本文選題：中心靜脈壓 + 腹內(nèi)壓��； 參考：《第二軍醫(yī)大學(xué)學(xué)報(bào)》2017年03期

【摘要】：目的觀察腰椎手術(shù)中使用不同手術(shù)床仰臥位、俯臥位對(duì)患者中心靜脈壓(CVP)與腹內(nèi)壓(IAP)的影響,為臨床俯臥位手術(shù)液體管理提供參考。方法選擇第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院2014年9月至12月全麻下行腰椎手術(shù)的患者36例,手術(shù)中使用Jackson手術(shù)床(Jackson組)與普通手術(shù)床(Normal組)患者各18例。觀察并記錄兩組患者在麻醉誘導(dǎo)后仰臥位、俯臥位10min時(shí)、手術(shù)結(jié)束前俯臥位及手術(shù)結(jié)束后仰臥位的CVP、IAP、平均動(dòng)脈壓(MAP)、心率(HR),以及麻醉誘導(dǎo)后患者仰臥位和俯臥位10、30、60min時(shí)的氧合指數(shù)(OI)。采用線性回歸方程分析IAP與CVP及不同體位IAP、CVP的相關(guān)性。結(jié)果與仰臥位相比,兩組患者俯臥位10 min時(shí)IAP均下降(P0.01),Jackson組CVP下降(P0.01),Normal組CVP升高(P0.01);Jackson組MAP、HR差異無(wú)統(tǒng)計(jì)學(xué)意義,Normal組MAP、HR均下降(P0.05);Jackson組OI升高(P0.01),Normal組OI差異無(wú)統(tǒng)計(jì)學(xué)意義。Jackson組患者俯臥位下IAP與CVP呈正相關(guān)(r=0.709 3,P0.01),Normal組IAP與CVP之間無(wú)相關(guān)性(P0.05);Jackson組和Normal組仰臥位下CVP與俯臥位下CVP均呈正相關(guān)(r=0.760 7,0.829 7;P0.01);Jackson組和Normal組仰臥位下IAP與俯臥位下IAP均呈正相關(guān)(r=0.752 8,0.920 0;P0.01)。結(jié)論使用Jackson手術(shù)床的患者翻身前后對(duì)循環(huán)影響小,俯臥位手術(shù)更有利于改善氧合。IAP可作為補(bǔ)液速度和補(bǔ)液量的補(bǔ)充監(jiān)測(cè)指標(biāo)。
[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 鹵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.
【作者單位】： 第二軍醫(yī)大學(xué)長(zhǎng)海醫(yī)院麻醉學(xué)部;
【分類號(hào)】：R614.2

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