斜仰卧位和俯卧位对MPCNL患者术中腹压及预后的影响

摘要

目的 比较斜仰卧位和俯卧位对微创经皮肾镜碎石术(MPCNL)患者术中腹压及预后的影响.方法 纳入2016年4月至2017年5月在自贡第三人民医院泌尿外科接受MPCNL术的74例单侧输尿管结石患者为研究对象,以随机抽签法将患者分为两组,每组37例,A组取斜仰卧位,B组取俯卧位,记录并比较两组患者的手术时间、平均术中出血量、通道建立时间、体位舒适度,以及术前、手术完成时患者平均动脉压(MAP)、血氧饱和度(SpO2)、平均心率(HR)、气道阻力与腹压,并比较两组患者术后住院时间、结石取净率和并发症情况.结果 A组患者的手术时间、术后住院时间、术中出血量分别为(41.58±17.09)min、(82.46±43.53)mL、(10.64±2.35)d,明显少于B组的(74.13±32.61)min、(143.75±92.38)mL、(14.26±5.60)d,差异均有统计学意义(P<0.05);A组术中重度不适患者比例为10.81%,明显低于B组的32.43%,差异有统计学意义(P<0.05);A组患者手术完成时的MAP、SpO2、HR、气道阻力、腹压分别为(53.06±11.87)mmHg、(83.18±9.35)%、(65.73±10.24)次/min、(14.72±1.53)cmH2O及(813.64±185.26)Pa,与B组的(64.17±11.15)mmHg、(75.74±8.26)%、(74.19±18.35)次/min、(17.24±2.15)cmH2O、(1176.92±196.73)Pa比较,差异均有统计学意义(P<0.05);两组患者的结石取净率均为100.00%;A组并发症总发生率为13.51%,明显低于B组的35.14%,差异有统计学意义(P<0.05).结论 与俯卧位比较,MPCNL术中取斜仰卧位能够有效抑制患者术中气道阻力与腹压的升高,减少对呼吸循环造成的影响,且能缩短手术时间,降低出血量,减小术后并发症风险,改善其预后.%Objective To compare the effects of oblique supine position and prone position on intraoperative abdominal pressure and prognosis in patients with minimally invasive percutaneous nephrolithotomy (MPCNL). Methods A total of 74 patients with unilateral ureteral calculi, who treated with MPCNL at Department of Urology Surgery of the Third People's Hospital of Zigong City from April 2016 to May 2017,were enrolled and divided into the two groups according to random number table method,with 37 cases in each group.The group A applied the oblique su-pine position,and the group B used the prone position.The operative time,mean intraoperative blood loss,channel estab-lishment time and postural comfort were recorded in the two groups,and the mean arterial pressure(MAP),blood oxy-gen saturation(SpO2),mean heart rate(HR),airway resistance and abdominal pressure were observed before operation and on the completion of operation. The postoperative hospital stay, stone removal rate and complications were com-pared between the two groups. Results The operative time, postoperative hospital stay and intraoperative blood loss were(41.58±17.09)min,(82.46±43.53)mL and(10.64±2.35)d in group A,which were significantly shorter than corre-sponding(74.13±32.61)min,(143.75±92.38)mL and(14.26±5.60)d in group B(P<0.05).The rate of severe intraopera-tive postural discomfort in group A was obviously lower than that in group B(10.81% vs 32.43%,P<0.05).The MAP lev-el, SpO2and HR, airway resistance and abdominal pressure at the completion of operation in group A were (53.06 ± 11.87) mmHg, (83.18±9.35)%, (65.73±10.24) times/min, (14.72±1.53) cmH2O and (813.64±185.26) Pa, respectively, which were significantly different from corresponding(64.17±11.15)mmHg,(75.74±8.26)%,(74.19±18.35)times/min, (17.24±2.15)cmH2O and(1 176.92±196.73)Pa in group B(P<0.05).The stone removal rates of the two groups were both 100.00%, and the total incidence rate of complications in group A was significantly lower than that in group B (13.51% vs 35.14%,P<0.05).Conclusions Compared with the prone position,the oblique supine position MPCNL can effectively inhibit the rise of patient's airway resistance and abdominal pressure,reduce the impact on the respiratory cir-culation,and shorten the operative time,reduce blood loss and postoperative complications,and improve its prognosis.