腰肋悬空体位对经皮肾镜碎石术老年患者血流动力学和内环境的影响

Effect of Flank Suspended Supine Position on Hemodynamics and Internal Environment in Elderly Patients Undergoing Percutaneous Nephrolithotomy

目的探讨经皮肾镜碎石术中腰肋悬空仰卧位对老年患者血流动力学和内环境的影响。方法择期行经皮肾镜碎石术的老年患者80例,随机分为两组,每组40例:A组采用腰肋悬空仰卧位,B组采用俯卧位。分别记录麻醉前(T0)、麻醉后摆放体位后5 min(T1)、手术开始30 min(T2)、60 min(T3)以及术毕(T4)患者的血压(blood pressure,BP)、心率(heart rate,HR)、脉搏氧饱和度(pulse oxygen saturation,SpO2),并于T0、T3、T4抽取动脉血行血气分析,检测电解质(K+、Na+)、红细胞压积(hematocrit,Hct)和血糖以及乳酸值;记录摆放体位至造瘘通道成功建立的时间、手术时间以及相关不良反应和血管活性药物的使用情况。结果 A组患者T4时PaO2、剩余碱(BE)值、K+、Hct及血糖均明显升高(P<0.05),B组T1时BP和HR明显下降,T2～T4逐渐上升并显著高于T0(P<0.05),T1～T4时SpO2明显下降(P<0.05),T3～T4时PaCO2以及血糖和乳酸水平升高,PaO2、pH和BE值下降(P<0.05)。组间比较,T1时A组患者BP和HR均明显高于B组,T2～T4时低于B组(P<0.05),T1～T4时SpO2大于B组(P<0.05);T3～T4时pH、PaO2和BE值以及K+、HCT均大于B组,PaCO2、血糖和乳酸均小于B组(P<0.05)。A组造瘘通道建立时间和手术时间较B组明显缩短(P<0.01)。B组不良事件的发生率和围术期血管活性药物的使用率明显高于A组(P<0.01)。结论经皮肾镜碎石术中腰肋悬空仰卧位对老年患者血流动力学和内环境的影响较小。

Objective To approach the effect of flank suspended supine position on hemodynamics and internal environment in elderly patients undergoing percutaneous nephrolithotomy. Methods Eighty elderly patients undergoing percutaneous nephrolithotomy were randomly divided into group A and group B（n=40 each）.The flank suspended supine position was adopted in group A,and the prone position in group B.Blood pressure（BP）,heart rate（HR） and pulse oxygen saturation（SpO2） were recorded at the time before anaesthesia（T0）,5 minutes after placing the posture（T1）,30 minutes（T2） and 60 minutes（T3） after operation beginning,and the end of the operation（T4）.The arterial blood was extracted for blood gas analysis and testing the electrolyte,glucose,hematocrit（HCT） and lactic acid levels at T0,T3 and T4.The time from placing the posture to completing the fistula,the duration of operation,the complication and the usage of vasoactive drugs were recorded. Results In group A,the levels of PaO2,BE,K＋,HCT and blood glucose increased at T4（P0.05）.In group B,BP and HR decreased at T1 but increased from T2 to T4 and significantly higher than those at T1（P0.05）,SpO2 decreased gradually from T1 to T4（P0.05）,PaCO2,blood glucose and lactic acid levels increased and PaO2,pH and BE decreased significantly at T3 and T4（P0.05）.BP and HR in group A were higher than those in group B at T1 but lower than those in group B from T2 to T4（P0.05）.SpO2 in group A was higher than that in group B from T1 to T4（P0.05）.The levels of pH,PaO2,BE,K＋ and HCT in group A were higher but PaCO2,blood glucose and lactic acid were lower than those in group B at T3 and T4（P0.05）.The time from placing the posture to completing the fistula and the duration of operation in group A were less than those in group B（P0.01）.The complication incidence and the usage of vasoactive drugs in group B were more than those in group A（P0.01）. Conclusion The flank suspended supine position has little effect on the hemodynamics and internal environment of elderly patients during percutaneous nephrolithotomy.