高龄病人行俯卧位下经皮椎体成形术中不同时间节点生命体征和血氧饱和度的变化分析
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摘要
[目的]观察和分析高龄病人行俯卧位下经皮椎体成形术中不同时间节点生命体征和血氧饱和度的变化特点,为术中针对性加强病情观察,积极做好急救应对措施提供依据。[方法]回顾性分析广州市某三级甲等医院2016年—2017年104例胸腰椎骨质疏松性压缩骨折病人行经皮椎体成形手术治疗的临床资料。全部病例年龄≥65岁,均采取俯卧位局部麻醉下手术,持续观察并记录病人从术前仰卧5 min至术后恢复仰卧位5 min期间的生命体征和血氧饱和度的变化。[结果]以病人在术前仰卧5 min时间点(T1)的生命体征和血氧饱和度为基线对照数据,病人在转为俯卧位后5 min(T2)、骨穿刺进针过程(T4)、注射骨水泥过程(T5)、骨水泥注射结束(T6)4个时间点的生命体征和血氧饱和度变化较大。变化特点为:T2、T4、T5、T6时间点的心率、呼吸频率均较T1显著增高(P<0.05),T2、T4时间点的收缩压显著增高(P<0.05),T5时间点的血氧饱和度明显降低(P<0.05)。[结论]高龄病人行俯卧位下经皮穿刺椎体成形术中某些时间节点的生命体征和血氧饱和度变化差异大,直接影响病人的耐受性和手术安全。手术室护士应掌握变化剧烈的时间点,有针对性地加强病情观察,做好应急措施,确保手术安全、顺利实施。
Objective:To observe and analyze the changes of vital signs and blood oxygen saturation(SaO_2) at different time points in elderly patients undergoing percutaneous vertebroplasty in the prone position,and to provide the basis of targeted observation during the surgery for positively preparation of emergency measures.Methods:Retrospective analysis of clinical data was conducted among 104 patients with thoracolumbar osteoporotic compression fractures underwent percutaneous vertebroplasty in a Tertiary Grade A hospital in Guangzhou from 2016 to 2017.All cases were ≥65 years old and underwent local anesthesia in the prone position.The changes of vital signs and SaO_2 were observed and recorded during the period from preoperative 5-min in the supine position to postoperative 5-min in the replaced supine position.Results:The vital signs and SaO_2 of the patient's preoperative 5-min(T1) in the supine position were used as the baseline.The vital signs and SaO_2 in the following time points changed largely: 5 minutes after body position changing(T2),the process of needle puncturing(T4),the process of injection of bone cement(T5),at the end of bone cement injection(T6).The changes were characterized by heart rate and respiratory rate at T2,T4,T5,and T6 were significantly higher than T1(P<0.05),and systolic blood pressure at T2 and T4 was significantly increased(P<0.05).SaO_2 at T6 time point was significantly decreased(P<0.05).There was no significant difference in heart rate,respiratory rate,systolic blood pressure,diastolic blood pressure and SaO_2 at other time points(P>0.05).Conclusions: The changes of vital signs and SaO_2 of elderly patients at the time of percutaneous vertebroplasty in the prone position were significantly different,which directly affected the patient's tolerance and surgical safety.The nurses in the operating room should master the time points of severe changes,strengthen the observation of the disease in a targeted manner,and make emergency measures to ensure the safe and smooth implementation of the operation.
Objective:To observe and analyze the changes of vital signs and blood oxygen saturation(SaO_2) at different time points in elderly patients undergoing percutaneous vertebroplasty in the prone position,and to provide the basis of targeted observation during the surgery for positively preparation of emergency measures.Methods:Retrospective analysis of clinical data was conducted among 104 patients with thoracolumbar osteoporotic compression fractures underwent percutaneous vertebroplasty in a Tertiary Grade A hospital in Guangzhou from 2016 to 2017.All cases were ≥65 years old and underwent local anesthesia in the prone position.The changes of vital signs and SaO_2 were observed and recorded during the period from preoperative 5-min in the supine position to postoperative 5-min in the replaced supine position.Results:The vital signs and SaO_2 of the patient's preoperative 5-min(T1) in the supine position were used as the baseline.The vital signs and SaO_2 in the following time points changed largely: 5 minutes after body position changing(T2),the process of needle puncturing(T4),the process of injection of bone cement(T5),at the end of bone cement injection(T6).The changes were characterized by heart rate and respiratory rate at T2,T4,T5,and T6 were significantly higher than T1(P<0.05),and systolic blood pressure at T2 and T4 was significantly increased(P<0.05).SaO_2 at T6 time point was significantly decreased(P<0.05).There was no significant difference in heart rate,respiratory rate,systolic blood pressure,diastolic blood pressure and SaO_2 at other time points(P>0.05).Conclusions: The changes of vital signs and SaO_2 of elderly patients at the time of percutaneous vertebroplasty in the prone position were significantly different,which directly affected the patient's tolerance and surgical safety.The nurses in the operating room should master the time points of severe changes,strengthen the observation of the disease in a targeted manner,and make emergency measures to ensure the safe and smooth implementation of the operation.
引文
[1] WEILNER S,SKALICKY S,SALZER B,et al.Differentially circulating miRNAs after recent osteoporotic fractures can influence osteogenic differentiation[J].Bone,2015,79:43-51.
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[3] 许正伟,贺宝荣,郝定均,等.胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展[J].中华骨科杂志,2016,36(17):1142-1148.
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[5] MECAAHY J,DAVIS A.Diagnosis and Management of Vertebral Compression Fractures[J].Am Fam Physician,2016,94(1):44-50.
[6] 唐晓明,戴健,朱国太,等.聚甲基丙烯酸甲酯骨水泥椎体成形治疗高龄骨质疏松性胸腰椎骨折[J].中国组织工程研究,2015,19(47):7545-7549.
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[8] LANDHAM P R,BAKER-RAND H L,GILBERT S J,et al.Is kyphoplasty better than vertebroplasty at restoring form and function after severe vertebral wedge fractures?[J].Spine J,2015,15(4):721-732.
[9] 邵爱娣,陈亚芳,马兰青.术前体位耐受评估及干预对老年经皮椎体成形患者生命体征和血氧饱和度的影响[J].北京医学,2017,39(1):117-118.
[10] 宋奇志,李涛,奉成斌,等.经皮椎体成形使用骨水泥对心血管系统的影响[J].中国组织工程研究,2014,18(21):3374-3379.
[11] CIMEN O B,ULUBAS B,SAHIN G,et al.Pulmonary function tests,respiratory muscle strength,and endurance of patients with osteoporosis[J].South Med J,2003,96(5):423-426.
[12] 柯珍勇,邓忠良,冉金伟,等.慢性腰背痛和体位对老年患者肺功能的影响及临床意义[J].中国临床康复,2004,8(15):3310-3312.
[13] LOMBARDI I,OLIVERIA L M,MAYER A F,et al.Evaluation of pulmonary function and quality of life in women with osteoporosis[J].Osteoporos Int,2005,16(10):1247-1253.
[14] REN H L,JIANG J M,CHEN J T,et al.Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebroplasty[J].Eur Spine J,2015,24(4):750-758.
[15] HOFFMANN C,PINGEL A,KANDZIORA F.Percutaneous,cementaugmented reposition and stabilisation of burst fractures T9 and T12 in osteoporosis[J].Eur Spine J,2014,23(12):2767-2768.
[16] ZHAO Y,LIU T,ZHENG Y,et al.Successful percutaneous retrieval of a large pulmonary cement embolus caused by cement leakage during percutaneous vertebroplasty:case report and literature review[J].Spine(Phila Pa 1976),2014,39(26):E1616-1621.
[17] 许太武,丁玉兴,李小亮,等.俯卧位下地心引力及机械性干涉对脊柱手术呼吸功能影响的临床研究[J].中华骨科杂志,1997,17(4):253-255.
[18] 王伟鹏,李立环.临床麻醉学[M].4版.北京:人民卫生出版社,2004:572-577.
[19] SARACEN A,KOTWICA Z.Complications of percutaneous vertebroplasty:an analysis of 1100 procedures performed in 616 patients[J].Medicine(Baltimore),2016,95(24):3850.
[20] 潘丽芬,刘婉玲,张春燕,等.经皮椎体成形术治疗脊柱压缩性骨折的手术体位改进[J].中华护理杂志,2010,45(7):605-607.
[21] 林学扬,张亮,高梁斌,等.经皮椎体成形手术体位对患者生命体征和血氧饱和度的影响[J].中国组织工程研究与临床康复,2011,15(30):5679-5683.
[2] MECAAHY J,DAVIS A.Diagnosis and management of vertebral compression fractures[J].Am Fam Physician,2016,94(1):44-50.
[3] 许正伟,贺宝荣,郝定均,等.胸腰椎骨质疏松性骨折经皮椎体成形术后骨水泥渗漏的研究进展[J].中华骨科杂志,2016,36(17):1142-1148.
[4] 吴四军,刘正,姚洪春,等.应用高黏度骨水泥PVP治疗骨质疏松性椎体压缩骨折与传统PKP的临床疗效比较[J].中华骨科杂志,2017,37(2):74-79.
[5] MECAAHY J,DAVIS A.Diagnosis and Management of Vertebral Compression Fractures[J].Am Fam Physician,2016,94(1):44-50.
[6] 唐晓明,戴健,朱国太,等.聚甲基丙烯酸甲酯骨水泥椎体成形治疗高龄骨质疏松性胸腰椎骨折[J].中国组织工程研究,2015,19(47):7545-7549.
[7] ESCHLER A,ENDER SA,SCHIML K,et al.Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws[J].PLoS One,2015,10(2):e0117122.
[8] LANDHAM P R,BAKER-RAND H L,GILBERT S J,et al.Is kyphoplasty better than vertebroplasty at restoring form and function after severe vertebral wedge fractures?[J].Spine J,2015,15(4):721-732.
[9] 邵爱娣,陈亚芳,马兰青.术前体位耐受评估及干预对老年经皮椎体成形患者生命体征和血氧饱和度的影响[J].北京医学,2017,39(1):117-118.
[10] 宋奇志,李涛,奉成斌,等.经皮椎体成形使用骨水泥对心血管系统的影响[J].中国组织工程研究,2014,18(21):3374-3379.
[11] CIMEN O B,ULUBAS B,SAHIN G,et al.Pulmonary function tests,respiratory muscle strength,and endurance of patients with osteoporosis[J].South Med J,2003,96(5):423-426.
[12] 柯珍勇,邓忠良,冉金伟,等.慢性腰背痛和体位对老年患者肺功能的影响及临床意义[J].中国临床康复,2004,8(15):3310-3312.
[13] LOMBARDI I,OLIVERIA L M,MAYER A F,et al.Evaluation of pulmonary function and quality of life in women with osteoporosis[J].Osteoporos Int,2005,16(10):1247-1253.
[14] REN H L,JIANG J M,CHEN J T,et al.Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebroplasty[J].Eur Spine J,2015,24(4):750-758.
[15] HOFFMANN C,PINGEL A,KANDZIORA F.Percutaneous,cementaugmented reposition and stabilisation of burst fractures T9 and T12 in osteoporosis[J].Eur Spine J,2014,23(12):2767-2768.
[16] ZHAO Y,LIU T,ZHENG Y,et al.Successful percutaneous retrieval of a large pulmonary cement embolus caused by cement leakage during percutaneous vertebroplasty:case report and literature review[J].Spine(Phila Pa 1976),2014,39(26):E1616-1621.
[17] 许太武,丁玉兴,李小亮,等.俯卧位下地心引力及机械性干涉对脊柱手术呼吸功能影响的临床研究[J].中华骨科杂志,1997,17(4):253-255.
[18] 王伟鹏,李立环.临床麻醉学[M].4版.北京:人民卫生出版社,2004:572-577.
[19] SARACEN A,KOTWICA Z.Complications of percutaneous vertebroplasty:an analysis of 1100 procedures performed in 616 patients[J].Medicine(Baltimore),2016,95(24):3850.
[20] 潘丽芬,刘婉玲,张春燕,等.经皮椎体成形术治疗脊柱压缩性骨折的手术体位改进[J].中华护理杂志,2010,45(7):605-607.
[21] 林学扬,张亮,高梁斌,等.经皮椎体成形手术体位对患者生命体征和血氧饱和度的影响[J].中国组织工程研究与临床康复,2011,15(30):5679-5683.
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