Department of Anaesthesiology, AZ Sint Jan Brugge-Oostende AV, Ruddershove 10, 8000 Brugge, Belgium.
Surg Endosc. 2010 Jun;24(6):1398-402. doi: 10.1007/s00464-009-0785-8. Epub 2010 Jan 7.
The effects of the patient's body position on the intraabdominal workspace in laparoscopic surgery were analyzed.
The inflated volume of carbon dioxide was measured after insufflation to a preset pressure of 15 mmHg for 20 patients with a body mass index (BMI) greater than 35 kg/m(2). The patients were anesthetized with full muscle relaxation. The five positions were (1) table horizontal with the legs flat (supine position), (2) table in 20 degrees reverse Trendelenburg with the legs flat, (3) table in 20 degrees reverse Trendelenburg with the legs flexed 45 degrees upward at the hips (beach chair position), (4) table horizontal with the legs flexed 45 degrees upward at the hips, and (5) table in 20 degrees Trendelenburg with the legs flat. The positions were performed in a random order, and the first position was repeated after the last measurement. Repeated measure analysis of variance was used to compare inflated volumes among the five positions.
A significant difference in inflated volume was found between the five body positions (P = 0.042). Compared with the mean inflated volume for the supine position (3.22 +/- 0.78 l), the mean inflated volume increased by 900 ml for the Trendelenburg position or when the legs were flexed at the hips, and decreased by 230 ml for the reverse Trendelenburg position.
The Trendelenburg position for lower abdominal surgery and reverse Trendelenburg with flexing of the legs at the hips for upper abdominal surgery effectively improved the workspace in obese patients, even with full muscle relaxation.
分析了腹腔镜手术中患者体位对腹腔内工作空间的影响。
对 20 例 BMI 大于 35 kg/m²的患者进行全身麻醉，在预设压力为 15 mmHg 的情况下充入二氧化碳，测量充气量。患者的体位有 5 种：（1）腿部放平的水平位（仰卧位），（2）腿部向上弯曲 45 度的 20 度反向特伦德伦伯位（沙滩椅位），（3）腿部向上弯曲 45 度的 20 度反向特伦德伦伯位，（4）腿部放平的水平位，（5）腿部放平的 20 度特伦德伦伯位。体位以随机顺序进行，最后一次测量后重复第一次体位。采用重复测量方差分析比较 5 种体位的充气量。
5 种体位的充气量差异有统计学意义（P = 0.042）。与仰卧位的平均充气量（3.22 ± 0.78 L）相比，特伦德伦伯位或腿部向上弯曲时充气量增加 900 ml，反向特伦德伦伯位时充气量减少 230 ml。
对于下腹部手术，采用特伦德伦伯位；对于上腹部手术，采用反向特伦德伦伯位并将腿部向上弯曲，可有效改善肥胖患者的工作空间，即使在完全肌肉松弛的情况下也是如此。
