妇科盆腔肿瘤患者术中两种不同体位摆放及管理技术研究

A research on placement and management of two different positions during operation in patients with gynecological pelvic tumor

  • 摘要:
      目的  探讨两种不同手术体位对妇科盆腔恶性肿瘤手术患者截石位并发症的预防效果。
      方法  将行妇科盆腔恶性肿瘤手术患者84例随机分为试验组和对照组,每组42例。试验组应用马镫形多功能腿架,并记录手术前平卧位(T0)、摆放截石位稳定后即刻(T1)、1 h调整体位稳定后即刻(T2)、2 h调整体位稳定后即刻(T3)、手术结束时恢复平卧位稳定后即刻(T4)时的下肢静脉压,记录手术出血量、手术时间和皮肤受压情况等。对照组采用手术床配套的传统腿架,术中不改变截石位腿架高度,记录对应时间点的相关参数。
      结果  2组下肢静脉压T0差异无统计学意义(P>0.05);与T0比较,T1~T4试验组和对照组下肢静脉压均有所增加,但试验组下肢静脉压增加幅度较小,稳定情况优于对照组,差异有统计学意义(P < 0.05)。试验组较对照组压力性损伤发生率降低,差异有统计学意义(P < 0.05)。
      结论  对于摆放截石位且手术时长大于2h的患者,应用马镫形多功能腿架,并在术中动态调整体位,能减轻对下肢静脉压的影响,预防深静脉血栓,降低因截石位引起的压力性损伤的发生率。

     

    Abstract:
      Objective   To investigate the effects of two different surgical positions in prevention of complications due to lithotomy position in patients with gynecological pelvic malignant tumor.
      Methods  A total of 84 patients with gynecological pelvic malignant tumor were randomly divided into experimental group and control group, with 42 cases in each group. The experimental group was treated with stirrup-shaped multifunctional leg frame, and the venous pressures of lower limbs at the time points of the supine position before surgery (T0), immediately after the stabilization of lithotomy position (T1), immediately after 1 h adjustment and stabilization of lithotomy position (T2), immediately after 2 h adjustment and stabilization of lithotomy position (T3), immediately after stabilization of the supine position at the end of surgery (T4) as well as the bleeding volume, operation time and skin compression were recorded. The control group was treated by the traditional leg frame matched with the operating table, the height of the leg frame at the lithotomy position was not changed during the operation, and the relevant parameters at the corresponding time points were recorded.
      Results  There was no significant difference in venous pressure of lower limbs at T0 between the two groups (P>0.05). Compared with T0, venous pressure of lower limbs from T1 to T4 increased in both groups, but the increase range in the experimental group was significantly smaller and stability of venous pressure of lower limbs was better than those in the control group (P < 0.05). The incidence of stress injury in the experimental group was significantly lower than that in the control group (P < 0.05).
      Conclusion  For patients with lithotomy position and operation time longer than 2 h, the application of stirrup-shaped multifunctional leg frame and dynamic adjustment of body position during operation can reduce the impact on venous pressure of lower limbs, prevent deep venous thrombosis and reduce the incidence of pressure injury caused by lithotomy position.

     

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