摘要
目的探讨俯卧位不同摆放方式对胸腰椎手术患者术中血液循环的影响及预防压力性损伤(PI)的效果。方法选取2020年4月—2021年2月87例行胸腰椎后路椎间融合器植入植骨融合术患者,将其随机分成观察组42例和对照组45例。比较2组患者深静脉血栓(DVT)、PI情况。分别记录摆俯卧位前平卧时(T_(0))、摆放俯卧位稳定后即刻(T_(1))、手术0.5 h(T_(2))、手术1 h(T_(3))、手术1.5 h(T_(4))、手术2 h(T_(5))、手术结束缝皮时(T_(6))、手术结束恢复仰卧位稳定后即刻(T_(7))时点下肢静脉压(LEVP)、心率、平均动脉压。结果与T_(0)时点比较,观察组患者T_(1)~T_(6)时点的LEVP均较高,差异有统计学意义(P<0.05);与T_(0)时点比较,对照组患者T_(1)~T_(7)时点的LEVP均较高,差异有统计学意义(P<0.05)。2组T_(1)、T_(7)时点LEVP与T_(0)时点LEVP的差值(ΔLEVP)比较,差异有统计学意义(P<0.05)。观察组下肢DVT发生例数1例,未发生者41例;对照组下肢DVT发生例数7例,未发生者38例。2组患者术后3 d下肢DVT发生率比较,差异有统计学意义(P<0.05)。观察组左侧和右侧髂部PI发生率较对照组低,差异有统计学意义(P<0.05),2组PI严重程度均为Ⅰ期。2组头面部、前胸部、膝部的PI发生率差异无统计学意义(P>0.05)。2组胸腰椎手术患者俯卧位不同时点心率、平均动脉压以及出血量、手术时间比较,差异无统计学意义(P>0.05)。结论俯卧位胸腰椎手术患者下肢低角度摆放较传统角度能有效减小手术对下肢静脉血液回流的影响,有利于DVT的预防。分散俯卧位支撑点面积能够减轻髂部压力,显著降低PI的发生率。
Objective To investigate the effects of different postures in prone position on intraoperative blood circulation in patients undergoing thoracolumbar surgery and its impact in preventing pressure injury(PI).Methods A total of 87 patients who underwent posterior thoracolumbar interbody fusion implant from April 2020 to February 2021 were selected and randomly divided into observation group(42 cases)and control group(45 cases).Deep vein thrombosis(DVT)and PI were compared between the two groups.Lower extremity venous pressure(LEVP),heart rate and mean arterial pressure at supine position before prone position(T_(0)),immediately after prone position stabilization(T_(1)),0.5 h after operation(T_(2)),1 hafter operation(T_(3)),1.5 h after operation(T_(4))and 2 h after operation(T_(5)),at the end of surgery(T_(6))and immediately after stability of returning the supine position following the operation(T_(7))were respectively recorded.Results Compared with T_(0),values of LEVP at time points from T_(1)to T_(6)in the observation group were higher(P<0.05).Compared with T_(0),values of LEVP at time points from T_(1)to T_(7)in the control group were higher(P<0.05).The difference values of LEVP between T_(1)and T_(0)as well as between T_(7)and T_(0)(ΔLEVP)were statistically significant between the two groups(P<0.05).In the observation group,DVT occurred in 1 case and did not occur in 41 cases.In the control group,7 cases of DVT occurred and 38 cases had no DVT.There was statistical significance in the incidence of lower extremity DVT_(3)d after operation between two groups(P<0.05).The incidence rates of PI in the left and right iliac parts of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).The severity of PI in both groups was stageⅠ.There were no significant differences in the incidence rates of PI in the head and face,anterior chest and the knees in two groups(P>0.05).There was no significant difference in heart rate,mean arterial pressure,blood l
作者
周小花
邹旗
金文杰
戴荣兄
张倩
周炜
唐琳
冯建萍
ZHOU Xiaohua;ZOU Qi;JIN Wenjie;DAI Rongxiong;ZHANG Qian;ZHOU Wei;TANG Lin;FENG Jianping(Department of Anesthesia and Perioperative Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029;Department of Orthopedics,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029;Nursing College of Nanjing Medical University,Nanjing,Jiangsu,211166)
出处
《实用临床医药杂志》
CAS
2023年第6期51-54,63,共5页
Journal of Clinical Medicine in Practice
基金
2021年度南京医科大学研究生教育研究专项课题项目(2021YJS—ZC003)
2021年度江苏省人民医院“临床能力提升工程”护理面上项目(JSPH-NB-2021-4)
2021年度江苏省人民医院“临床能力提升工程”护理青年项目(JSPH-NB-2021-23)。
关键词
俯卧位
胸腰椎手术
下肢静脉压
深静脉血栓
压力性损伤
血液循环
prone position
thoracolumbar surgery
venous pressure of lower extremity
deep venous thrombosis
pressure injury
blood circulation