改良泌尿外科手术床在经皮肾镜碎石取石术中的应用

Application of modified urological surgical bed in percutaneous nephrolithotomy

目的探讨改良泌尿外科手术床在经皮肾镜碎石取石(PCNL)手术中的应用效果。方法选择韶关市第一人民医院2016年12月至2017年12月收治的200例采用俯卧位进行PCNL治疗的患者进行研究。按随机数表法将患者分为对照组和观察组各100例。对照组采用俯卧位垫进行传统摆放,观察组采用改良泌尿外科手术床摆放俯卧位。比较两组患者的俯卧位前(T0)与俯卧位后3 min(T1)、5 min(T2)、10 min(T3)的生命体征[收缩压(SBP)、舒张压(DBP)]、血流动力学指标[心率(HR)、中心静脉压(CVP)]以及趾指血氧饱和度(SpO2)和呼吸功能的差异。结果对照组患者T0与T1、T2、T3时的HR分别为(69.4±8.3)次/min、(71.7±8.8)次/min、(73.1±7.8)次/min、(74.7±4.3)次/min,CVP分别为(7.4±1.3)cmH2O、(7.8±1.4)cmH2O、(7.9±1.4)cmH2O、(7.8±1.4)cmH2O,观察组患者T0与T1、T2、T3时的HR分别为(73.5±7.8)次/min、(75.5±7.5)次/min、(74.7±8.0)次/min、(74.2±6.2)次/min,CVP分别为(7.4±1.7)cmH2O、(7.7±1.3)cmH2O、(7.6±1.4)cmH2O、(7.6±1.7)cmH2O,两组各时间点的HR、CVP比较差异均无统计学意义(P>0.05);对照组患者的T0与T1、T2、T3时的SBP分别为(118.3±16.5)mmHg、(124.5±21.6)mmHg、(125.3±19.9)mmHg、(125.5±18.4)mmHg,DBP分别为(73.1±8.8)mmHg、(77.3±6.8)mmHg、(78.2±7.1)mmHg、(77.5±7.5)mmHg,观察组患者的T0与T1、T2、T3时的SBP分别为(118.1±20.1)mmHg、(120.3±19.7)mmHg、(120.2±19.9)mmHg、(119.3±18.7)mmHg,DBP分别为(73.4±11.8)mmHg、(75.5±8.3)mmHg、(75.3±8.5)mmHg、(74.6±9.1)mmHg,两组各时间点的SBP、DBP比较差异均无统计学意义(P>0.05);观察组患者的趾指血氧饱和度和潮气量下降的发生率分别为18.00%、16.00%,明显低于对照组的2.00%、6.00%,差异均有统计学意义(P<0.05)。结论PCNL手术中应用改良泌尿外科手术床进行俯卧位手术,能方便、快捷防止局部皮肤受损,降低神经的损伤,对呼吸功能的影响不大。

Objective To explore the application of modified urological surgical bed in percutaneous nephrolithotomy(PCNL).Methods A total of 200 patients with PCNL in prone position were selected from Shaoguan First People's Hospital from December 2016 to December 2017.According to random number table,the patients were randomly divided into control group and observation group,with 100 patients in each group.The vital signs(systemic blood pressure[SBP],diastolic blood pressure[DBP]),hemodynamic indexes(heart rate[HR],central venous pressure[CVP]),oxygen saturation of blood(SpO2),and respiratory function were compared between the two groups before PCNL(T0)and 3 minutes(T1),5 minutes(T2)and 10 minutes(T3)after PCNL.Results In the control group,HR at T0,T1,T2,T3 was(69.4±8.3)times/min,(71.7±8.8)times/min,(73.1±7.8)times/min,(74.7±4.3)times/min,and CVP was(7.4±1.3)cmH2O,(7.8±1.4)cmH2O,(7.9±1.4)cmH2O,(7.8±1.4)cmH2O,respectively,versus(73.5±7.8)times/min,(75.5±7.5)times/min,(74.7±8.0)times/min,(74.2±6.2)times/min and(7.4±1.7)cmH2O,(7.7±1.3)cmH2O,(7.6±1.4)cmH2O,(7.6±1.7)cmH2O in the observation group;there was no significant difference in HR and CVP between the two groups(P>0.05).In the control group,at T0,T1,T2,T3,SBP was(118.3±16.5)mmHg,(124.5±21.6)mmHg,(125.3±19.9)mmHg,(125.5±18.4)mmHg,and DBP was(73.1±8.8)mmHg,(77.3±6.8)mmHg,(78.2±7.1)mmHg,(77.5±7.5)mmHg,respectively,versus(118.1±20.1)mmHg,(120.3±19.7)mmHg,(120.2±19.9)mmHg,(119.3±18.7)mmHg and(73.4±11.8)mmHg,(75.5±8.3)mmHg,(75.3±8.5)mmHg,(74.6±9.1)mmHg in the observation group;there was no significant difference in SBP and DBP between the two groups(P>0.05).The incidences of SpO2 decrease and tidal volume decrease in the observation group were 18.00%and 16.00%,significantly lower than 2.00%and 6.00%in the control group(P<0.01).Conclusion In PCNL operation,the modified urological surgical bed can be used for prone position operation,which is convenient and quick to prevent local skin damage,reduce nerve damage,and has little effect on respiratory function.