改进头低足高“人”字形卧位在腹腔镜直肠癌前切除术中的应用研究

A Study on Patients Taking"人"-shaped Head High-Feet Low Prone Position During Laparoscopic Anterior Resection for Rectal Cancer

为探讨改进头低足高"人"字形卧位在腹腔镜直肠癌前切除术中的应用效果,将2018年6月至2019年8月拟于我院行腹腔镜直肠癌前切除术的130例患者随机分为对照组和观察组,各65例。对照组术中取常规头低足高截石位,观察组术中取改进头低足高"人"字形卧位。比较2组患者体位变化前后心率、平均动脉压差值,围术期不同时间点眼内压,肩部、下肢疼痛发生率及疼痛程度,以及体位满意度。围术期取6个时点,即体位安置前3min(T0),气腹并头低足高位后3min(T1)、60min(T2)、120min(T3),恢复平卧位前3min(T4)及恢复平卧位后3min(T5)、30min(T6)。结果显示,观察组患者摆放体位前后及恢复平卧位前后心率、平均动脉压差值均大于对照组(P<0.05)。2组患者摆放体位后至恢复平卧位前,眼内压均逐渐升高;但T1、T2、T3、T4、T5时观察组患者眼内压均明显低于对照组,且观察组相邻两观察时间点间眼内压差值均明显小于对照组,P<0.05。观察组术后肩部疼痛、下肢疼痛麻木发生率均低于对照组,且观察组患者术后肩部疼痛、下肢疼痛评分均低于对照组,P<0.05。观察组体位满意度明显高于对照组,P<0.05。结果表明,腹腔镜直肠癌前切除术中患者取改进头低足高"人"字形卧位,可有效减少其术中心率、平均动脉压波动,控制术中眼内压,降低术后下肢痛、肩痛发生率,增加体位满意度,值得临床推广应用。

This study was to investigate the efficacy of patients taking " 人"-shaped prone position during laparoscopic anterior resection for rectal cancer(LARRC)in author’s hospital(2018-06-2019-08)into control group(65 cases,patients took routine head high-feet low lithotomy posture)and observation group(65 cases,modified as " 人"-shaped prone posture);then,compared both groups’ patients’ heart rate(HR),and average arterial pressure(AAP)difference before and after posture change;intraocular pressures at different time-points of perioperation;the incidence and intensity of shoulder pain and lower exteremitis pain,as well as satisfactory degree on postures.Here were 6 time-points:3 min before taking posture(T0),3 min head high-feet low posture with pneumoperitoneum(T1),afterwards,60 min(T2),120 min(T3);30 min before turning to horizontal posture(T4),as well as 3 min after so did(T5),and 30 min after so did(T6).As results,before and after taking posture,as well as before and after turning to horizontal posture,HR and AAP difference of observation groups’ patients were larger than control groups’ patients(P<0.05);from posture taken to before turning to horizontal posture,both groups’ intraocular pressure were gradually uplifted,but at T1,T2,T3,T4 and T5 observation group’s one was significantly lower than control groups’ one,and,the difference of pressure between the every two adjoining time-points was less than the control groups’ difference(P<0.05);in observation group the incidence of pain & numbness of shoulder and lower extremities was lower than that in control group(P<0.05),also,the score on pain of shoulder and lower exteremities did so(P<0.05);the posture satisfactory degree of observation group was significantly higher than that of control group(P<0.05).Results show that patients taking " 人"-shaped head high-feet low prone posture can effectively reduce intraoperative wave of HR and AAP,control intraoperative intraocular pressure,relieve postoperative lower extremity and shoulder pain incidence,uplift satisfactory degree on posture,thus worthy to be popularized to use clinically.