不同手术体位对妇科腹腔镜手术的影响

The impact of different positions on the gynecological laparoscopic surgery

目的:观察、分析不同手术体位对妇科腹腔镜手术的影响。方法:选取2009年1月至2012年12月接受妇科腹腔镜手术的180例患者作为研究对象。根据患者体位倾斜程度随机分为3组,每组60例。患者均采用床头向下倾斜的头低臀高位施术,体位分别倾斜20度(T20组)、30度(T30组)、40度(T40组),记录3组患者调整体位30 min的收缩压、舒张压、平均压、气道峰值及呼气末二氧化碳分压,观察患者术后肩痛、下肢麻木疼痛、恶心呕吐症状,并进行对比分析。结果:T20组与T40组相比,各项指标差异均有统计学意义(P<0.05)。结论:随着头低臀高倾斜角度的增加,患者循环、呼吸指标及术后不良反应有升高趋势,20度体位在妇科腹腔镜术中及术后对患者的影响相对较小,更适合应用。

Objective：To observe and analyze the impact of the different positions on the gynecological laparoscopic surgery. Methods：Between Jan. 2009 and Dec. 2012 180 patients who were treated with gynecological laparoscopic surgery were selected as the research object. All the patients were randomly divided into three groups of T20 group,T30 group and T40 group, each group had 60 ca- ses. All patients were kept the position of low head and high hip with a downward tilt of the bed during laparoscopic surgery. The pa- tients of T20 group were treated by 20 degrees tilt angle, patients in T30 group were treated by 30 degrees tilt angle and patient in T40 group were treated by 40 degrees tilt angle. The information of systolic pressure, diastolic pressure, average pressure, airway peak and partial pressure of end-expiratory carbon dioxide of three groups after adjusting the position for 30 min were recorded, and the postopera- tive symptoms of shoulder pain, lower limb numbness, nausea and vomiting in patients were observed. Then the record result of three groups were compared. Results：The T20 group and T40 group showed statistically significant difference in the comparison of the indica- tors （ P 〈 0.05 ）. Conclusions ： With the tilt angle of the position increasing, it is a rising trend on circulation, respiration and postopera- tive adverse reactions. Compared with 30 and 40 degrees tilt angle position, the 20 degrees tilt angle position in gynecological laparo- scopie operation has relatively small effect on patients during and after gynecological laparoscopic operation,it is more suitable for popu- larization in clinic.