经皮肾镜碎石术的手术体位影响

Influence of body position on percutaneous nephrolithotomy

目的探讨经皮肾镜碎石术的手术体位影响及护理对策。方法回顾性分析经皮肾镜碎石术患者380例，手术时间≤2小时的俯卧位162例，斜仰卧位116例；手术时间〉2小时的俯卧位70例，斜仰卧位32例。比较两种体位引起血压（BP）、心率（HR）、血氧饱和度（SpO2）波动和舒适度评价的差异。结果手术时间≤2小时，俯卧位与斜仰卧位对患者血压、心率、血氧饱和度的影响及舒适度评价的差异无统计学意义。手术时间〉2小时，舒适度评分：俯卧位（2．8±1．06）分，斜仰卧位（1．25±0．6）分，差异有统计学意义，P〈0．01；心率变化值：俯卧位（17．8±16．0）次／min，斜仰卧位（9．68±10．3）次／min，差异有统计学意义，P〈0．01；SpO2差值：俯卧位（2．0±1．3）％，斜仰卧位（1．4±0．87）％，差异有统计学意义，P〈0．05。结论采取相应的护理对策，手术时间≤2小时，可以忽略体位对生命体征、舒适度的影响；手术时间〉2小时，选择俯卧位时，需与麻醉医生密切配合，尽量减小体位对生命体征的影响，提高舒适度。

Objective To explore the influence of body position on percutaneous nephrolithotomy and its nursing countermeasures. Methods 380 patients undergoing percutaneous nephrolithotomy, including 278 ones （162 taking prone position and 116 taking oblique supine position） whose operation time ≤2 hours and 102 ones （ 70 taking prone position and 32 taking oblique supine position） whose operation time 〉 2 hours, were retrospective analyzed. Comparisons of the two surgical positions were done in comfort index and the changes of blood pressure （BP）, heart rate （HR）, and oxygen saturation （SpO2）. Results When the operation time ≤ 2 hours, there were no significant differences in BP, HR, SpO2, and comfort index between the patients taking prone position and the patients taking oblique supine position. When the operation time was more than 2 hours, the comfort index was （2.8 ± 1.06） and （1.25 ± 0.6）, the change of HR was （17.8 ± 16.0） beats/rain and （9.68 ± 10.3） beats/rain, and the change of SpO2 was （2.0 ± 1.3）% and （1.4±0.87） in the patients taking prone position and the patients taking oblique supine position, respectively, with statistical differences （P〈0.01 or P〈0.05）. Conclusions After taking appropriate nursing countermeasure, the influence of position on vital signs and comfort index can be ignored when the operation time≤ 2 hours, when prone position is taken and operation time 〉2 hours, cooperation with anesthesiologist should be taken to minimize the influence of body position on vital signs and improve the patients＇ comfort.