腰肋悬空和俯卧位经皮肾镜取石术患者血流动力学的影响因素研究

Different influences on patients hemodynamics between the prone position and supine position percu- taneous Uthotripsy

目的比较腰肋悬空位和俯卧位经皮肾镜取石术（PCNL）对患者及血流动力学的影响。方法肾结石患者100例随机分为腰肋悬空位和俯卧位2组，每组50例，分别记录2组患者术前、改变体位后、术中、术毕各时间段的血压、心率、呼吸、血氧饱和度及血气分析结果；采用视觉模拟评分（VAS）记录患者的体位舒适感、呼吸困难感和术后24h疼痛评分；统计学分析比较2组患者相关数据的差异。结果腰肋悬空位和俯卧位组患者术前、术中、术毕收缩压分别为（137±12）、（119±15）、（115±17）mmHg（1mmHg=0．133kPa）和（137±10）、（110±18）、（104±16）mmHg，舒张压分别为（81±9）、（74±8）、（63±14）mmHg和（84±8）、（63±9）、（60±15）mmHg。与术前相比，2组术中、术后血压均有下降，差异有统计学意义（P〈0．05）；2组手术前后心率、呼吸频率、血氧饱和度等差异无统计学意义（P〉0．05）。两组患者术前、术中、术毕血pH值分别为7．4±0．0、7．3±0．0、7．3±0．0和7．4±0．0、7．3±0．0、7．3±0．0，剩余碱分别为（2．1±0．5）、（-2．7±0．5）、（-1．5±0．5）mmol／L和（3．2±0．5）、（-3．8±0．5）、（-2．5±0．5）mmol／L，与术前相比2组术中术后pH值、剩余碱均有下降，差异有统计学意义（P〈0．05），且俯卧位下降更明显；2组手术前后血钠、血钾指标差异无统计学意义（P〉0．05）。俯卧位组体位舒适感、呼吸困难感和术后疼痛感方面VAS评分分别为1．6±0．4、7．1±0．5和4．8±0．8，腰肋悬空位组分别为7．5±0．2、1．4±0．3和4．7±0．8，2组体位舒适感和呼吸困难评分差异有统计学意义（P〈0．05）。结论与俯卧位PCNL相比，腰肋悬空位对血流动力学、血气分析结果影响小，体位舒适感好，适用于年老体弱、肥胖、身体畸形和有慢性心肺疾患的患者。

Objective To compare the clinical characters and hemodynamic data of the prone position and supine position percutaneous nephrolithotomy. Methods Patients with kidney stones in 100 cases were randomly assigned into the supine position group and prone position group. There were 50 cases in each group. The following data were recorded at preoperative, intraoperative, change position： the blood pressure, heart rate, respiration, saturation of blood oxygen and blood gas analysis results. The VAS score was recorded in patients for postural comfort, dyspnea and pain score. Results The systolic blood pressure in the preoperative, intraoperative, postoperative on supine position and prone position were as follows： （137 ±12）, （119 ±15）, （115 ±17） mm Hgand （137±10）, （110±18）, （104 ±16） mm Hg. The diastolic blood pressure was as follows： （81±9） , （74 ±8）, （63 ±14） mm Hg and （84 ±8）, （63 ±9） , （60 ± 15） mm Hg. Compared with preoperative, there was a blood pressure decreased in both groups. The blood pH at preoperative, intraoperative, postoperative in supine position and prone position： 7.4 ±0.7.3 ±0, 7.3 ±0 and 7.4 ±0, 7.3 ±0, 7.3 ±0. The base excess （BE） of two groups were： （2.1 ±0.5） , （-2.7±0.5）, （-1.5±0.5） mmol/L and （3.2 ±0.5）, （-3.8 ±0.5）, （-2.5±0.5） mmol/L. Compared with preoperative data, the pH and BE declined in both groups. The prone position had more pro- nounced decrease in serum sodium, serum potassium; but with no significant difference. Supine group in postural comfort and breathing difficulties were 1.6 ± 0.4 and 7.1 ± 05, while prone group were 7.5 ± 0.2 and 1.4 ± 0.3. The supine position showed better in postural comfort and breathing difficulties with statistical significance. Conclusions Compared with the prone position, the supine positioned percutaneous nephrolithotomy could have less influence on hemodynamics, blood gas analysis. It could have better postural comfort.