不同手术体位在老年肥胖患者经皮肾镜取石术中的应用效果观察
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摘要
目的探究斜仰卧位联合截石位、传统俯卧位在老年肥胖患者经皮肾镜取石术中的应用效果。方法选取我院2008年9月~2015年9月收治的行经皮肾镜取石术老年肥胖患者共112例,按照入院时间顺序随机分为对照组(n=55)与观察组(n=57),对照组患者采取传统俯卧位,观察组采取斜仰卧位联合截石位,比较两组患者手术一般情况、一次性结石除净率及不同体位对患者循环、呼吸的影响。结果观察组手术持续时间、术中出血量均明显低于对照组,结石一次性除净率高于对照组(P<0.05)。观察组患者体位安置后30min SBP、DBP、HR及Sa O2%与安置前无明显差异(P>0.05)。对照组体位安置后30min SBP、DBP、Sa O2%低于安置前,HR高于安置前(P<0.05)。对照组不能耐受手术体位摆放人数及VAS 3级以上人数明显多于观察组(P<0.05)。结论斜仰卧位联合截石位在老年肥胖患者经皮肾镜取石术中具有手术操作简便、创伤性小、对患者循环、呼吸系统影响较小等特点,值得临床推广运用。
Objective To explore the application of oblique supine position combined with lithotomy position and traditional prone position in elderly obese patients' percutaneous nephrolithotomy. Methods A total of 112 elderly obese patients which treated with percutaneous nephrolithotomy were selected in our hospital from September 2008 to 2015 September, all patients were randomly divided as the control group(n=55) and observation group(n=57) according to the sequence of hospitalize time. The patients in control group were given the traditional prone position, the patients in observation group were given the oblique supine position combined with lithotomy position. The operation general condition, one-time stone disposable rate and effect of different postures on patients with circulation and respiration were compared between two groups. Results Duration of operation time, intraoperative bleeding in observation group was significantly lower than that in control group, one-time stone disposable rate higher than that of the control group(P < 0.05). SBP, DBP, HR, Sa O2 at 30 min after placement were not significantly different(P > 0.05) with before-replacement in the observation group. SBP DBP, Sa O2 at 30 min after placement in control group were lower than before-placement, HR higher than beforeplacement(P < 0.05). The patients who could not tolerate the operation position and the number of VAS 3 in control group significantly more than the observation group(P < 0.05). Conclusion Oblique supine position combined with lithotomy position in the elderly obese patients' percutaneous nephrolithotomy has the advantages of simple operation, traumatic small, little influence on circulatory and respiratory system, it is worth of clinical application.
Objective To explore the application of oblique supine position combined with lithotomy position and traditional prone position in elderly obese patients' percutaneous nephrolithotomy. Methods A total of 112 elderly obese patients which treated with percutaneous nephrolithotomy were selected in our hospital from September 2008 to 2015 September, all patients were randomly divided as the control group(n=55) and observation group(n=57) according to the sequence of hospitalize time. The patients in control group were given the traditional prone position, the patients in observation group were given the oblique supine position combined with lithotomy position. The operation general condition, one-time stone disposable rate and effect of different postures on patients with circulation and respiration were compared between two groups. Results Duration of operation time, intraoperative bleeding in observation group was significantly lower than that in control group, one-time stone disposable rate higher than that of the control group(P < 0.05). SBP, DBP, HR, Sa O2 at 30 min after placement were not significantly different(P > 0.05) with before-replacement in the observation group. SBP DBP, Sa O2 at 30 min after placement in control group were lower than before-placement, HR higher than beforeplacement(P < 0.05). The patients who could not tolerate the operation position and the number of VAS 3 in control group significantly more than the observation group(P < 0.05). Conclusion Oblique supine position combined with lithotomy position in the elderly obese patients' percutaneous nephrolithotomy has the advantages of simple operation, traumatic small, little influence on circulatory and respiratory system, it is worth of clinical application.
引文
[1]张成龙,齐忠权.尿路结石现代治疗方法的探讨[J].中华腔镜泌尿外科杂志(电子版),2015,9(1):59-62.
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[3]郭锥锋.经皮肾镜取石术的研究进展[J].国际泌尿系统杂志,2014,34(3):389-392.
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[6]罗建仕,陈光,曾四平,等.不同体位经皮肾镜取石术对患者肾血流动力学的影响研究[J].黑龙江医学,2014,38(9):1011-1013.
[7]张发.不同体位微创经皮肾镜取石术治疗梗阻性结石术中肾盂内压的比较[D].南昌:南昌大学医学院,2014:1-35.
[8]郑艳红,苏茜茜,朱建龙,等.不同手术体位在经皮肾镜碎石取石术中的应用研究[J].浙江创伤外科,2011,19(5):611-612.
[9]舒铁环,李力,向桂桥,等.两种体位对微创经皮肾镜取石术中腹内压及出血量的影响[J].中国内镜杂志,2012,18(3):249-251.
[10]乔亮,刘志权,向俊,等.三种不同体位在经皮肾镜碎石术中的应用对比[J].现代泌尿外科杂志,2013,18(3):275-277.
[11]胡宏.微创经皮肾镜取石术治疗上尿路结石25例临床分析[J].中国医药科学,2013,3(22):185-186.
[12]田雪梅.两种不同手术体位在经皮肾镜取石手术中的比较[J].延边医学,2015,4(155):195-196.
[13]汤晓芬,张丽青,郑冬华,等.斜仰卧位联合改良截石位在微创经皮肾镜碎石取石术中的应用[J].护理学报,2011,18(18):54-56.
[14]许可慰,张彩霞,郭正辉,等.斜仰卧-截石位经皮肾镜取石术治疗复杂性肾结石[J].中华腔镜泌尿外科杂志(电子版),2012,6(5):5-8.
[15]杨杨.斜仰卧位联合截石位在经皮肾镜取石手术中的应用体会[C].中华护理学会第15届全国手术室护理学术交流会议,2011:1-34.
[16]彭丽,王兰英.斜仰卧位联合截石位经皮肾镜碎石取石术112例围术期护理[J].齐鲁护理杂志,2014,20(2):78-79.
[17]黄寿付,覃斌,李长赞,等.复杂性输尿管上段结石行经皮肾输尿管镜取石术的效果观察[J].现代诊断与治疗,2015,26(24):5703-5704.
[2]陈占敏.微创经皮肾镜碎石术治疗上尿路结石的临床分析[J].中国实用医药,2015,10(5):96-97.
[3]郭锥锋.经皮肾镜取石术的研究进展[J].国际泌尿系统杂志,2014,34(3):389-392.
[4]姜道彬,邱明,龙平华,等.经皮肾镜取石术治疗肾结石的研究进展[J].海南医学,2012,23(1):113-115.
[5]常丛旺,王学华.经皮肾镜取石术治疗上尿路结石新进展[J].中国医药科学,2012,2(21):60-62.
[6]罗建仕,陈光,曾四平,等.不同体位经皮肾镜取石术对患者肾血流动力学的影响研究[J].黑龙江医学,2014,38(9):1011-1013.
[7]张发.不同体位微创经皮肾镜取石术治疗梗阻性结石术中肾盂内压的比较[D].南昌:南昌大学医学院,2014:1-35.
[8]郑艳红,苏茜茜,朱建龙,等.不同手术体位在经皮肾镜碎石取石术中的应用研究[J].浙江创伤外科,2011,19(5):611-612.
[9]舒铁环,李力,向桂桥,等.两种体位对微创经皮肾镜取石术中腹内压及出血量的影响[J].中国内镜杂志,2012,18(3):249-251.
[10]乔亮,刘志权,向俊,等.三种不同体位在经皮肾镜碎石术中的应用对比[J].现代泌尿外科杂志,2013,18(3):275-277.
[11]胡宏.微创经皮肾镜取石术治疗上尿路结石25例临床分析[J].中国医药科学,2013,3(22):185-186.
[12]田雪梅.两种不同手术体位在经皮肾镜取石手术中的比较[J].延边医学,2015,4(155):195-196.
[13]汤晓芬,张丽青,郑冬华,等.斜仰卧位联合改良截石位在微创经皮肾镜碎石取石术中的应用[J].护理学报,2011,18(18):54-56.
[14]许可慰,张彩霞,郭正辉,等.斜仰卧-截石位经皮肾镜取石术治疗复杂性肾结石[J].中华腔镜泌尿外科杂志(电子版),2012,6(5):5-8.
[15]杨杨.斜仰卧位联合截石位在经皮肾镜取石手术中的应用体会[C].中华护理学会第15届全国手术室护理学术交流会议,2011:1-34.
[16]彭丽,王兰英.斜仰卧位联合截石位经皮肾镜碎石取石术112例围术期护理[J].齐鲁护理杂志,2014,20(2):78-79.
[17]黄寿付,覃斌,李长赞,等.复杂性输尿管上段结石行经皮肾输尿管镜取石术的效果观察[J].现代诊断与治疗,2015,26(24):5703-5704.