Effect of modified herringbone-Trendelenburg position during gynecological laparoscopic operation of the elderly / 中国实用护理杂志

ABSTRACT

Objective To explore the effects of modified herringbone-Trendelenburg position during gynecological laparoscopic operation of the elderly. Methods A total of 60 elderly patients undergoing gynecological laparoscopic operation under general anesthesia were recruited and assigned to the observation group (30 cases) and control group (30 cases) by random digits table method with 30 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 herringbone-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) , every 30 minutes (times 4 to 11), while supine at the end of pneumoperitoneum (time 12) and before awakening (time 13);Patients were followed up at 24 h and 48 h after surgery, researcher investigate and record the scores of the Operation Position Comfort Questionnaire, the situation of the pain in the shoulder and postoperative complications of the lower limbs. Results There was no statistically significant difference (t=-1.098,-0.772,-0.656, P>0.05) of the IOP at T1, T2, T13. The IOP in the observation group had statistically significant difference compared with the control group at T3 to T12 (t=6.523-19.866, P<0.01). The incidence rate of the postoperative complications of the lower limbs in the observation group was 6.7%(2/30) lower than 26.7%(8/30) of the control group (χ2=4.320, P<0.05) and the VAS scores of the patients in the two groups was statistically significant (t=2.471, P<0.05). The incidence rate of the postoperative shoulder pain in the observation group was 10.0%(3/30) lower than 43.3%(13/30) of the control group (χ2=8.523, P<0.01), and the Visual Analogue Scale scores of the patients in the two groups was statistically significant (t=3.575, P<0.05).The scores of the Operation Position Comfort Questionnaire in the observation group was higher than the control group (t=-2.319, P<0.05). Conclusions Modified herringbone- Trendelenburg position can reduce the elevation of intraocular pressure in elderly patients without affecting the operation ,and effectively improve the comfort of the operation position of the patients, reduce the incidence rate of the shoulder pain and postoperative complications of the lower limbs, is conducive to the operation safety of elderly patients.