| ObjectiveThe study modified the surgical position in elderly patients with gynecological laparoscopic surgery.Observe its influence on the comfort and position related complications of the patients,to explore a better surgical position that can not only help to reduce the postural related complications of the elderly patients,but also can improve the comfort of operation position in the guarantee of the operative field.MethodsA total of 100 elderly patients undergoing gynecological laparoscopic operation under general anesthesia were recruited and assigned to the observation group(n=50)and control group(n=50)by random digits table method with 50 cases each according to admitting time;Patients in the control group were placed in conventional Trendelenburg position,while the patients in the observation group were positioned in modified Trendelenburg position.Intraocular pressure(IOP)were measured in the patients at anesthesia induction(T1),5 minutes after general anesthesia in supine position(T2),and 5 minutes after pneumoperitoneum while in the operation position(T3),30 minutes after pneumoperitoneum while in the operation position(T4),and every 30 minutes(times 5 to 11),while supine at the end of pneumoperitoneum(time 12)and before awakening(time 13);Before general anesthesia while in supine lithotomy position investigate and record the scores of the Operation Position Comfort Questionnaire of the patients.Patients were followed up at 24 h,48h and 72 h after surgery,researcher investigate and record the situation of the pain in the shoulder and postoperative complications of the lower limbs.Unstructured interviews were conducted with the doctors,anesthesiologists,and circuiting nurses after the operation.The SPSS17.0 statistical software was used to process the collected data,and P<0.05 indicated that the difference was statistically significant.The quantitative data in the general data of patients were analyzed by independent-sample T test and Mann-Whitney U test,qualitative data by chi-square test.Intraocular pressure and mean arterial pressure analysis were analyzed by of variance of repeated measurement.For data is not in Gauss Distribution,median/quartile were used to describe.The data of the interview were analyzed by Colaizzi's seven-step method of phenomenological analysis.Results1.There was no significant difference on the age,BMI,total operative time,the amount of intravenous fluid,blood loss,intraocular pressure and mean arterial pressure between the two groups before operation(P>0.05).2.There was no significant differences at T1,T2 on the intraocular pressure between the two groups(P>0.05).T3,T12 and each measuring point between T3-T12,the intraocular pressure of the patients in observation group is lower than the control group and the differences of intraocular pressure between two groups was statistically significant(P<0.05).The IOP was decreased at T12 and this decrease in observation group patients was enough for mean IOP to normalize at that stage to(19.60±0.82)mmHg.However,in control group mean IOP was(24.40±0.98)mmHg.The IOP of the two groups decreased to the normal level at T13.3.The mean arterial pressure of control group at T3 was(85.17±8.08)mmHg and that of the observation group was(81.35±8.81)mmHg,the difference between the two groups was statistically significant(t=2.261,P<0.05).The mean arterial pressure of control group at T4 was(89.02±9.08)mmHg,and that of the observation group was(84.84±10.65)mmHg,the difference was statistically significant(t=2.105,P<0.05).Except for T3,T4 there was no significant difference between the two groups on the mean arterial pressure(P>0.05).4.The lower limbs postoperative complications incidence of the control group was 12/50(24%)and that of the observation group was 4/50(8%),the differences was statistically significant(?2=4.762,P<0.05).The VAS scores of the control group was(3.20±0.82)points,and that of the observation group was(72.15±0.51)points and the differences was statistically significant((Z=-2.375,P<0.05).5.The postoperative shoulder pain incidence of control group was 18/50(36%),and that of the observation group was 6/50(12%),the differences was statistically significant(?2=7.895,P<0.05).The VAS scores of the control group was(4.20±1.25)points,and that of the observation group was(1.78±0.51)points,the differences was statistically significant((Z=-3.501,P<0.05).6.The scores of the Operation Position Comfort Questionnaire of the control group was(67.80±4.05)points and that of the observation group was(73.18±4.38)points,the differences was statistically significant(Z=-5.422,P<0.05).7.Surgeons,anesthesiologists and nurses showed better evaluation of the observation group,and the surgery field exposure of the observation group is good,will not affect the surgeon's operation,will not hinder the patients' breath.Conclusions1.Compared with the traditional trendelenburg position,the elevation of intraocular pressure was reduced in patients with modified trendelenburg position without affecting the operation.2.Modified trendelenburg position improved the comfort of the operation position of the patients effectively,and reduce the incidence rate of the shoulder pain and postoperative complications of the lower limbs,is conducive to the operation safety of elderly patients. |
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