腰肋悬空半截石位和俯卧位经皮肾镜取石术对主观感觉的影响

Effect of the flank suspended semi-lithotomy and prone position on subjective sensation of the patients under percutaneous nephrolithotomy

摘要:

目的 探讨腰肋悬空半截石位和俯卧位经皮肾镜取石术（PCNL）对主观感觉的影响。方法 选取2018年6月－2020年12月于长江航运总医院泌尿外科行PCNL的患者100例，通过入院顺序将患者分为治疗组（腰肋悬空半截石位组）和对照组（俯卧位组），每组50例。比较两组患者体位舒适度、呼吸困难感、术后24 h疼痛感、术者舒适度、麻醉师舒适度、手术时间和结石清除率。结果 治疗组手术时间明显较对照组短［（86.0±9.7）和（108.1±11.2）min］，患者体位舒适度［（5.8±0.6）和（3.7±0.6）分］和呼吸困难感［（3.3±0.7）和（5.7±0.7）分］优于对照组，差异有统计学意义（t = -10.92，t = 16.33，t = -18.44；均P < 0.01）。术后24 h伤口疼痛感［（3.8±0.6）和（3.6±0.6）分］和结石清除率［86.0%（43/50）和90.0%（45/50）］比较，差异均无统计学意义（t = 1.48，P = 0.146；χ² = 0.38，P = 0.538）。治疗组术者舒适度［（6.2±1.4）和（5.4±1.6）分；t = 2.31，P = 0.025］和麻醉师舒适度［（7.4±1.3）和（6.7±1.4）分；t = 2.51，P = 0.015］均明显优于对照组。结论 采用腰肋悬空半截石位行PCNL手术，患者拥有较好的体位舒适度，呼吸困难感轻微，手术安全有效，适合于高龄高危、极度肥胖和慢性心肺功能不全的患者。

Abstract:

Objective To explore the subjective sensation of the patients with percutaneous nephrolithotomy (PCNL) under the flank suspended semi-lithotomy position and prone position.Methods 100 cases under PCNL from June 2018 to December 2020, were divided into the treatment group (the flank suspended semi-lithotomy position group) and the control group (the prone position group) according to the order of admission, there were 50 cases in each group. The patients’ postural comfort, dyspnea, pain 24 h after operation, operator comfort, anesthesiologist comfort, operation time and stone removal rate were compared between the two groups.Results As compared to the control group, the treatment group had shorter operation time [(86.0 ± 9.7) vs (108.1 ± 11.2) min], better patients’ posture comfort [(5.8 ± 0.6) vs (3.7 ± 0.6) ] and less dyspnea [(3.3 ± 0.7) vs (5.7 ± 0.7)], there was statistical difference (t = -10.92, t = 16.33, t = -18.44; P < 0.01). There was no statistical significance between the two groups in the results of postoperative pain [(3.8 ± 0.6) vs (3.6 ± 0.6)] and stone removal rate [86.0% (43/50) vs 90.0% (45/50)] (t = 1.48, P = 0.146; χ² = 0.38, P = 0.538). As compared to the control group, the treatment group had better operator comfort [(6.2 ± 1.4) vs (5.4 ± 1.6); t = 2.31, P = 0.025] and anesthesiologist comfort [(7.4 ± 1.3) vs (6.7 ± 1.4); t = 2.51, P = 0.015].Conclusion Under the position of flank suspended semi-lithotomy, the patients under PCNL experienced better postural comfort and less dyspnea. This surgical position of flank suspend semi-lithotomy is especially suitable for the patients of the elderly, frail, high-risk obese and chronic cardiopulmonary insufficiency.