体位変換に伴う循環動態の腹臥位と膝胸位間での比較

Comparison of Prone Position and Knee-Chest Position in Hemodynamics During Postural Change

Miyoshi Hirotsugu

Nakamura Ryuji

Kondo Takashi

Kato Takahiro

Yasuda Toshimichi

Tanaka Hiroyuki

Hamada Hiroshi

Kawamoto Masashi

麻酔と蘇生

Ansesthesia and Resuscitation

全静脈麻酔下で腹臥位または膝胸位へ体位変換した際の循環動態を両体位で比較するため，腰部脊椎手術を受けた患者を後方視的に調査した。体位変換の直前，体位変換直後， ３分後， ５分後の心拍数（HR）および収縮期血圧（SBP），拡張期血圧（DBP），平均血圧（MBP）を測定した。各パラメーターを体位変換前の値を基準とし体位変換後の変化率を算出し膝胸位（Knee-chest群）と腹臥位（Prone群）で比較した。統計はt検定を用いた。対象患者はKnee-chest群３０名，Prone群３０名であった。SBPは体位変換直後から５分後までKnee-chest群で有意に低く，MBPは５分後でKnee-chest群で有意に低く，HRは体位変換直後から５分後までKnee-chest群で有意に高かった。このため，全静脈麻酔管理下で膝胸位への体位変換は，腹臥位への体位変換よりも血圧の低下に注意する必要があると結論した。

We compared the hemodynamics of posture change under general anesthesia between prone position and knee chest position. Patients who underwent lumbar spinal surgery were retrospectively investigated.　Heart rate (HR) and systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP) were measured before and after postural change, 3 minutes and 5 minutes after postural change.　The rate of change of each parameter was calculated and compared in both groups of knee-chest and prone position.　Student’s t-test was used as statistical methods. We analyzed 60 patients (30 Knee-chest, 30 Prone).　SBP was significantly lower in the Knee-chest group from immediately after postural change to 5 minutes after postural change. MBP was significantly lower in the Knee-chest group 5 minutes after postural change. HR was significantly higher in the Knee-chest group from immediately after body change to 5 minutes after postural change.　In conclusion, SBP and MBP were significantly lower in the knee-chest position than in the prone position during postural change. Postural change to the kneechest position requires attention to lowering of blood pressure than postural change to the prone position.

腹臥位

膝胸位

循環動態

全身麻酔

prone position

knee-chest position

hemodynamics

general anesthesia

Medical sciences [ 490 ]

jpn

広島麻酔医学会

[ISSN] 0385-1664

[NCID] AN00232251