老年患者MPCNL术中改变体位所致循环波动的防治

Prevention of Influence of Body Position During Percutaneous Nephrolithotomy on Circulation and Respiration Function in Elderly Patients

目的探讨在微创经皮肾镜下碎石术(minimally invasive percutaneous nephrolithotomy,MPCNL)术中两次改变体位对老年患者(60～78岁)循环的影响及其防治。方法共46例患者按数字随机法分为两组。A组(预防组):术中分步改变体位,改变体位前快速扩容。B组(对照组):从截石位立即改俯卧位一次;改变体位前不进行扩容。监测两组患者的血压(BP)、心率(HR)、反应及感受;分析在麻醉前后以及截石体位与俯卧体位改变的血压和心率变化与基础值的差异。结果两组病人两次体位变动后,A组与B组比较血压、心率均有显著下降(P<0.01),出现低血压需用升压药或加用阿托品纠正,病例数组间差异有统计学意义(P<0.05)。结论在MPCNL术中两次体位变动可致血液循环波动;采用分步改变体位前快速扩容可以有效预防血压下降、心率减慢和缓解患者不适。

Objective To explore the effect of changing the body position twice on the 60～78-year-old patients＇ circulation function during minimally invasive percutaneous nephrolithotomy （MPCNL ）and its prevention.Methods A total of 46 elderly patients who had undergone MPCNL were randomly divided into prevention group （group A） and control group （group B）.The patients in group A were performed rapid circulating blood volume expansion before changing the body position and making carve-step,while the patients in group B were not performed rapid circulating blood volume expansion before changing the body position from lithotomy position to prone position.All of the patients＇ blood pressure （BP）,heart rates （HR）,reactions,and feelings were monitored.The changes of blood pressure and heart rate before and after anesthesia,after the lithotomy position and the prone position were analyzed and then compared with the basic values.Results Compared with group B,blood pressure and heart rate of the patients in group A decreased significantly after changing the body position twice （P0.01）.There were statistically significant differences in the number of the cases which needed to use pressor agents or atropine during hypotension between the two groups （P0.05）.Conclusions Changing body position twice during MPCNL is the main cause of cycle fluctuations,and rapid circulating blood volume expansion and graded changes of body position can effectively prevent hypotension,slow the heart rate,and subside the uncomfortable symptoms in elderly patients undergone MPCNL.