腰肋悬空位和俯卧位经皮肾镜碎石术对患者血流动力学影响的比较

Effect of supine and prone position in percutaneous nephrolithotomy lithotripsy on renal hemodynamics

目的探讨腰肋悬空位和俯卧位经皮肾镜碎石术对患者血流动力学的影响。方法 2010年1月～2011年1月我院100例经皮肾镜碎石术,随机分为腰肋悬空位和俯卧位两组,每组50例,分别记录两种手术体位患者的术前、改变体位后、术中30min、术毕各时间段患者血压、心率、呼吸、血氧饱和度的数据;统计并比较两种不同体位上述相关数据的差异。结果俯卧位组在改变体位后,其血压(收缩压/舒张压)相比术前血压基础值都呈明显下降趋势,而心率则无明显变化;腰肋悬空位组在改变体位后,其血压(收缩压/舒张压)相比术前血压基础值都呈下降趋势,而心率则无明显变化;在血流动力学方面,两组术中、术后相比术前在血压方面都有所下降,两组组内比较均有统计学意义(P<0.05);而两组间在血流动力学方面比较,俯卧位与腰肋悬空位组间比较,俯卧位对血压的影响相比仰卧位更明显(P<0.05)。而两组在血氧饱和度、呼吸频率方面改变体位后与基础值相比两组均无明显变化,两组间和组内比较无统计学差异(P<0.05)。结论腰肋悬空位经皮肾镜碎石术对血流动力学影响较俯卧位小,因此该术式对年老体衰、高危肥胖、身体畸形体位搬动不便和有慢性心肺疾患的患者尤为适用,是一种安全、有效、便利的治疗肾结石的微创方式。

Objective To investigate the supine position and prone position in percutaneous lithotripsy of renal hemodynamic effects on patients.Methods 100 patients in our hospital 2010.1-2011.1 percutaneous renal lithotripsy,were randomly divided into supine position and prone position groups,50 patients in each group were recorded position of two surgical patients before and after the change of position,30-minute surgery,the time of surgery in patients with blood pressure,heart rate,respiration,blood oxygen saturation data;statistics and compare the two different positions between the relevant data.Results Change in position in the prone position group,the blood pressure（systolic / diastolic） blood pressure compared to baseline were tested before surgery significantly decreased,while heart rate did not change significantly;Gray floating bits set in the change of position,its blood pressure（systolic / diastolic blood pressure） compared to preoperative baseline values tended to decrease,and heart rate did not change significantly;the two groups in hemodynamics,two groups of postoperative blood pressure before surgery compared to aspects of the decreased compared within the two groups are statistically significant;and hemodynamics between the two groups compared in the prone position between the two groups,prone position on blood pressure compared to the supine position is more evident.The two groups in oxygen saturation,respiratory rate： the change in position after the two groups were compared with baseline,no significant changes between the two groups and no significant group differences.Conclusions the supine position compared to prone position percutaneous renal lithotripsy effects on hemodynamics with smaller,so supine position Percutaneous lithotripsy of age and decay,high-risk obesity,physical deformity and inconvenience position moving patients with chronic heart and lung disease is particularly applicable,is a safe,effective,convenient and minimally invasive way of treating kidney stones.