Application Effect Of Optimized Lithotomy Position In Gynecological Laparoscopic Surgery

Objective:To explore the safety and effectiveness of the optimized lithotomy position in undergoing gynecological laparoscopic surgery of patients.Methods:From March 2018 to January 2019,patients who underwent gynecological laparoscopic surgery in the operating room of the Affiliated Hospital of Yan'an University were randomly divided into experimental group and control group,40 cases in each group.The patients were placed in waking state.The experimental group adopted the optimized head-low-hip-high lithotomy position,and the control group adopted the conventional head-low-hip-high lithotomy position.Plunger type tonometer was used to monitor intraocular pressure changes.The blood pressure,mean arterial pressure?MAP?,heart rate?HR?,airway pressure?Paw?and end-tidal carbon dioxide(P_ETCO₂)of the two groups of patients were collected with the help of electrocardiograph and anesthesia machine.The detection time points of the above indicators are before anesthesia induction?T1?,after tracheal intubation before pneumoperitoneum?T2?,post-pneumoperitoneal posture change 5min?T3?,posture change 15min?T4?,posture change 30min?T5?,postural changes of 60 minutes?T6?,postural changes of 90 minutes?T7?,5 minutes after the pneumoperitoneum was restored to the supine position?T8?,and before tracheal intubation?T9?,where the monitoring of respiratory dynamics parameters started from T2.In addition,the posture anesthesia postoperative comfort level and the surgeon's satisfaction with the surgical field exposure of the two groups of patients were evaluated by the surgical posture comfort scale and the surgeon satisfaction questionnaire.Finally,related complications were evaluated.Results:1.Comparing the general data of the two groups of patients?such as:age,gender,weight,type of surgery,ASA classification?,the differences were not statistically significant?P>0.05?and comparable.2.The intraocular pressure in the experimental group and the control group showed the same trend with time.The intraocular pressure in both groups decreased after anesthesia induction,and the intraocular pressure began to rise after the pneumoperitoneum was established,and continued until T7.After the end of pneumoperitoneum,the intraocular pressure of the two groups of patients also recovered quickly.However,the difference in intraocular pressure between the two groups was statistically significant?F=43.518,P<0.05?.From T4-T7,the intraocular pressure of the patients in the experimental group during the posture change was significantly lower than that in the control group at the corresponding monitoring points.3.After tracheal intubation?T2?,the blood pressure,HR,and MAP of both groups decreased;during T3-T7,the blood pressure,HR,and MAP of the two groups did not fluctuate significantly and were within the normal range;T8-T9 the data above gradually began to increase.There was no statistically significant difference?P>0.05?in blood pressure,HR and MAP between the control group and the experimental group.P_ETCO₂showed an upward trend and then a downward trend in both groups,and there was no statistically significant difference?P>0.05?between the two groups.The Paw of the two groups of patients showed an upward trend with the adjustment of posture and the extension of the operation time,which reached a peak at T6 and then gradually decreased.The Paw of the experimental group was significantly lower than that of the control group.The difference between the two groups of patients was statistically significant?F=15.606,P<0.05?.4.In terms of post-anaesthesia posture comfort of the two groups of patients,the posture comfort of the experimental group was significantly better than that of the control group,which showed that 78.79%of the patients in the experimental group had no discomfort with the posture of placement?41.18%?;the proportion of patients in the control group who feels uncomfortable in the posture of placement is 58.82%,which is higher than that of the same type in the experimental group?21.21%?;the difference between the two groups is statistically significant?Z=-3.114,P<0.05?.5.A comparative analysis of the surgeons'satisfaction with the surgical field exposure between the two groups revealed that there was no statistically significant difference between the two groups??²=1.016,P>0.05?.In both groups,surgeons were satisfied with the surgical field exposure.6.This study analyzed the occurrence of postoperative posture-related complications.The results showed that the incidence of complications among all enrolled patients was low,only shoulder pain and conjunctival edema occurred.Although the incidence of posture-related complications in the experimental group was lower than that in the control group,there was no statistically significant difference between the two groups??2=0.580,P>0.05?.Conclusion:In gynecological laparoscopic surgery,compared with the traditional head-low-hip-high lithotomy position,the optimized head-low-hip-high lithotomy position can significantly improve the progressive increase of intraocular pressure and reduce the intraoperative airway pressure Increase and significantly improve the patient's posture comfort.