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目的探讨直肠癌经腹前切除术(Dixon)患者采用单、双侧下肢截石位时体位变换对患者血流动力学的影响。方法 2009年1月至2010年4月在我院行直肠癌经腹前切除术的手术患者32例,随机分为试验组和对照组。试验组采用一侧下肢抬高、另一侧下肢平放的单侧下肢截石位;对照组采用双下肢均抬高的改良截石位。分别记录两组在手术前后不同体位、不同时段收缩压、舒张压、平均动脉压、心率、中心静脉压,对两组数据进行重复测量资料的方差分析。结果两组测量指标均有随时间变化趋势,随时间变化的差异有统计学意义,组间差异无统计学意义。时间因素与分组的交互作用检验结果显示,心率和舒张压两项的差异无统计学意义,组间与时间因素的交互作用对收缩压、平均动脉压、中心静脉压的影响有统计学意义,试验组收缩压、平均动脉压、中心静脉压变化较对照组变化平缓。结论直肠癌经腹腔前切除术应用单侧下肢截石位可减轻患者血压、中心静脉压的波动程度,对患者的血流动力学影响较小。
Objective To investigate the effects of single and bilateral lithotomy position lithotripsy on hemodynamics in patients with rectal cancer undergoing anastomosis (Dixon). Methods From January 2009 to April 2010, 32 patients undergoing resection of anastomosis of rectal cancer in our hospital were randomly divided into test group and control group. In the test group, unilateral lower extremity lithotomy was performed on one side of the lower extremities, while the lower limbs were placed on the other side. The control group was treated with improved lithotomy position with both lower extremities elevated. Respectively before and after surgery were recorded in different positions, systolic blood pressure at different time, diastolic blood pressure, mean arterial pressure, heart rate, central venous pressure, the two groups of data repeated measures of variance analysis. Results The measurement indexes of both groups changed with time. The difference with time was statistically significant, but there was no significant difference between groups. The interaction between time and grouping showed that there was no significant difference in heart rate and diastolic blood pressure. The interaction between group and time had statistical significance on systolic blood pressure, mean arterial pressure and central venous pressure. Experimental group systolic blood pressure, mean arterial pressure, central venous pressure changes compared with the control group changes gently. Conclusion The application of unilateral anterior abdominal resection of rectal cancer lithotomy can reduce the patient’s blood pressure, central venous pressure fluctuations, the patient’s hemodynamic less.