Hemodynamic effect of the modified Z Trendelenburg position in patients undergoing laparoscopic radical surgery of endometrial carcinoma / 中国实用护理杂志

ABSTRACT

Objective:To explore the hemodynamic effect of the modified Z Trendelenburg position in patients undergoing laparoscopic radical surgery of endometrial carcinoma, to provide a reference for the selection of the operative position of patients.Methods:A total of 80 patients who undergoing laparoscopic radical surgery of endometrial carcinoma from April 2017 to April 2019 in the Central Hospital of Xiangyang were recruited and assigned to experiment group and control group by random digits table method with 40 cases in each group. Patients in the experiment group were positioned in modified Z Trendelenburg position, while the patients in the control group were placed in conventional Trendelenburg position. The data of heart rate, mean arterial pressure, central venous pressure, systemic circulation resistance, cardiac output were recorded at 10 minutes before pneumoperitoneum (T 0), pneumoperitoneum immediately (T 1) and 5 minutes (T 2), 10 minutes (T 3), 30 minutes (T 4), 60 minutes (T 5) after pneumoperitoneum and 1 minute after recover horizontal position (T 6). Followed up investigation at 24 h after surgery, the degree of pain in the shoulder and the lower limbs were also recorded by Visual Analogue Scale(VAS). Results:The differences of heart rate, mean arterial pressure, systemic circulation resistance and cardiac output between the two groups had no statistical significance at T 0 to T 6 (all P>0.05). The central venous pressure were (9.86±1.95), (10.94±1.53), (11.33±2.24), (11.14±1.54),(7.75±1.59) cmH 2O(1 cmH 2O=0.098 kPa) respectively from T 2 to T 6 in the experiment group, lower than that of control group (18.83±2.82), (16.81±2.93), (16.27±3.56), (15.76±2.33), (8.92±1.68) cmH 2O at the same time, the differences were statically significant ( t values were 3.057-15.736, all P<0.05). The VAS scores of shoulder pain and low leg pain in experiment group were (3.48±1.10), (2.35±0.66) points, lower than that of control group (4.16±1.32), (2.99±1.02) points, the differences were statically significant ( t values were 2.404, 3.228, P<0.05). Conclusions:Modified Z Trendelenburg position can maintain the circulatory system hemodynamic stability, reduce the degree of shoulder pain and low leg pain after surgery in the laparoscopic radical resection for endometrial carcinoma patients.