摘要
目的:探讨俯卧位腰椎后路手术患者术中合理的头颈姿态。方法:以厚度1.5 cm的软垫逐层加高或降低头部垫枕高度;以500 ml规格的软包装塑料袋(抽出液体200 ml)替代硅胶垫,连接动脉测压装置,对49例气管插管全麻下行腰椎后路手术患者不同头颈前曲角度时面颊受压压力进行测定,观察术后并发症。结果:面颊受压部位简易测压装置测压结果:标准体位时(头颈下垂角度15°~25°),P_0=(24.08±2.43)mm Hg;升高垫枕,P_1(垫高1.5 cm)=(27.69±2.59)mm Hg;P_2(垫高3 cm)=(31.23±2.35)mm Hg;降低垫枕,P_(-1)(降低1.5 cm)=(18.37±2.35)mm Hg;P_(-2)(降低3 cm)≤16 mm Hg。术后发现面颊部Ⅰ°压疮1例,无眼睑、口唇部位水肿。结论:将头颈一侧偏转限制在30°以内,将头颈下垂(前屈)控制在15°~25°(与双侧肩胛骨连线平面夹角)之间作为俯卧位体位摆放标准,可以保证面-颈部皮下毛细血管回流通畅,减少面颊水肿或压疮,同时减少颈椎损伤的危险。
Objective：To discuss the reasonable head and neck posture of patients undergoing posterior lumbar surgery in prone position. Methods：By increasing or reducing the head pillow height layer by layer with 1.5 cm - thick soft cushion, or replacing the silicone pad with 500 ml soft - packing plastic bag （200 ml liquid extracted） to connect with an arterial pressure measuring device, the facial pressure of 49 patients of intubation anesthesia undergoing posterior lumbar surgery with different head and neck forward curving angles was measured, and then they were observed for postoperative complications. Results ：The pressure result measured by simple facial pressure measuring device： in standard posture （head and neck dropping angle 15°-25°） ：P〈0 = （24. 08± 2.43 ） mmHg; pillow height increased ： P1 （ cushion height 1.5 cm） = （ 27.69 ±2.59 ） mmHg; P2 （ cushion height 3 cm） = （ 31.23 ± 2.35 ） mmHg; pillow height lowered ： P1 （ reduced by 1.5 cm） = （ 18.37 ± 2.35 ） mmHg ; P2 （ reduced by 3 cm） ≤ 16 mmHg. It was discovered after operation that one case of these patients had cheek pressure sores I, without swelling in eyelids and lips. Conclusion ： To limit the deflection on one side of head and neck within 30° and control the head and neck drooping （ forward curving） within 15° - 25° （ included angle with the plane of connecting lines of shoulder blades on two sides） as standard prone position could guarantee an unobstructed return of subcutaneous capillary vessels of face and neck, reduce the cheek edemas or pressure sores, and also reduce the risk of cervical spine injury.
作者
沈微烨
费建平
孙蓉
张征石
SHEN Wei - ye FEI Jian - ping SUN Rong et al(Kunshan Hospital of Traditional Chinese Medicine,Suzhou 215300)
出处
《护理实践与研究》
2017年第4期72-74,共3页
Nursing Practice and Research
关键词
腰椎后路手术
俯卧位
颈椎屈曲
面部压疮
Undergoing posterior lumbar surgery
Prone position
Flexion of cervical spine
Facial pressure sores
