腹腔镜手术中体位对患者呼吸循环的影响及术后不良反应观察

Effect of Body Position on Respiratory Circulation and Postoperative Adverse Reactions in Laparoscopic Surgery

目的:探讨腹腔镜手术中不同角度头低位对患者呼吸循环的影响及术后不良反应。方法:选取2021年1-12月佛山市第一人民医院禅城医院行头低位腹腔镜手术患者90例,按随机数字表法分为A、B、C组,各30例。A组气腹后摇床头后倾15°,B组气腹后摇床头后倾20°,C组气腹后摇床头后倾25°。比较三组不同时间[麻醉后(T_(0))、气腹并改变体位后10 min(T_(1))、气腹结束后5 min未改变体位前(T_(2))]的呼吸循环指标[平均动脉压(MAP)、心率(HR)、气道峰压(Ppeak)、呼气末二氧化碳分压(P_(ET)CO_(2))值],并观察术后不良反应发生情况。结果:T_(0)时,三组MAP、HR、Ppeak、P_(ET)CO_(2)比较,差异无统计学意义(P>0.05);T_(1)、T_(2)时,三组MAP、HR、Ppeak、P_(ET)CO_(2)均高于T_(0)时,且A组均低于B、C组,差异均有统计学意义(P<0.05)。A组的不良反应发生率低于B、C组,差异有统计学意义(P<0.05)。结论:腹腔镜手术中头低位15°相较于头低位20°、25°对患者呼吸循环的影响更小,术后不良反应发生率也更低,手术医师应在可操作范围内尽量减少头低位角度,以提高手术的安全性。

Objective:To investigate the effects of different angles of head down on respiratory circulation and postoperative adverse reactions in laparoscopic surgery.Method:A total of 90 patients who underwent head down laparoscopic surgery in Chancheng Hospital of Foshan First People’s Hospital from January to December 2021 were divided into group A,B and C according to the method of random number table,with 30 cases in each group.The rear tilt of the head of the shaking table was 15°in group A,20°in group B and 25°in group C.The respiratory and circulatory indexes[mean arterial pressure(MAP),heart rate(HR),peak airway pressure(Ppeak),and pressure of end-tidal carbon dioxide(P_(ET)CO_(2))]of the three groups at different times[after anesthesia(T_(0)),10 min after pneumoperitoneum and changing posture(T_(1)),and 5 min after pneumoperitoneum without changing posture(T_(2))]were compared,and the occurrence of postoperative adverse reactions was observed.Result:There were no significant differences in MAP,HR,Ppeak and P_(ET)CO_(2) between the three groups at T_(0)(P>0.05).At T_(1) and T_(2),MAP,HR,Ppeak and P_(ET)CO_(2) in the three groups were higher than those at T_(0),and group A was lower than group B and C,the differences were statistically significant(P<0.05).The incidence of adverse reactions in group A was lower than that in group B and C(P<0.05).Conclusion:Compared with 20°and 25°of head down position,15°of head down position in laparoscopic surgery has less impact on respiratory circulation and lower incidence of postoperative adverse reactions.Surgeons should reduce the angle of head down position within the operable range to improve the safety of operation.