| 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10 min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、60 min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（P<0.01），Jackson组CVP下降（P<0.01），Normal组CVP升高（P<0.01）；Jackson组MAP、HR差异无统计学意义，Normal组MAP、HR均下降（P<0.05）；Jackson组OI升高（P<0.01），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，P<0.01），Normal组IAP与CVP之间无相关性（P>0.05）；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；P<0.01）；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；P<0.01）。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。 |
| 关键词: 中心静脉压 腹内压 俯卧位 麻醉 Jackson手术床 |
| DOI：10.16781/j.0258-879x.2017.03.0282 |
| 投稿时间：2016-10-25修订日期：2017-01-03 |
| 基金项目: |
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| Effect of supine or prone position on central venous pressure and intra-abdominal pressure: a comparison of Jackson operating table and normal operating table |
| NI Li-ya,MA Yu,WEN Ping-shan,DENG Xiao-ming* |
(Division of Anesthesiology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the effect of supine or prone position on central venous pressure (CVP) and intra-abdominal pressure (IAP) during lumbar spine surgery when using Jackson operating table or normal operating table. Methods This study included 36 patients undergoing lumbar spine surgery in Changhai Hospital of Second Military Medical University between Sep. and Dec. 2014, with 18 patients in the Jackson operating table (Jackson group) and 18 patients in the normal operating table (Normal group). We recorded and analyzed the CVP, IAP, mean arterial pressure (MAP) and heart rate (HR) of the patients in two groups in the supine position after anaesthesia induction, prone position after anaesthesia induction for 10 min, prone position before the end of surgery and supine position at the end of surgery. Oxygenation index (OI) was recorded after anaesthesia induction in the supine position and prone position for 10 min, 30 min and 60 min. Linear regression analysis was used to analyze the correlation between IAP and CVP when in different positions. Results Compared with supine position, the IAP values in two groups were significantly decreased in the prone position for 10 min (P<0.01), CVP value in Jackson group was significantly decreased (P<0.01) and that in Normal group was significantly increased (P<0.01); MAP and HR in Normal group were significantly decreased (P<0.05) and OI in Jackson group was significantly increased (P<0.01), while MAP and HR of the patients in Jackson group and OI in Normal group were not significantly different from the supine position. There was a positive correlation between IAP and CVP in the prone position in the Jackson group (r=0.709 3, P<0.01),but not in the Normal group (P>0.05). In the Jackson and Normal groups, the results of linear regression analysis showed positive correlations between CVP in the supine position and CVP in the prone position (r=0.760 7, 0.829 7; P<0.01), and between IAP in the supine position and IAP in the prone position (r=0.752 8, 0.920 0; P<0.01). Conclusion The effect of prone position on circulation is less in the Jackson group and it can improve oxygenation when the surgery is in the prone position. IAP may be used as a supplementary monitoring index of rehydration rate and fluid volume. |
| Key words: central venous pressure intra-abdominal pressure prone position anesthesia Jackson operating table |
