手术体位对颈后路单开门椎板成形术总出血量和血流动力学的影响

Effect of surgical position on total blood loss and hemodynamics in cervical unilateral open-door laminoplasty

目的:探讨手术体位对颈后路单开门椎板成形术手术总出血量及血流动力学的影响。方法:选择2016年1月~2017年12月全麻下行颈后路单开门椎板成形术的患者49例,按手术体位不同分为两组,其中俯卧位17例(A组,男13例、女4例),坐位组32例(B组,男28例、女4例),为减少性别差异的影响,从B组28例男患者中随机选取13例与4例女患者组成C组。分别在手术日晨、全麻诱导后(仰卧位)5min和摆好体位后5min测量并记录患者收缩压及心率,记录A、B组患者的术中出血量和术后引流量,并为总出血量。分别对A、B两组组内及A、C两组组间数据进行对比分析。结果:A组由仰卧位变为俯卧位后收缩压变化差值[d(BP)]为-19±21mm Hg,心率变化差值[d(HR)]为-7±10次/分,体位改变后收缩压及心率均下降,且变化有统计学意义(P<0.05);B组由仰卧位变为坐位后d(BP)为-12±23mm Hg,收缩压下降且有统计学意义(P<0.05),d(HR)为-3±9次/分,变化无统计学意义(P>0.05)。A组手术总出血量、d(BP)、d(HR)分别为272.94±105.82ml、-19±21mm Hg、-7±10次/分,C组分别为194.12±79.69ml、-3±21mm Hg、-3±9次/分,A组手术总出血量大于C组(P<0.05),收缩压下降较C组更明显(P<0.05),两组间心率变化差异无统计学意义(P>0.05)。结论:与俯卧位相比,坐位行颈后路单开门椎板成形术可减少手术总出血量,虽然两种体位下收缩压均下降且心率变化无明显差异,但在安全范围内坐位能维持更高的血压值。

Objectives： To discuss the effect of surgical position on total blood loss and hemodynamics in cervical unilateral open-door laminoplasty. Methods： A total of 49 patients undergoing cervical unilateral open-door laminoplasty under general anesthesia from January 2016 to December 2017 was selected, they were divided into two groups according to their different postures, 17 patients in prone position group（group A, 13 males/4 females） and 32 patients in sitting position group（group B, 28 males/4 females）. To control the impact of gender disparity, 13 males randomly selected from group B and the 4 females in group B, formed group C. Systolic pressure and heart rate were measured and recorded in the morning of surgery date, 5 min after general anesthesia induction（supine position） and 5min after setting up position. The total amount of bleeding was operation bleeding plus postoperative drainage volume. Statistical methods were used to compare and analyze the data of these groups. Results： The difference of systolic blood pressure[d（BP）] in group A was -19±21mmHg, and the difference of heart rate [d（HR）] was -7±10/min. Systolic blood pressure and heart rate decreased with the change of position, and the difference was statistically significant（P〈0.05）. In group B, d（BP） was -12±23mmHg and d（HR） was -3±9/min, there was statistically significant difference in systolic blood pressure（P〈0.05）, but no significant difference in heart rate（P〉0.05）. The total blood loss, systolic blood pressure difference, heart rate difference were 272.94±105.82ml, -19±21mmHg, -7±10/min in group A, and 194.12±79.69ml, -3±21mmHg, -3±9/min in group C. The total blood loss in group A was more than that in group C（P〈0.05）. The decrease of systolic pressure in group A was significantly higher than that in group C（P〈0.05）. There was no significant difference in heart rate change between the two groups（P〉0.05）. Conclusions： Compared with prone position, sitting position in unilateral open-door operation could reduce the total blood loss. Although systolic blood pressure decreased in both postures and there was no significant difference in heart rate change between the two groups, sitting position could maintain a higher blood pressure value in a safe range.