悬吊式小儿截石位体位器具的设计与应用

悬吊式小儿截石位体位器具的设计与应用

刘碧玉,梁淑玲

（徐州医科大学附属医院  江苏省徐州市221000）

Design and application of a suspended pediatric lithotomy position device

Liu Biyu and Liang Shuling

(Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu Province 221000)

[摘要] 目的：设计一种小儿悬吊式截石体位摆放器具，以解决做小儿截石位手术时无适配的体位用具，而增加体位摆放困难的问题。方法：1. 制作方法 用不同花色棉布裁剪出大、中、小三种规格的八边形各两片；缝制长40-50cm，宽3cm的系带数根。将棉芯铺在两层棉布中间依次进行缝合，对边钉上系带，系带根部相对面可缝上子母贴。2. 使用方法 ①将多功能手术床腿板摇至下垂或者卸下，将L型麻醉头架固定于床尾部床沿。②选择大小适宜的悬吊棉垫。③麻醉后将患儿膝关节至小腿置于悬吊棉垫内，小儿髋关节处约平齐麻醉头架，骶尾部与床尾平齐，保持腰骶部不悬空。④将棉垫两端系带上的子母贴相粘后再将系带固定于麻醉头架上，改变系带在麻醉头架的位置可调节两腿宽度，保持双下肢外展<90°[1]。调节麻醉头架的高度和倾斜角度可调节双腿悬吊高度及患儿大腿与躯干屈曲度，以满足手术术野暴露。优点： ①不同规格、不同颜色的悬吊带便于选择，棉布材质柔软透气增加舒适性且易于固定。②可清洗消毒重复利用，成本低[2]。③解决了长期以来小儿截石位摆放时无合适器具的难题，缩短了体位摆放时间。④良好的暴露降低医生操作的难度，减少麻醉和手术时间。⑤可控高度和角度的悬吊方法符合体位安置原则，减少并发症发生的风险。结论： 经临床试用得到了医护的好评，无并发症发生。

[关键词] 体位摆放；悬吊式；小儿截石位；器具设计；应用效果。

[Abstract] Objective: To design a suspension type lithotomy positioning device for children, in order to solve the problem of difficulty in positioning due to the lack of suitable positioning tools during pediatric lithotomy surgery. Methods: 1. Making method: cut out two pieces of Octagon in large, medium and small sizes with cotton cloth of different colors; Sew several straps with a length of 40-50cm and a width of 3cm. Lay the cotton core between two layers of cotton cloth and sew them in sequence. Nail a tie on the opposite side, and sew a child and mother sticker on the opposite side of the tie root. 2. Method of use: ① Shake the leg board of the multi-functional operating table to a drooping position or remove it, and fix the L-shaped anesthesia head rest on the edge of the bed at the end of the bed. ② Choose a suitable size suspension cotton pad. ③ After anesthesia, place the child's knee joint to the lower leg in a suspended cotton pad, with the hip joint of the child approximately level with the anesthesia head rest, and the sacrococcygeal part level with the bed end, keeping the lumbosacral part not suspended. ④ Adhere the child and mother straps on both ends of the cotton pad together, and then fix the straps on the anesthesia head rest. Change the position of the straps on the anesthesia head rest to adjust the width of both legs and maintain the abduction of both lower limbs at<90

° [1]. Adjusting the height and tilt angle of the anesthesia head rest can adjust the suspension height of both legs and the flexion degree of the patient's thighs and trunk to meet the exposure of the surgical field. Advantages: ① Hanging straps of different specifications and colors are easy to choose, and cotton fabric is soft and breathable, increasing comfort and easy to fix. ② Can be cleaned, disinfected, and reused, with low cost [2]. ③ Solved the long-standing problem of no suitable equipment for placement of pediatric lithotomy positions, and shortened the time for placement. ④ Good exposure reduces the difficulty of doctors' operations, reduces anesthesia and surgical time. ⑤ The suspension method with controllable height and angle conforms to the principle of posture placement, reducing the risk of complications. Conclusion: After clinical trial, it has received high praise from medical staff and no complications have occurred.

[Keywords] Positioning; Suspended type; Pediatric lithotomy position; Appliance design; Application effect.

1.临床资料：

1.1 对象 选择肛周疾病患儿、会阴外伤患儿、骶尾部肿瘤患儿共10例，年龄2月至6岁，手术麻醉方式为全身麻醉。

2.材料、器具：清洁棉布、棉芯、麻醉头架。

3.制作方法：用棉布裁剪出大、中、小三种规格的八边形各两片，3cm宽系带数根。将棉芯铺在两层棉布中间依次进行缝合，钉上系带（如图1），在靠近棉垫处的宽系带相对面可缝制子母贴。使用麻醉头架作为固定支架。

4.体位安置方法：①将多功能手术床腿板摇至下垂或者卸下，将L型麻醉头架固定于床尾部床沿。②选择大小适宜的悬吊棉垫。③麻醉后将患儿膝关节至小腿置于悬吊棉垫内，小儿髋关节处约平齐麻醉头架，骶尾部与床尾平齐，保持腰骶部不悬空。④将棉垫两端系带上的子母贴相粘或将系带相系后再将系带固定于麻醉头架上，改变系带在麻醉头架的位置可调节两腿宽度，保持双下肢外展<90°（如图2）。调节麻醉头架的高度和倾斜角度可调节双腿悬吊高度及患儿大腿与躯干屈曲度，以满足手术术野暴露。

5.护理要点：

5.1体位摆放时注意床单平整干燥，腿部悬吊带平整，麻醉插管及输液管路妥善固定防止脱管。

5.2 保持双腿外展小于90度，小腿悬吊高度不高于大腿长度，骶尾部不悬空。

5.3做好患儿约束与保暖。

6.临床应用效果总结：

6.1在10例患儿体位摆放中，平均摆放用时为60秒，医生对术野暴露满意度为100％，术中体位稳定，术后无一例体位并发症出现。

7.优点：

7.1可根据患儿大小制作多种尺寸规格，棉垫材质柔软透气，易于固定，且能保护患儿肌肤，增加舒适性。

7.2不同规格的悬吊带适用与不同体格大小的患儿，便于巡回护士选择使用。

7.3可清洗消毒、可重复利用，成本低。

7.4解决了长期以来小儿截石位摆放时无合适器具的难题，缩短了小儿截石位摆放的时间。

7.5良好的暴露降低医生操作的难度，减少麻醉和手术时间。

7.6可控高度和角度的悬吊方法减少对肢体的过度牵拉，减少体位摆放并发症的风险。

参考文献：

［1］中华护理学会手术室护理专业委员会.[M].手术室护理实践指南,2022:54

［2］熊晏群,谭燕.小儿奶糖卷手术体位垫的制作与使用［J］．当代护士(上旬刊)，2020，27(13):189