Northwestern Prentice Women's Hospital, and Northwestern University Feinberg School of Medicine (Ms. Young), Chicago, Illinois.
Division of Female Pelvic Medicine and Reconstructive Surgery (Drs. Mou, Geynisman-Tan, Collins, Mueller, Lewicky-Gaupp, and Kenton, and Ms. Tavathia).
J Minim Invasive Gynecol. 2021 Jan;28(1):26-29. doi: 10.1016/j.jmig.2020.03.005. Epub 2020 Mar 27.
To determine if there were differences in intra-abdominal pressure (IAP) in the supine, low lithotomy, and high lithotomy positions.
Prospective cohort study.
University medical center.
Twenty-nine women undergoing surgery for prolapse or stress incontinence.
Relevant medical history, including the pelvic organ prolapse quantification stage, body mass index, and airway grade (Mallampati score), was abstracted from patients' medical charts. IAP was measured in centimeters of water (cmHO) on the day of their surgery before induction of general or intravenous anesthesia using a T-doc air charged urodynamic catheter (Laborie Aquarius; Ontario, Canada) placed in a patient's vagina (for patients with incontinence) or rectum (for patients with prolapse).
IAP was measured in 3 positions: supine (legs at 0°), low lithotomy (legs in Yellowfin stirrups at 45°; Allen Medical, Acton, MA), and high lithotomy (legs at 90°). The means ± SDs IAP for the groups were as follows: in the supine position, 18.6 cmHO ± 7.6; low lithotomy, 17.7 cmHO ± 6.6; and high lithotomy, 17.1 cmHO ± 6.3. In the same women, there was a significant decrease in IAP from the supine to high lithotomy positions, with a mean difference of 1.4 cmHO ± 3.7, p = .05. Similarly, there was a significant, though smaller, decrease in mean IAP when moving from the supine to low lithotomy positions in these same women (mean decrease of 0.9 cmHO ± 1.5, p = .004). Neither change is clinically significant based on previous research that suggests 5 cmHO is a clinically significant change.
Placing patients' legs in a low or high lithotomy position does not result in a clinically significant increase in IAP. Therefore, surgeons and anesthesiologists can consider positioning patients' lower extremities in stirrups while patients are awake to minimize discomfort and possibly reduce the risk of nerve injuries.
确定在仰卧位、低位截石位和高位截石位时，腹腔内压力（IAP）是否存在差异。
前瞻性队列研究。
大学医学中心。
29 名因脱垂或压力性尿失禁接受手术的女性。
从患者的病历中提取相关病史，包括盆腔器官脱垂量化分期、体重指数和气道分级（Mallampati 评分）。在全身麻醉或静脉麻醉诱导前，使用 T-doc 空气充注尿动力学导管（加拿大安大略省 Laborie Aquarius）测量患者阴道（用于压力性尿失禁患者）或直肠（用于脱垂患者）内的 IAP，以厘米水柱（cmHO）表示。
在 3 种体位下测量 IAP：仰卧位（腿部 0°）、低位截石位（腿部在 Yellowfin 马镫位 45°；Allen Medical，马萨诸塞州 Acton）和高位截石位（腿部 90°）。各组 IAP 的平均值±标准差如下：仰卧位 18.6cmHO±7.6；低位截石位 17.7cmHO±6.6；高位截石位 17.1cmHO±6.3。在同一女性中，从仰卧位到高位截石位，IAP 显著下降，平均差异为 1.4cmHO±3.7，p=0.05。同样，在这些相同的女性中，从仰卧位到低位截石位，IAP 也显著下降（平均下降 0.9cmHO±1.5，p=0.004）。这两种变化都没有达到先前研究中提出的 5cmHO 为临床显著变化的标准，因此均不具有临床意义。
将患者腿部置于低位或高位截石位不会导致 IAP 出现临床显著增加。因此，外科医生和麻醉师可以考虑在患者清醒时将其下肢置于马镫中，以减轻不适并可能降低神经损伤的风险。
