斜仰卧截石位经皮肾碎石术对呼吸循环功能影响.docVIP

斜仰卧截石位经皮肾碎石术对呼吸循环功能影响 　　【摘 要】目的 观察斜仰卧截石位经皮肾碎石术对患者呼吸循环功能的影响。方法 将美国麻醉师学会（ASA）分级Ⅰ～Ⅱ级的肾结石或（并）输尿管上段结石患者120例，随机分为两组，每组60例，F组在全麻俯卧位下实施经皮肾镜取石术；X组在全麻斜仰卧截石位下实施经皮肾镜取石术。监测两组患者麻醉前（T0）、摆体位前（T1）、摆体位后10min（T2）、30min（T3）、回归体位后5min（T4）五个时点的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）、心率（HR）、血氧饱和度（SPO2）、呼气末二氧化碳分压（PETCO2）、气道压力（Paw）的变化及手术时间、术中出血量。结果 F组气道压力（Paw）、呼气末二氧化碳分压（PETCO2）在T2、T3显著升高，差异有统计学意义（P0.05），血压均有不同程度的下降，但X组安置后收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）均高于F组（P0.05）。结论 全麻俯卧位下实施经皮肾镜取石术对呼吸循环功能有一定影响，而斜仰卧截石位可避免这种影响。 　　【关键词】斜仰卧截石位；俯卧位；经皮肾碎石术；呼吸功能；循环功能 　　Abstract：Objective To investigate the effects of percutaneous nephrolithotomy in the Semisupine-lithotomy position on the respiratory and circulatory function. Methods 120 ASAⅠ～Ⅱcases with normal circulatory and respiratory function underwent percutaneous nephrolithotomy were divided into two groups（FandX） according to patient’s willingness，60 cases in each group.the group F was performed percutaneous nephrolithotomy in the Prone position under general anesthesia，while the group II was performed percutaneous nephrolithotomy in the Semisupine-lithotomy position under general anesthesia. Systolic blood pressure（SBP），diastolic blood pressure DBP），mean arterial pressure（MAP），heart rate（HR），oxygen saturation（SPO2），end-tidal carbon dioxide partial pressure（of PETCO2），changes in airway pressure（Paw）were measured at before anesthesia（T0），position before the swing（T1），position after the swing 10min（T2），30min（T3），after the return position 5min（T4）five points，and compare the operation time，blood loss. Results There were differences between these two groups in T2 and T3 time period. PETCO2、Paw of the group F at T2 and T3 were higher than the group X（P0.05），blood pressure decreased in varying degrees，but the group X SBP，MAP，DBP were higer than F group（P0.05）. Conclusion Prone position under general anesthesia PCNL have some effects on respiratory and circulatory function，while oblique supine lithotomy position can avoid these effects. 　　Key words：Semisupine-lithotomy po