| 钱华.持续排气法在后腹膜腹腔镜手术中预防皮下气肿的应用研究[J].上海护理,2023,23(1): |
| 持续排气法在后腹膜腹腔镜手术中预防皮下气肿的应用研究 |
| Application of continuous exhaust method in preventing subcutaneous emphysema in retroperitoneal laparoscopic surgery |
| DOI： |
| 中文关键词: 腹腔镜 肾部分切除术 后腹膜腔 气腹 皮下气肿 排气 负压吸引 |
| 英文关键词:laparoscopy Partial nephrectomy Retroperitoneal cavity Pneumoperitoneum Subcutaneous emphysema Exhaust Negative pressure suction |
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| 中文摘要: |
| 目的 探讨保持气腹压力的持续排气法在预防经腹膜后入路腹腔镜手术皮下气肿的应用效果。方法 以2020年10月至2021年9月收治于常州市第一人民医院经腹膜后入路行腹腔镜肾部分切除术的101例患者为研究对象。将其随机分为观察组（n=49）与对照组（n=52）。对照组术中使用常规人工间歇吸引排气法，观察组采用持续吸引排气法。比较两组患者术中气腹实际压力值、擦拭镜头次数、手术时间及术后皮下气肿的发生率、住院时间等指标。结果 观察组49例患者中，有4例发生皮下气肿，且均为1～2级；对照组52例患者中，10例发生了1～2级皮下气肿，3例发生了3～4级皮下气肿；两组比较，差异有统计学意义（P<0.05）。且观察组术中擦拭镜头次数[（3.18±0.99）次]少于对照组[（6.41±2.91）次]，手术时间[（135.73±45.40）min]及住院天数[（15.50±3.89）d]亦短于对照组[（158.71±61.95）min及（16.04±4.24）d]，差异均有统计学意义（P<0.05）。另，术中持续腹压监测曲线图表明，观察组术中腹腔内实际气腹压力波动于11～13 mmHg，较对照组（5～18mmHg）更趋于平稳。结论 保持气腹压力稳定的持续排气法可明显提高腹膜后入路腔镜手术操作的流畅性，缩短手术时间，减少患者术后皮下气肿发生率，有一定推广应用价值。 |
| 英文摘要: |
| Objective To investigate the effect of continuous ventilation to maintain pneumoperitoneum pressure in preventing subcutaneous emphysema in laparoscopic surgery via retroperitoneal approach. Methods: 101 patients who received laparoscopic partial nephrectomy via retroperitoneal approach from October 2020 to September 2021 in Changzhou First People's Hospital were selected as the study subjects. They were randomly divided into observation group (n=49) and control group (n=52). In the control group, the routine artificial intermittent suction and exhaust method was used, while in the observation group, the continuous suction and exhaust method was used. The actual pressure of pneumoperitoneum during operation, the number of lens wipes, the operation time, the incidence of subcutaneous emphysema after operation, and the hospital stay were compared between the two groups. Results Among the 49 patients in the observation group, 4 patients had subcutaneous emphysema, all of which were grade 1~2; Among 52 patients in the control group, 10 patients had grade 1~2 subcutaneous emphysema and 3 patients had grade 3~4 subcutaneous emphysema; The difference between the two groups was statistically significant (P<0.05). In addition, the times of lens wiping [(3.18 ± 0.99) times] in the observation group was less than that in the control group [(6.41 ± 2.91) times], and the operation time [(135.73 ± 45.40) min] and hospital stay [(15.50 ± 3.89) d] in the observation group were also shorter than those in the control group [(158.71 ± 61.95) min and (16.04 ± 4.24) d] (P<0.05). In addition, the continuous intraoperative abdominal pressure monitoring curve shows that the actual intraperitoneal pneumoperitoneum pressure in the observation group fluctuates between 11 and 13 mmHg, which is more stable than that in the control group (5 ～18mmHg). Conclusion The continuous exhaust method of maintaining stable pneumoperitoneum pressure can significantly improve the smoothness of retroperitoneal endoscopic surgery, shorten the operation time, and reduce the incidence of subcutaneous emphysema in patients after surgery, which has certain popularization and application value. |
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