不同角度头低脚高位对腹腔镜下全子宫切除术患者的影响

Effects of different angle of head low feet high on laparoscopic total hysterectomy patients

目的：观察床后倾的不同角度对腹腔镜全子宫切除术患者术中术后的影响。方法选择2014年1月至4月全麻下行腹腔镜全子宫切除术的患者60例，随机分两组，每组30例。摆好膀胱截石位，询问患者自觉舒适，开始麻醉诱导插管，气腹后手术开始，观察组将手术床后倾10度，对照组将手术床后倾20度。术后送回病房，统一取床头摇高30度半卧位。观察常规生命体征、心电图、血压、心率等监测；气腹后30 min（T1）、60 min（T2）的气道峰压（Paw）、血气：pH、PaO2、PaCO2、SpO2、BE 等；手术时间；手术麻醉并发症发生情况等。结果观察组气腹后60 min MAP、HR、Paw 分别为（99.2±12.3）mm Hg、（91.0±12.6）次/ min、（22.6 ± 3.7）cm H2 O，对照组分别为（111.0±11.2）mm Hg、（102.2 ±11.2）次/ min、（25.4±3.1）cm H2 O，差异有统计学意义（P 〈0.05）；血气变化：观察组 pH 值为（7.37±0.07）、PaO2为（210.3 ± 46.1）mm Hg、PaCO2为（39.7± 5.3）mm Hg、SpO2为（98.9±0.8）%、BE 为（-4.4± 0.7）mmovl/ L，对照组 pH 值为（7.28±0.05）、PaO2为（176.4± 46.2）mm Hg、PaCO2为（47.1 ± 4.5）mm Hg、SpO2为（96.1 ±1.2）%、BE 为（-5.4±0.9）mmovl/ L，两组比较差异有统计学意义（P 〈0.05）；并发症发生情况，剧烈呛咳喉气管支气管痉挛、球结膜充血水肿短暂失明、恶心呕吐返流误吸窒息、舌后坠呼吸抑制寒战、肠胀气烦躁对镇痛泵效果不满意等：观察组10例次，占33%，对照组18例次，占60%，两组比较差异有统计学意义（P 〈0.05）。结论控制腹腔镜全子宫切除术，患者头低脚高位床后倾的角度〈10度对预防其呼吸循环等相关并发症有重要意义。

Objective To observe the different aspects of bed backward on postoperative patients who underwent total laparoscopic hysterectomy. Methods From January to April 2014,sixty patients un-derwent total laparoscopic hysterectomy under general anesthesia,were randomly divided into two groups, with 30 cases in each group. Patients were placed lithotomy position and feel comfortable,begin to anesthe-sia induction and intubation. Observation group：the operation began after pneumoperitoneum and bed by hypsokinesis 10 degrees. Control group：surgical bed be tilted 20 degrees. After surgery,Patients were sent ward and take half supine position to rest,the head of a bed up 30 degrees. The normal vital signs,elec-trocardiogram, blood pressure, heart rate monitor, the airway peak pressure （ Paw ）,＆amp;nbsp;blood gas（pH,PaO2 ,PaCO2 ,SpO2 ,BE,etc）of 30 min（T1）,60 min（T2）after pneumoperitoneum, operation time,complications of surgery anesthesia were observed. Results MAP,HR,Paw of 60 min af-ter pneumoperitoneum in observation group was（99. 2 ±12. 3）,（91. 0 ±12. 6）,（22. 6 ±3. 7）,in control group was（111. 0 ±11. 2）,（102. 2 ± 11. 2）,（25. 4 ± 3. 1）,there were significant differences（P 〈 0. 05）. Blood gas changes in observation group was（7. 37 ±0. 07）,（210. 3 ±46. 1）,（39. 7 ±5. 3）,（98. 9 ±0. 8）, in control group was（7. 28 ±0. 05）,（176. 4 ±46. 2）,（47. 1 ±4. 5）,（96. 1 ±1. 2）,（ -5. 4 ±0. 9）,there were significant differences（P 〈 0. 05）. Complications including severe choking cough,bronchospasm, conjunctival congestion,edema,temporary blindness,nausea,vomiting,regurgitation aspiration asphyxia, tongue after falling respiratory depression,chills,bowel bilges gas agitated for analgesia pump effect was not satisfied,and so on. Complications occure in 10 cases（33% ）of observation group,and 18 cases （60% ）of control group,there was significant difference（P 〈0. 05）. Conclusions Control patients with head low feet high bed retroversion Angle 〈 10 degrees in laparoscopic total hysterectomy,has important significance in preventing its respiratory complications.