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

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SaO2%与安置前无明显差异（P＞0.05）。对照组体位安置后30min SBP、DBP、SaO2%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, SaO2 at 30min after placement were not significantly different(P>0.05) with before-replacement in the observation group. SBP DBP, SaO2 at 30min after placement in control group were lower than before-placement, HR higher than before-placement(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.