不同手术体位在老年肥胖患者经皮肾镜取石术中的应用效果观察.doc

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1、不同手术体位在老年肥胖患者经皮肾镜取石术中的应用效果观察［摘要］目的探究斜仰卧位联合截石位、传统俯卧位在老年肥胖患者经皮肾镜取石术中的应用效果。方法选取我院2008年9月〜2015年9月收治的行经皮肾镜取石术老年肥胖患者共112例，按照入院时间顺序随机分为对照组(n-55)与观察组(n=57),对照组患者采取传统俯卧位,观察组采取斜仰卧位联合截石位，比较两组患者手术一般情况、一次性结石除净率及不同体位对患者循环、呼吸的影响。结果观察组手术持续时间、术中出血量均明显低于对照组，结石一次性除净率高于对

2、照组(P0.05)o对照组体位安置后30minSBP、DBP、Sa02%低于安置前，HR高于安置前(PV0.05)。对照组不能耐受手术体位摆放人数及VAS3级以上人数明显多于观察组(P〈0.05)。结论斜仰卧位联合截石位在老年肥胖患者经皮肾镜取石术中具有手术操作简便、创伤性小、对患者循环、呼吸系统影响较小等特点，值得临床推广运用。［关键词］斜仰卧位；截石位；俯卧位；老年；肥胖；经皮肾镜取石术［中图分类号］R699.2［文献标识码］B［文章编号］2095-0616(2016)09-210-03［Ab

3、stract］ObjectiveToexploretheapplicationofobliquesupinepositioncombinedwith1ithotomypositionandtraditionalpronepositioninelderlyobesepatients'percutaneousnephrolithotomy.MethodsAtotalof112elderlyobesepatientswhichtreatedwithpercutaneousnephrolithotomyw

4、ereselectedinourhospitalfromSeptember2008to2015September,allpatientswererandomlydividedasthecontrolgroup(n=55)andobservationgroup(n二57)accordingtothesequenceofhospitalizetime.Thepatientsincontrolgroupweregiventhetraditionalproneposition,thepatientsino

5、bservationgroupweregiventheobliquesupinepositioncombinedwith1ithotomyposition.Theoperationgeneralcondition,one-timestonedisposablerateandeffectofdifferentposturesonpatientswithcirculationandrespirationwerecomparedbetweentwogroups.ResultsDurationofoper

6、ationtime,intraoperativebleedinginobservationgroupwassignificantlylowerthanthatincontrolgroup,one-timestonedisposableratehigherthanthatofthecontrolgroup(P0.05)withbefore-replacementintheobservationgroup.SBPDBP,Sa02at30minafterplacementincontrolgroupwe

7、relowerthanbefore-placement,HRhigherthanbefore-placement(P<0.05).ThepatientswhocouldnottoleratetheoperationpositionandthenumberofVAS3incontrolgroupsignificantlymorethantheobservationgroup(P<0.05).ConclusionObliquesupinepositioncombinedwithlithotomypos

8、itionintheelderlyobesepatients'percutaneousnephrolithotomyhastheadvantagesofsimpleoperation,traumaticsmall,littleinfluenceoncirculatoryandrespiratorysystem,itisworthofclinicalapplication.［Keywords］Supineobiiqueposition；Lithotomyposition；Pronep