人字形体位行腹腔镜腹部手术体位变化对身体受压部位压力的影响

Effect of posture change on the pressure of compressed parts of body during laparoscopically abdominal surgery of herringbone posture

目的:探讨采用人字形体位行腹腔镜腹部手术患者在体位变化时身体受压部压力的影响,并进行分析。方法:采用便利抽样方法,抽取在医院行腹腔镜下直肠手术及腹腔镜下胰腺手术的102例患者资料,所有手术患者在进入手术室采用人字形体位卧于手术床时、体位摆放后、第1次体位改变后、第2次体位改变后及手术结束体位复原后测量压力数值,并使用广义混合效应模型对测量结果进行统计学分析,确认人字形体位在体位变化时对受压点压力的影响。结果:患者体位呈水平时骶尾部压力最大为4.91 kPa,体位变化为头低位时足跟部压力最大为8.57 kPa,体位变化为头高位时骶尾部压力最大为3.57 kPa。头低位时肩胛、骶尾及足跟处压力较水平及头高位时高;术中调整手术床为头低位和从其他角度调整为水平位,肩胛处受压点压力值分别为(4.01±4.11)kPa和(3.86±3.70)kPa,与入室时水平位比较差异有统计学意义(Z=2.82,Z=3.44;P<0.05)。结论:采用人字形体位进行腹腔镜腹部手术,患者头高位时的受压点压力值明显低于水平位及头低位;调整患者体位方向会对各受压处压力产生不同的影响;使用具有静态支撑作用的可塑型床面可有效维持受压点压力的稳定性。

Objective:To investigate and analyze the effect of the pressure of compressed parts of body when patients,who adopted herringbone posture to undergo laparoscopically abdominal surgery,changed posture.Methods:The convenient sampling method was adopted to select the data of 102 patients who underwent laparoscopic rectal surgery and laparoscopic pancreatic surgery in hospital.The pressure values of all patients were measured when they were lying on the operating table as herringbone posture,and after their body positions were placed,and after their body position changed at the first time,and after their body position changed at the second time and after their body positions recovery at the end of the operation.The measurement results were statistically analyzed by using the generalized mixed effect model,and then,the effects of the pressure on compressed points were confirmed when herringbone posture changed.Results:The maximum pressure of sacrococcygeal region was 4.91 kPa when the position of patients were supine position,and the maximum pressure of foot heel was 8.57 kPa when head was low position.The maximum pressure of sacrococcygeal region was 3.57 kPa when head was high position.The pressures of the shoulder,sacrococcygeal tail and heel were higher than those of supine position and head at high position,respectively.The pressure values of compressed point of shoulder were(4.01±4.11)kPa and(3.86±3.70)kPa,respectively,when the operating table was adjusted to low position of head and the position was adjusted to horizontal position during surgery.And the differences of the pressure value between the two positions and the horizontal position when patients went in operation room were significant(Z=2.82,Z=3.44,P<0.05),respectively.Conclusion:The pressure value of compression point in patients with high head position is significantly lower than that in patients with horizontal position and low head position,respectively,when they adopted herringbone posture to implement laparoscopically abdominal surgery.The adjustment of position direction of patients can cause different effects,and the plastic bed surface with support effect in static state can effectively maintain the stability of pressure at the compression point.