俯卧位与可调节斜卧位对腰椎间盘切除术中腹内压及出血量的影响

Comparison of effects between prone position and variable oblique position on intra-abdominal pressure and surgical bleeding during discectomy

中文关键词:  腹内压  体位  可调节斜卧位  俯卧位  腰椎间盘切除术

英文关键词:Intra-abdominal pressure  Prone position  Variable oblique position  Discectomy

中文摘要:

  【摘要】 目的：比较俯卧与可调节斜卧手术体位对腰椎间盘突出症患者手术过程中腹内压力及术中出血量的影响。方法：选择2007年10月～2009年10月全麻下行腰椎间盘突出症手术患者156例，随机分为两组，其中俯卧位患者78例（A组），可调节斜卧位患者78例（B组）。分别在全麻诱导后（仰卧位）5min、摆放体位后5min和手术结束时测量两组患者气道阻力值，通过尿管测量膀胱内压力来间接反映腹内压力值，记录两组患者的手术时间、术中出血量，并进行对比分析。结果：A组患者手术时间、术中出血量及术中平均单位时间出血量分别为74.4±13.8min、288.7±105.9ml和3.8±0.7ml/min，B组分别为59.2±10.0min、178.1±58.6ml和3.0±0.5ml/min，两组间比较有显著性差异（P＜0.05）。A组术前仰卧位时的腹内压平均值为765±167Pa，摆放体位后为1063±194Pa，手术结束时为1074±191Pa；B组分别为788±170Pa、809±176Pa和817±186Pa。A组术前仰卧位时的气道阻力为14.1±1.2cmH2O，摆放体位后为17.3±1.9cmH2O，手术结束时为17.6±2.0cmH2O；B组分别为14.2±1.5cmH2O、14.9±1.5cmH2O和15.0±1.6cmH2O。两组术前仰卧位时的气道阻力及腹内压无明显差异（P＞0.05）；A组摆放体位后及手术结束时的腹内压力及气道阻力明显大于术前仰卧位（P＜0.05），同时A组摆放体位后及手术结束时的腹内压及气道阻力明显大于B组（P＜0.05）。A组术中出血量与摆放体位后腹内压力有显著相关性（r=0.772，P＝0.000），而B组术中出血量与摆放体位后腹内压力无显著相关性（r=0.287，P＝0.174）。结论：采用可调节斜卧位行后路腰椎间盘切除术可以降低术中胸腹部受压的几率，减少术中出血量，缩短手术时间。

英文摘要:

  【Abstract】 Objective：To compare the the effects of prone position and variable oblique position for posterior discectomy with regarding to intra-abdominal pressure and surgical bleeding．Method：A total of 156 patients undergoing single-level lumbar discectomy under general anesthesia during October 2007 and October 2009 were reviewed retrospectively．Patients were randomly divided into two groups with 78 cases in prone position（group A） and 78 cases in variable oblique position（group B）．All patients had their intra-abdominal pressure measured by a urinary bladder catheter，and the airway pressure including 5min postanesthesia induction（supine），5min postpositioning either in prone or oblique position and at the end of surgery before position alteration was documented respectively．The operation time and intraoperative bleeding were recorded and analyzed.Result：The operation time，intraoperative bleeding and average blood loss per minute were 74.4±13.8min，288.7±105.9ml and 3.8±0.7ml/min respectively in group A，while 59.2±10.0min，178.1±58.6ml and 3.0±0.5ml/min in group B，which showed statistically significant difference between two groups（P＜0.05）．The average intra-abdominal pressure in group A was 765±167Pa in the supine after anesthesia induction，1063±194Pa after positioning and 1074±191Pa at the end of surgery；while those were 788±170Pa，809±176Pa and 817±186Pa respectively in group B.The average airway pressure of group A was 14.1±1.2cmH2O for supine after anesthesia induction，17.3±1.9cmH2O after positioning and 17.6±2.0cmH2O at the end of surgery，while those were 14.2±1.5cmH2O，14.9±1.5cmH2O and 15.0±1.6cmH2O respectively in group B.There were no statistically significant difference between two groups either for intra-abdominal pressure or airway pressure in the supine position after anesthesia induction（P＞0.05）.In group A，the intra-abdominal pressure and airway pressure after positioning in prone position and at the end of surgery were significantly higher than those in the supine position（P＜0.05）.The intra-abdominal pressure and airway pressure in group A were significantly higher than those in group B after operative positioning and at the end of surgery（P＜0.05）.Correlation between the intraoperative bleeding and intra-abdominal pressure after positioning was statistically significant in group A（r=0.772，P＝0.000），but no significance in group B（r=0.287，P＝0.174）．Conclusion：Variable oblique position for posterior discectomy can reduce the compression to the thorax and abdomen，decrease intraoperative bleeding and shorten the operation time compared with the prone position．