Page 80 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第2期
·230 · Journal of Nanjing Medical University（Natural Sciences） 2021年2月

·临床研究·

动态调节截石位对术中妇科盆腔肿瘤患者下肢血流动力学的

影响

冯建萍，张 彬，傅士龙，胡根花，张 倩，孙 杰 *
南京医科大学第一附属医院麻醉科 江苏 南京 210029

［摘 要］ 目的：探讨截石位妇科盆腔肿瘤患者术中间断短暂放平下肢再还原对下肢血流动力学的影响。方法：南京医科大
学第一附属医院2018年10月—2019年8月拟行妇科盆腔肿瘤手术患者101 例，随机分为2组，实验组 51例，对照组50例。两
组麻醉前行大隐静脉穿刺连接压力传感器至监护仪。实验组使用可调式马镫形多功能腿架，记录术前平卧（T0）、摆截石位后
即刻（T1）、1 h改变体位后即刻（T2）、2 h改变体位后即刻（T3）、手术结束时恢复体位后即刻（T4）的下肢静脉压、上肢血流灌注
指数（perfusion index，PI）。穿刺侧脚趾夹脉氧仪，记录下肢血流PI、趾脉率（BPM）和血氧饱和度（SpO2 ）。对照组使用传统截石
位腿架，术中不调整截石位腿架高度，记录摆体位前平卧（T0）、摆体位后即刻（T1）、手术1 h（T2）、手术2 h（T3）、手术结束恢复
体位后即刻（T4）下肢静脉压及对应参数。结果：与T0比较，T1~T4两组下肢静脉压明显增加（P＜0.01）；T2~T4时实验组较对
照组下肢静脉压波动较小，稳定情况明显优于对照组（P＜0.05），而T1 时比较，两组无明显差异。与T0 时比较，两组T1~T4下
肢PI明显降低（P＜0.05）；T2 、T3实验组较对照组下肢PI明显增加（P＜0.05），而T4无差别（P＞0.05）。两组比较，上肢PI、血氧
饱和度、脉率无差异（Ｐ＞0.05）。结论：在不影响手术操作的情况下，时长>2 h 的截石位手术患者术中每小时放平下肢再还
原，能减轻对血流动力学的影响，有利于预防深静脉血栓的。
［关键词］ 截石位；动态调节；血流动力学
［中图分类号］ R614.2 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）02⁃230⁃04
doi：10.7655/NYDXBNS20210215

Effects of dynamic regulation of lithotomy position on lower limb hemodynamics in
patients with intraoperative gynecological pelvic tumor

FENG Jianping，ZHANG Bin，FU Shilong HU Genhua，ZHANG Qian，SUN Jie *
Department of Anesthesiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China

［Abstract］ Objective：This study aims to investigate the effects of lithotomy on the hemodynamics of lower limbs in patients with
gynecologic pelvic tumor whose lower limbs restored horizontally for 5 min after placing lithotomy position during the operation.
Methods：From October 2018 to August 2019，101 patients with gynecological pelvic tumor surgery were enrolled in our study. They
were randomly divided into two groups，51 patients in the experimental group and 50 patients in the control group. Experimental group
received adjustable multi⁃function stirrup leg rack to obtain lithotomy position，and their legs were restored horizontally for 5 min every
one hour. The control group received conventional leg rack until the end of surgery. The great saphenous vein pressure of the two
groups patients were monitored before anesthesia（T0），at the beginning of lithotomy position（T1），1 h（T3），2 h after surgery（T3），and
at the end of surgery（T4）. The upper and lower limb of perfusion index（perfusion index，PI），pulse rate and blood oxygen saturation
（SpO2 ）were recorded and compared. Results：Compared with T0，venous pressure of lower extremity in T1 ⁃ T4 group increased
significantly（P < 0.01）. Compared with the control group，the fluctuation of venous pressure in the experimental group of T2~T4 was
less，and the stability was significantly better than that in the control group（P < 0.05）. However，there was no significant difference
between two groups at T1. Compared with T0，the lower limb PI of T1⁃T4 in the two groups was significantly reduced（P < 0.05）.
Compared with the control group，the lower limb PI increased significantly（P < 0.05）at T2 and T3 but not T4 in the experimental

［基金项目］ 江苏省人民医院面上项目（YHK201701）；江苏省妇幼健康科研面上项目（F201846）
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通信作者（Corresponding author），E⁃mail：dgsunjie@hotmail.com