护理干预对预防截石位手术中老年患者并发症的影响

Effect of nursing intervention on prevention of complications associated with surgeries in lithotomy postion in middle-aged and elderly patients

目的探讨护理干预对预防截石位手术中老年患者并发症的影响。方法对传统截石位和改良截石位的四肢摆放进行比较。选取在我院住院且没有神经和心血管系统疾病的140例截石位手术中老年患者，随机分成对照组和干预组，对照组采用传统截石位，干预组采用改良截石位，将患者双上肢以自身床单固定于身体两侧，术毕头低脚高位，双下肢间隔3min先后平放，记录体位改变前后血压和心率的变化，对比两种方法对术后并发症的影响。结果对照组在改变体位后收缩压（SBP）和舒张压（DBP）均明显下降（P〈0．05），心率的变化无统计学意义；干预组与对照组相比，SBP及DBP下降程度明显减少（P〈0．05）；对照组压疮的发生率、下肢麻木、肿胀等不良反应明显高于干预组。结论改良截石位双上肢、下肢的摆放方法可以显著减少血压下降程度，避免上肢外展导致臂丛神经受损，有利于预防中老年人术后并发症的发生。

Objective To explore the effect of nursing intervention on the prevention of complications associated with surgeries in lithotomy position in middle-aged and elderly patients. Methods Placement of four limbs was compared between traditional lithotomy position and modified lithotomy position. 140 middle-aged and elderly patients undergoing surgeries in lithotomy position who had no neurological or cardiovascular diseases were randomly divided into intervention group and control group. The control group received traditional lithotomy position and the intervention group received modified lithotomy position, with the upper extremities fastened on both sides of the body by a bed sheet in a postoperative trendelenburg position, both legs being placed flat in 3 mins. The changes in blood pressure and heart rate were noted after alteration in body positon and the effects on the postoperative complications were compared between these two positions. Results After alteration in body position, SBP and DBP obviously decreased in the control group （ P〈 0.05 ）, while heart rate did not change significantly. As compared with the control group, the level of a decrease in SBP and DBP lowered obviously in the intervention group （ P〈 0.05 ）. The incidence rates of pressure ulcers and lower limb numbness or swelling were obviously higher in the control group than in the intervention group. Conclusions Modified lithotomy position with placement of the upper and lower extremities can markedly lower a decrease in blood pressure and avoid injury to brachial plexus caused by abduction of the upper extremities, and is beneficial for the prevention of postoperative complications in middle-aged and elderly patients.