俯卧位与改良平卧截石位下经皮肾镜术治疗肾结石时患者血流动力学及疗效对比研究

A comparative study of hemodynamics and efficacy of percutaneous nephrolithotomy between prone position and modified supine position in kidney calcium patients

目的对比研究俯卧位与改良平卧截石位下经皮肾镜术治疗肾结石时患者血流动力学及疗效。方法选取收住的肾结石患者60例,随机数字表法分为改良平卧位组与俯卧位组各30例,分别在改良平卧位、俯卧位下手术,观察疗效,患者麻醉前30 min(T0)、麻醉成功后(T1)、术中30 min(T2)、拔管时(T3)等不同时点时心率、收缩压、舒张压、血氧饱和度(Sp O2)变化。结果两组手术时间、术中出血量及术后住院时间比较差异无统计学意义(P>0.05),改良平卧位组、俯卧位组结石清除率分别为86.67%、90.00%,比较差异无统计学意义(P>0.05);两组患者T0、T1、T2、T3等不同时点时心率、收缩压、舒张压、Sp O2比较差异无统计学意义(P>0.05);两组高危患者T0时心率、收缩压、舒张压、Sp O2比较差异无统计学意义(P>0.05),T1、T2、T3时心率、收缩压、舒张压两组高危患者比较差异有统计学意义(P<0.05),T1、T2、T3时Sp O2两组高危患者比较差异无统计学意义(P>0.05)。结论俯卧位与改良平卧截石位下经皮肾镜术治疗肾结石时疗效及血流动力学均无明显差别,但是高危患者采用改良平卧截石位下手术术中及拔管时血流动力学相对影响较小。

Objective To compare the hemodynamics and efficacy of percutaneous nephrolithotomy between prone position and modified supine position in kidney calcium patients.Methods Sixty patients with nephrolith admitted to hospital were randomized into modified supine position group（n =30）and prone position group（n =30）.All the patients underwent surgeries in respective positions.The effi-cacies and changes in heart rate,systolic pressure,diastolic pressure,blood oxygen saturation（SpO2 ）at 30 min before anesthesia（T0）, the beginning of anesthesia（T1）,intraoperative 30 min（T2）,and extubation（T3）were observed and compared.Results There were no significant differences in operation time,intraoperative blood loss and postoperative hospital stay（P 〉0.05）.There was no significant difference in stone clearance rate between modified supine position group and prone position group（86.67% vs 90.00%,P 〉0.05）. There were no significant differences in heart rate,systolic pressure,diastolic pressure and SpO2 at T0,T1,T2 and T3（P 〉0.05）.There were no significant differences in heart rate,systolic pressure and diastolic pressure at T0 between high risk patients in the two groups （P 〉0.05）while there were significant differences at T1,T2 and T3（P 〈0.05）.There were no significant difference in SpO2 at T1,T2 and T3（P 〉0.05）.Conclusions There are no significant differences in hemodynamics and efficacy of percutaneous nephrolithotomies between prone position and modified supine position,but there is less hemodynamic influence during operation and at extubation for high risk patients undergoing percutaneous nephrolithotomy in modified supine position.