Jackson手术床和普通床仰卧位、俯卧位对中心静脉压与腹内压的影响

发布时间：2018-06-24 00:02

本文选题：中心静脉压 + 腹内压　；参考：《第二军医大学学报》2017年03期

【摘要】：目的观察腰椎手术中使用不同手术床仰卧位、俯卧位对患者中心静脉压(CVP)与腹内压(IAP)的影响,为临床俯卧位手术液体管理提供参考。方法选择第二军医大学长海医院2014年9月至12月全麻下行腰椎手术的患者36例,手术中使用Jackson手术床(Jackson组)与普通手术床(Normal组)患者各18例。观察并记录两组患者在麻醉诱导后仰卧位、俯卧位10min时、手术结束前俯卧位及手术结束后仰卧位的CVP、IAP、平均动脉压(MAP)、心率(HR),以及麻醉诱导后患者仰卧位和俯卧位10、30、60min时的氧合指数(OI)。采用线性回归方程分析IAP与CVP及不同体位IAP、CVP的相关性。结果与仰卧位相比,两组患者俯卧位10 min时IAP均下降(P0.01),Jackson组CVP下降(P0.01),Normal组CVP升高(P0.01);Jackson组MAP、HR差异无统计学意义,Normal组MAP、HR均下降(P0.05);Jackson组OI升高(P0.01),Normal组OI差异无统计学意义。Jackson组患者俯卧位下IAP与CVP呈正相关(r=0.709 3,P0.01),Normal组IAP与CVP之间无相关性(P0.05);Jackson组和Normal组仰卧位下CVP与俯卧位下CVP均呈正相关(r=0.760 7,0.829 7;P0.01);Jackson组和Normal组仰卧位下IAP与俯卧位下IAP均呈正相关(r=0.752 8,0.920 0;P0.01)。结论使用Jackson手术床的患者翻身前后对循环影响小,俯卧位手术更有利于改善氧合。IAP可作为补液速度和补液量的补充监测指标。
[Abstract]:Objective to observe the effect of supine position and prone position on central venous pressure (CVP) and intraabdominal pressure (IAP) in lumbar spine operation, and to provide reference for clinical fluid management in prone position. Methods Thirty-six patients undergoing lumbar spine surgery under general anesthesia were selected from Changhai Hospital of the second military Medical University from September to December 2014. There were 18 patients in Jackson operation bed (Jackson group) and 18 in normal operation bed (normal group). The mean arterial pressure (map), heart rate (HR) and oxygenation index (Oi) of the patients in supine position and prone position were observed and recorded at supine position and prone position 10min after anesthesia induction and supine position after operation respectively. The mean arterial pressure (map), heart rate (HR) and oxygenation index (Oi) in supine position and prone position after anesthesia induction were observed and recorded. The correlation between IAP and CVP and IAPP CVP in different positions was analyzed by linear regression equation. Results compared with supine position, Two groups of patients prone position 10 min IAP decreased (P0.01) in Jackson group CVP decreased (P0.01) normal group CVP increased (P0.01) there was no significant difference in MAPHR of normal group (P0.05) Oi increased (P0.01) normal group (P0.01) normal group OI difference was not statistically significant. Jackson group patients in prone position IAP and CVP were positive. There was no correlation between IAP and CVP in normal group (P 0.05). There was a positive correlation between CVP in supine position and CVP in prone position in Jackson group and normal group (r 0.760 7 卤0.829 7 P 0.01). In Jackson group and normal group, there was a positive correlation between IAP in supine position and IAP in prone position (P 0.01). Conclusion patients with Jackson operating bed have little influence on circulation before and after turning over. Prone position operation is more helpful to improve oxygenation. IAP can be used as a supplementary monitoring index of fluid resuscitation speed and fluid volume.
【作者单位】：第二军医大学长海医院麻醉学部;
【分类号】：R614.2

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