术中改良体位在胸腔镜肺癌根治术患者中的应用

Application of intraoperative modified position in lung cancer patients undergoing thoracoscopic radical resection

目的分析术中改良体位在胸腔镜肺癌根治术患者中的应用效果。方法将108例接受胸腔镜肺癌根治术治疗的患者按术中体位的不同分为常规组54例和改良组54例。常规组术中采用常规体位,改良组术中采用改良体位。对比两组患者手术指标、循环指标[收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、眼压]、呼吸指标[气道峰压(P_(peak))、脉搏血氧饱和度(SpO_(2))、呼气末二氧化碳分压(PetCO_(2))、气道压]、双下肢静脉血流速及术后并发症发生情况。结果改良组患者体位摆放时间明显长于常规组,手术时间明显短于常规,术中出血量明显少于常规组,满意度评分明显高于常规组,差异均有统计学意义(P﹤0.01)。术中,常规组患者SBP、DBP、MAP、眼压均高于体位摆放前和改良组,差异均有统计学意义(P﹤0.05)。术中,改良组患者PetCO_(2)、P_(peak)和SpO_(2)均高于本组体位摆放前,气道压低于本组体位摆放前,常规组患者PetCO_(2)、P_(peak)、SpO_(2)和气道压均高于本组体位摆放前,且改良组患者PetCO_(2)、P_(peak)、气道压均低于常规组,SpO_(2)高于常规组,差异均有统计学意义(P﹤0.05)。术中,两组患者双下肢血流速均低于本组体位摆放前,且改良组患者双下肢静脉血流速均高于常规组,差异均有统计学意义(P﹤0.05)。改良组患者术后并发症总发生率低于常规组患者,差异有统计学意义(P﹤0.05)。结论术中改良体位更符合胸腔镜肺癌根治术患者的个性化要求,可缩短手术时间,减少术中出血量,通过减轻对患者胸腔的压迫而减轻对患者循环指标与呼吸指标的影响,减轻患者双下肢静脉血流速减缓程度,降低术后并发症发生风险。

Objective To analyze the application effect of intraoperative modified position in lung cancer patients un-dergoing thoracoscopic radical resection.Method A total of 108 lung cancer patients who underwent thoracoscopic radi-cal resection were divided into the conventional group(54 cases)and the improved group(54 cases)according to differ-ent positions during operation.In the conventional group,the conventional position was adopted,and in the improved group,the modified position was adopted.Surgical indicators,circulation indicators[systolic blood pressure(SBP),dia-stolic blood pressure(DBP),mean arterial pressure(MAP),intraocular pressure],respiratory indicators[peak airway pres-sure(P_(peak)),pulse blood oxygen saturation(SpO_(2)),partial pressure of end-tidal carbon dioxide(PetCO_(2)),airway pressure],blood flow velocity of both lower limbs and postoperative complications were compared between the two groups.Result The patients in the improved group had significantly longer posture time,significantly shorter operation time,significant-ly less intraoperative blood loss,and significantly higher satisfaction score than the conventional group,the differences were statistically significant(P<0.01).During the operation,SBP,DBP,MAP and intraocular pressure in conventional group were higher than those before postural placement and improved group,and the differences were statistically signifi-cant(P<0.05).During the operation,PetCO_(2),P_(peak),and SpO_(2) of the improved group were higher and airway pressure was lower than those before postural placement,PetCO_(2),P_(peak),SpO_(2) and airway pressure of the conventional group were high-er than those before postural placement,PetCO_(2),P_(peak) and airway pressure of the improved group were lower than those of the conventional group,and SpO_(2) was higher than that of the conventional group,the differences were statistically signifi-cant(P<0.05).During the operation,the blood flow velocity of both lower limbs in both groups were lower than those be-fore postural placement,and the blood flow velocity of both lower limbs in the improved group were higher than those in the conventional group,the differences were statistically significant(P<0.05).The total incidence of postoperative compli-cations in the improved group was lower than that in the conventional group,and the difference was statistically signifi-cant(P<0.05).Conclusion The intraoperative modified position is more meet the individual requirements of patients un-dergoing thoracoscopic radical resection,can shorten the operation time,reduce the amount of intraoperative blood loss,reduce the impact on the circulatory and respiratory indexes of patients by alleviating the compression of the chest cavity,reduce the degree of venous blood flow of patients’lower limbs,and reduce the risk of postoperative complications.