腰肋悬空半截石位和俯卧位经皮肾镜取石术对主观感觉的影响

Effect of the flank suspended semi-lithotomy and prone position on subjective sensation of the patients under percutaneous nephrolithotomy

目的探讨腰肋悬空半截石位和俯卧位经皮肾镜取石术(PCNL)对主观感觉的影响。方法选取2018年6月-2020年12月于长江航运总医院泌尿外科行PCNL的患者100例,通过入院顺序将患者分为治疗组(腰肋悬空半截石位组)和对照组(俯卧位组),每组50例。比较两组患者体位舒适度、呼吸困难感、术后24 h疼痛感、术者舒适度、麻醉师舒适度、手术时间和结石清除率。结果治疗组手术时间明显较对照组短[(86.0±9.7)和(108.1±11.2)min],患者体位舒适度[(5.8±0.6)和(3.7±0.6)分]和呼吸困难感[(3.3±0.7)和(5.7±0.7)分]优于对照组,差异有统计学意义(t=-10.92,t=16.33,t=-18.44;均P<0.01)。术后24 h伤口疼痛感[(3.8±0.6)和(3.6±0.6)分]和结石清除率[86.0%(43/50)和90.0%(45/50)]比较,差异均无统计学意义(t=1.48,P=0.146;χ^(2)=0.38,P=0.538)。治疗组术者舒适度[(6.2±1.4)和(5.4±1.6)分;t=2.31,P=0.025]和麻醉师舒适度[(7.4±1.3)和(6.7±1.4)分;t=2.51,P=0.015]均明显优于对照组。结论采用腰肋悬空半截石位行PCNL手术,患者拥有较好的体位舒适度,呼吸困难感轻微,手术安全有效,适合于高龄高危、极度肥胖和慢性心肺功能不全的患者。

Objective To explore the subjective sensation of the patients with percutaneous nephrolithotomy(PCNL)under the flank suspended semi-lithotomy position and prone position.Methods 100 cases under PCNL from June 2018 to December 2020,were divided into the treatment group(the flank suspended semi-lithotomy position group)and the control group(the prone position group)according to the order of admission,there were 50 cases in each group.The patients’postural comfort,dyspnea,pain 24 h after operation,operator comfort,anesthesiologist comfort,operation time and stone removal rate were compared between the two groups.Results As compared to the control group,the treatment group had shorter operation time[(86.0±9.7)vs(108.1±11.2)min],better patients’posture comfort[(5.8±0.6)vs(3.7±0.6)]and less dyspnea[(3.3±0.7)vs(5.7±0.7)],there was statistical difference(t=-10.92,t=16.33,t=-18.44;P<0.01).There was no statistical significance between the two groups in the results of postoperative pain[(3.8±0.6)vs(3.6±0.6)]and stone removal rate[86.0%(43/50)vs 90.0%(45/50)](t=1.48,P=0.146;χ^(2)=0.38,P=0.538).As compared to the control group,the treatment group had better operator comfort[(6.2±1.4)vs(5.4±1.6);t=2.31,P=0.025]and anesthesiologist comfort[(7.4±1.3)vs(6.7±1.4);t=2.51,P=0.015].Conclusion Under the position of flank suspended semi-lithotomy,the patients under PCNL experienced better postural comfort and less dyspnea.This surgical position of flank suspend semilithotomy is especially suitable for the patients of the elderly,frail,high-risk obese and chronic cardiopulmonary insufficiency.