改进头低足高“人字形”截石位在老年妇科腹腔镜手术中的效果观察

Effect of modified herringbone-Trendelenburg position during gynecological laparoscopic operation of the elderly

目的 探讨改进头低足高“人字形”截石位在老年患者妇科腹腔镜手术中的应用效果.方法 选取全麻下择期行妇科腹腔镜手术的老年患者60例,依据入院顺序采用随机数字表法分为观察组30例和对照组30例.对照组采用常规头低足高截石位,观察组采用改进头低足高“人字形”截石位.于麻醉诱导后（T1）、麻醉完成后平卧截石位（T2）、气腹并头低足高后5 min（T3）、30 min（T4）、60 min（T5）、90 min（T6）、120 min（T7）、150 min（T8）、180 min（T9）、210 min（T10）、240 min（T11）、气腹解除后恢复平卧位5 min（T12）、麻醉结束恢复清醒前（T13）测量患者的眼压值;并于术后24、48 h对患者进行随访,调查并记录患者手术体位舒适度、肩部疼痛情况和下肢疼痛麻木情况.结果 在T1、T2、T13三个时间点,2组患者眼压值比较差异无统计学意义（t=-1.098、-0.772、-0.656,均P＆gt;0.05）,在T3~T12的每个测量时间点观察组患者平均眼压值低于对照组,差异有统计学意义（t=6.523~19.866,均P＜0.01）;下肢疼痛麻木发生率观察组为6.7%（2/30）,低于对照组的26.7%（8/30）,差异有统计学意义（χ2=4.320,P＜0.05）;发生下肢疼痛麻木患者的疼痛评分观察组低于对照组,差异有统计学意义（t=2.471,P＜0.05）;肩部疼痛发生率观察组为10.0%（3/30）,低于对照组的43.3%（13/30）,差异具有统计学意义（χ2=8.523,P＜0.01）;发生术后肩痛患者的疼痛评分观察组低于对照组,差异有统计学意义（t=3.575,P＜0.05）;观察组患者手术体位舒适度总分高于对照组,差异有统计学意义（t=-2.319,P＜0.05）.结论 改进头低足高“人字形”截石位能在保证术野的前提下,有效地减少老年患者术中眼压值的升高,并能提高患者手术体位的舒适度,有效减少术后下肢和肩部疼痛的发生率,有利于老年患者手术安全.

Objective To explore the effects of modified herringbone-Trendelenburg position during gynecological laparoscopic operation of the elderly. Methods A total of 60 elderly patients undergoing gynecological laparoscopic operation under general anesthesia were recruited and assigned to the observation group （30 cases） and control group （30 cases） by random digits table method with 30 cases each according to admitting time;Patients in the control group were placed in conventional Trendelenburg position, while the patients in the observation group were positioned in modified herringbone-Trendelenburg position .Intraocular pressure （IOP） were measured in the patients at anesthesia induction （T1）,5 minutes after general anesthesia in supine position （T2） , and 5 minutes after pneumoperitoneum while in the operation position （T3） , every 30 minutes （times 4 to 11）, while supine at the end of pneumoperitoneum （time 12） and before awakening （time 13）;Patients were followed up at 24 h and 48 h after surgery, researcher investigate and record the scores of the Operation Position Comfort Questionnaire, the situation of the pain in the shoulder and postoperative complications of the lower limbs. Results There was no statistically significant difference （t=-1.098,-0.772,-0.656, P＆gt;0.05） of the IOP at T1, T2, T13. The IOP in the observation group had statistically significant difference compared with the control group at T3 to T12 （t=6.523-19.866, P〈0.01）. The incidence rate of the postoperative complications of the lower limbs in the observation group was 6.7%（2/30） lower than 26.7%（8/30） of the control group （χ2=4.320, P〈0.05） and the VAS scores of the patients in the two groups was statistically significant （t=2.471, P〈0.05）. The incidence rate of the postoperative shoulder pain in the observation group was 10.0%（3/30） lower than 43.3%（13/30） of the control group （χ2=8.523, P〈0.01）, and the Visual Analogue Scale scores of the patients in the two groups was statistically significant （t=3.575, P〈0.05）.The scores of the Operation Position Comfort Questionnaire in the observation group was higher than the control group （t=-2.319, P〈0.05）. Conclusions Modified herringbone- Trendelenburg position can reduce the elevation of intraocular pressure in elderly patients without affecting the operation ,and effectively improve the comfort of the operation position of the patients, reduce the incidence rate of the shoulder pain and postoperative complications of the lower limbs, is conducive to the operation safety of elderly patients.