，-2．569；P＜0．05），而HR差異無統計學意義（t分彆為-0．909，-0．953；P＞0．05）；兩組在體位恢複3 min後SBP、DBP、HR和CVP變化差異無統計學意義（ P＞0．05）。觀察組患者齣現非切口疼痛5例，痳木2例；對照組髮生非切口疼痛21例，痳木27例，兩組術後併髮癥比較差異有統計學意義（χ2分彆為14．590，36．735；P＜0．05）。結論對老年患者採用下肢水平仰臥體位有助于滿足手術醫生和痳醉醫生的手術需要，最大限度維持呼吸循環繫統穩定和平衡，降低被迫性體位對肢體神經血管壓迫損傷，提高手術安全性及手術效果，增進患者舒適感。
목적：비교절석위여하지수평위량충불동체위대행노년복강경하위암근치술환자혈류동역학급체위상관병발증적영향。방법근거수술시간진행편호분조，관찰조44례（단호），대조조40례（쌍호），대조조상규채용절석위파방하지，관찰조채용평와위수평파방하지。기록량조체위안치전、안치즉각、안치3 min、체위회복전、회복즉각、회복3 min BP、HR、중심정맥압（ CVP）적변화급술후24，48 h환자병발증발생솔。결과량조체위안치전SBP、DBP、HR화CVP파동차이무통계학의의（P＞0．05），체위안치즉각관찰조환자적SBP、DBP、HR화CVP분별위（118．60±10．25）mmHg，（75．21±5．67）mmHg，（75．44±6．88）차/min，（8．16±1．08） cmH2O，명현우우대조조적（143．90±9．52） mmHg，（94．06±6．19）mmHg，（97．05±6．78）차/min，（10．94±1．19） cmH2O，차이유통계학의의（t 분별위-2．445，-2．360，-2．685，-2．482；P＜0．05）。체위안치후3 min，관찰조환자적SBP、DBP、HR화CVP분별위（130．20±9．53）mmHg，（74．86±5．01）mmHg，（81．24±13．19）차/min，（7．44±1．69）cmH2O，명현우우대조조적（140．96±6．79）mmHg，（95．02±7．92）mmHg，（95．80±9．91）차/min，（10．62±0．98）cmH2O，차이유통계학의의（ t분별위-2．630，-2．419，-0．889，-2．429；P＜0．05）。관찰조체위회복전、체위회복즉각SBP、DBP、CVP은정정황명현우우대조조，차이구유통계학의의（t분별위-2．542，-2．345，-2．551；2．790，-2．362，-2．569；P＜0．05），이HR차이무통계학의의（t분별위-0．909，-0．953；P＞0．05）；량조재체위회복3 min후SBP、DBP、HR화CVP변화차이무통계학의의（ P＞0．05）。관찰조환자출현비절구동통5례，마목2례；대조조발생비절구동통21례，마목27례，량조술후병발증비교차이유통계학의의（χ2분별위14．590，36．735；P＜0．05）。결론대노년환자채용하지수평앙와체위유조우만족수술의생화마취의생적수술수요，최대한도유지호흡순배계통은정화평형，강저피박성체위대지체신경혈관압박손상，제고수술안전성급수술효과，증진환자서괄감。
Objective To compare the effects of two different positions , lithotomy position and horizontal position , on the elderly laparoscopic radical gastrectomy for gastric cancer patients with hemodynamics and postural-related complications .Methods According to operation time , subjects were numbered and divided into two groups , the observation group with 44 cases ( odd numbers ) , and the control group with 40 cases ( even numbers ) .In the control group ,lower extremity were placedin conventional lithotomy position .In the observation group, lower extremity were placed in horizontal position .The data before placement,at the placement, after placement for 3 min, before postural recovery , atpostural recovery , and after postural recovery for 3 min, BP after resettlement for 3 min, HR, CVP and the incidence of complications for 48 and 24 h of the two groups were recorded .Results The fluctuation of DBP , SBP HR and CVP between the two groups before placement had no significant difference (P>0.05).At the placement, SBP, DBP, HR and CVP inthe observation group were (118.60 ±10.25) mmHg, (75.21 ±5.67) mmHg, (75.44 ±6.88)/min, and (8.16 ±1.08) cmH2O, respectively, which was better than those in the control group with ( 143.90 ±9.52 ) mmHg, ( 94.06 ± 6.19)mmHg, (97.05 ±6.78)/min, and (10.94 ±1.19) cmH2O, respectively, showing a statistical significance (t=-2.445, -2.360, -2.685, and -2.482, respectively; P<0.05).After placement for 3 min,SBP, DBP, HR and CVP in the observation group were (130.20 ±9.53) mmHg, (74.86 ±5.01) mmHg, (81.24 ±13.19)/min, and (7.44 ±1.69)cmH2O, respectively, which was better than those in the control group with (140.96 ±6.79) mmHg, (95.02 ±7.92) mmHg, (95.80 ±9.91)/min, and (10.62 ± 0.98)cmH2O, respectively, showing a significant difference between two groups (t =-2.630, -2.419,-0.889, and -2.429, respectively;P<0.05).The stability of SBP, DBP, and CVP in the observation group before the postural recovery , and at the postural recovery , was better than that of the control group , with a statistically significant (t=-2.542, -2.345, -2.551, 2.790, -2.362, and -2.569, respectively;P<0.05), while HR had no significant difference (t=-0.909 and -0.953; P>0.05); the changes ofSBP, DBP, HR and CVP between the two group safter postural recovery for 3 min were no statistical significance ( P>0.05).Patients in the observation group appeared non-incision pain in 5 cases (11.36%), numbness in 2 cases (4.55%);in the control group, there were 21 cases ( 52.50%) of non-incision pain, 27 cases (67.50%) of numbness;there was a statistically significant difference in postoperative complications between the two groups (χ2 =14.590 and 36.735;P<0.05).Conclusions The horizontal position for lower extremity is helpful for elderly patients to meet need operation of operation and anesthesia doctor , to maintain respiratory and circulatory system stability and balance to large extent , to reduce the forced position on limb nerve and vascular compression injury , and improve the operation safety and effects , as well as patient ’ comfort.
