Halliwill J R, Hewitt S A, Joyner M J, Warner M A
Department of Physiology and Biophysics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Anesthesiology. 1998 Dec;89(6):1373-6. doi: 10.1097/00000542-199812000-00014.
Compartment syndrome of a lower extremity from hypoperfusion is a rare but potentially devastating complication of the lithotomy position during surgery. The aim of this study is to determine the effects of various lithotomy positions on lower-extremity blood pressures.
Blood pressure in eight young, healthy people was studied for 10 lithotomy positions. Blood pressure measurements were taken in both the upper arm (brachial artery) and the lower extremity (dorsalis pedis). The heart-to-ankle height gradient in each position was measured, and a predicted lower-extremity systolic pressure was calculated. The measured and predicted lower-extremity systolic blood pressures were compared with repeated measures analysis of variance.
As a group, the mean systolic blood pressures in the lower extremities correlated closely with the predicted values. However, the difference between measured and predicted pressures varied among the 10 positions (P < 0.05).
Although lower-extremity systolic blood pressures in the young, healthy volunteers correlated with predicted values, there was an additional reduction in pressure associated with the lithotomy position. This surprising finding suggests that a lengthy procedure necessitating the use of a lithotomy position for only a portion should be planned so the remainder of the procedure can take place before establishing the position or so the position can be changed to an alternative position when it is no longer needed.
低灌注导致的下肢骨筋膜室综合征是手术截石位时一种罕见但可能具有毁灭性的并发症。本研究的目的是确定各种截石位对下肢血压的影响。
对8名年轻健康受试者的10种截石位进行血压研究。在上臂（肱动脉）和下肢（足背动脉）测量血压。测量每个体位的心脏至脚踝高度梯度，并计算预测的下肢收缩压。采用重复测量方差分析比较测量的和预测的下肢收缩压。
总体而言，下肢平均收缩压与预测值密切相关。然而，在10个体位中，测量值与预测值之间的差异有所不同（P < 0.05）。
尽管年轻健康志愿者的下肢收缩压与预测值相关，但截石位会额外导致血压降低。这一惊人发现表明，对于仅需部分时间采用截石位的长时间手术，应进行规划，以便在确定体位之前完成手术的其余部分，或者在不再需要时将体位更换为其他体位。
