改良斜仰卧截石位在经皮肾镜碎石取石术中的应用效果观察
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摘要
目的观察改良斜仰卧截石位在经皮肾镜碎石取石术中的应用效果。方法 100例行上段输尿管结石微创治疗的患者,按照随机数字表法分为观察组和对照组,每组50例。所有患者均给予经皮肾镜碎石取石术,对照组患者采取常规俯卧位加一般护理方法 ,观察组患者采取改良斜仰卧截石位加合适的护理方式。观察比较两组患者的术中出血量、手术体位摆置时间、手术时间及麻醉前后生命体征指标变化情况。结果观察组患者的术中出血量为(63.22±5.27)ml,明显少于对照组的(81.42±6.09)ml,手术体位摆置时间及手术时间分别为(4.24±1.52)、(42.33±7.61)min,均明显短于对照组的(4.95±1.73)、(47.88±6.42)min,差异均有统计学意义(P<0.05)。观察组患者麻醉后即时和麻醉后5 min的心率(HR)、收缩压(SBP)、舒张压(DBP)均明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者麻醉前、麻醉后即时、麻醉后5 min的HR、SBP、DBP比较差异均无统计学意义(F=0.934、0.327、1.367,P=0.395、0.722、0.258>0.05)。但对照组麻醉前、麻醉后即时、麻醉后5 min的HR、SBP、DBP比较差异均有统计学意义(F=5.045、6.403、15.798, P=0.008、0.002、0.000<0.05)。结论改良斜仰卧截石位在经皮肾镜碎石取石术中具有良好的临床应用效果,能够减少术中出血量,缩短手术体位摆置时间及手术时间,有效维持患者术中生命体征平稳,值得临床推广。
Objective To observe the application effect of modified oblique lithotomy position in percutaneous nephrolithotomy. Methods A total of 100 upper ureteral calculi patients undergoing minimally invasive therapy were divided by random number table method into observation group and control group, with 50 cases in each group. All patients received percutaneous nephrolithotomy. The control group received routine prone position and general nursing method, and the observation group received modified oblique lithotomy position and appropriate nursing method. Observation and comparison were made on intraoperative bleeding volume, operation posture setting time, operation time and vital signs before and after anesthesia between the two groups. Results The observation group had obviously less intraoperative bleeding volume as(63.22±5.27) ml than(81.42±6.09) ml in the control group, and obviously shorter operation posture setting time and operation time respectively as(4.24±1.52) and(42.33±7.61) min than(4.95±1.73) and(47.88±6.42) min in the control group. Their difference was statistically significant(P<0.05). At immediately after anesthesia and 5 minutes after anesthesia, the observation group had obviously lower heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) than the control group, and their difference was statistically significant(P<0.05). The observation group had no statistically significant difference in HR, SBP, DBP before anesthesia, immediately after anesthesia and 5 minutes after anesthesia(F=0.934, 0.327, 1.367, P=0.395, 0.722, 0.258>0.05). But the control group had statistically significant difference in HR, SBP, DBP before anesthesia, immediately after anesthesia and 5 minutes after anesthesia(F=5.045, 6.403, 15.798, P=0.008, 0.002, 0.000<0.05). Conclusion Modified oblique lithotomy position shows good clinical application effect in percutaneous nephrolithotomy, and it can reduce bleeding volume during operation, shorten operation position setting time and operation time, and effectively maintain the stability of vital signs during operation. It is worthy of clinical promotion.
Objective To observe the application effect of modified oblique lithotomy position in percutaneous nephrolithotomy. Methods A total of 100 upper ureteral calculi patients undergoing minimally invasive therapy were divided by random number table method into observation group and control group, with 50 cases in each group. All patients received percutaneous nephrolithotomy. The control group received routine prone position and general nursing method, and the observation group received modified oblique lithotomy position and appropriate nursing method. Observation and comparison were made on intraoperative bleeding volume, operation posture setting time, operation time and vital signs before and after anesthesia between the two groups. Results The observation group had obviously less intraoperative bleeding volume as(63.22±5.27) ml than(81.42±6.09) ml in the control group, and obviously shorter operation posture setting time and operation time respectively as(4.24±1.52) and(42.33±7.61) min than(4.95±1.73) and(47.88±6.42) min in the control group. Their difference was statistically significant(P<0.05). At immediately after anesthesia and 5 minutes after anesthesia, the observation group had obviously lower heart rate(HR), systolic blood pressure(SBP), diastolic blood pressure(DBP) than the control group, and their difference was statistically significant(P<0.05). The observation group had no statistically significant difference in HR, SBP, DBP before anesthesia, immediately after anesthesia and 5 minutes after anesthesia(F=0.934, 0.327, 1.367, P=0.395, 0.722, 0.258>0.05). But the control group had statistically significant difference in HR, SBP, DBP before anesthesia, immediately after anesthesia and 5 minutes after anesthesia(F=5.045, 6.403, 15.798, P=0.008, 0.002, 0.000<0.05). Conclusion Modified oblique lithotomy position shows good clinical application effect in percutaneous nephrolithotomy, and it can reduce bleeding volume during operation, shorten operation position setting time and operation time, and effectively maintain the stability of vital signs during operation. It is worthy of clinical promotion.
引文
[1]杨夕柏.俯卧位、仰卧位及侧卧位在经皮肾镜碎石取石术中的应用研究.中国内镜杂志, 2013, 19(10):1098-1100.
[2]袁顺辉,杨德林,李志鹏,等.侧斜头低截石位行输尿管镜治疗输尿管上段结石.中国内镜杂志, 2016, 22(8):87-89.
[3]汪隆旺,肖瑞海,余义,等.侧卧斜仰截石位单通道微创经皮肾镜联合输尿管软镜一期治疗复杂性肾结石的疗效观察.临床泌尿外科杂志, 2017, 32(6):422-425.
[4]刘学治,周军来,萧建亮,等.改良斜仰卧截石位经皮肾镜手术治疗肾输尿管结石临床观察.临床误诊误治, 2016, 29(6):36-38.
[5]郭景阳,杨文增,张彦桥,等.斜仰卧截石位单通道经皮肾镜联合经皮软镜治疗复杂肾结石的疗效观察.中国内镜杂志,2017, 23(4):95-97.
[6]杜昌国,贺利锋,王东,等.不同体位经皮肾镜取石术治疗孤立性肾结石的疗效观察.局解手术学杂志, 2017, 26(9):690-693.
[2]袁顺辉,杨德林,李志鹏,等.侧斜头低截石位行输尿管镜治疗输尿管上段结石.中国内镜杂志, 2016, 22(8):87-89.
[3]汪隆旺,肖瑞海,余义,等.侧卧斜仰截石位单通道微创经皮肾镜联合输尿管软镜一期治疗复杂性肾结石的疗效观察.临床泌尿外科杂志, 2017, 32(6):422-425.
[4]刘学治,周军来,萧建亮,等.改良斜仰卧截石位经皮肾镜手术治疗肾输尿管结石临床观察.临床误诊误治, 2016, 29(6):36-38.
[5]郭景阳,杨文增,张彦桥,等.斜仰卧截石位单通道经皮肾镜联合经皮软镜治疗复杂肾结石的疗效观察.中国内镜杂志,2017, 23(4):95-97.
[6]杜昌国,贺利锋,王东,等.不同体位经皮肾镜取石术治疗孤立性肾结石的疗效观察.局解手术学杂志, 2017, 26(9):690-693.