Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the urological surgery.
Compartment syndrome, rhabdomyolysis and risk of acute renal failure as complications of the urological surgery.
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泌尿外科手术并发症包括筋膜室综合征、横纹肌溶解症和急性肾功能衰竭的风险。
作者：
D. Kochiashvili;M. Sutidze;C. Tchovelidze;I. Rukhadze;A. Dzneladze
根据目前对在这些体位（Lloyd Davies和Trendelenburg倾斜）下操作时CS风险的了解，在非绝对必要时将患者保持在该体位（腿高于心脏）可被视为疏忽。如果这意味着重新定位和重新铺巾，从而增加了几分钟的额外时间，并花费少量的额外铺巾，这肯定是一个很小的代价支付优秀的围手术期护理？如果不可能重新定位，应每两小时将头向下倾斜的位置颠倒一次，持续一段短时间，以使下肢更自然地灌注。Raza等人建议，如果预期手术持续时间超过4小时，则应每隔2小时将腿从支架上移除一次，以防止再灌注损伤。使用艾伦箍筋优于小腿支撑或金属垫木。Turnbull和米尔斯建议，当对处于劳埃德·戴维斯体位的患者进行手术时，我们当然应该回顾我们对加压袜和间歇加压装置的使用。当患者在这些异常位置接受长时间手术时，误诊（即：误认为DVT）或延迟术后CS治疗（通过长时间重新评估）将被视为疏忽。延误或漏诊不仅可能危及肢体（并导致非常长的住院时间）-它可能危及生命。根据目前的知识，外科医生在异常位置进行长时间手术时必须意识到这种并发症，幸运的是这种并发症很罕见。围手术期护理的实践指南应反映当前的知识，并确保风险最小化。采取法律的行动的病人，如果他们经历了这种情况，可能会被授予大量的费用对疏忽，如果缺乏照顾可以证明或诊断已被延误。
Current knowledge related to the risk of CS when operating in these positions (Lloyd Davies and Trendelenburg tilt) is such that it can be deemed negligent to keep patients in this position (with legs higher than the heart) when not absolutely necessary. If it means repositioning and redraping, thus adding a few extra minutes to the episode and costing a small amount in additional drapes, surely this is a small price to pay for excellent perioperative care? If repositioning is impossible to execute, the head-down tilt position should be reversed every two hours, for a short period of time, to allow more natural perfusion of the lower limbs to occur. Raza et al recommend that if the anticipated procedure duration is beyond four hours, the legs should be removed from supports every two hours for a short period to prevent reperfusion injury. The use of Allen stirrups is preferred to calf supports or metal skids. Turnbull and Mills suggest that we should certainly review our use of compression stockings and intermittent compression devices when operating on patients in the Lloyd Davies position. It will be deemed negligent to misdiagnose (ie: mistake for a DVT) or delay treatment (by prolonged re-assessment) of CS postoperatively when patients have been subjected to prolonged surgery in these abnormal positions. Delayed or missed diagnosis may not only be limb-threatening (and cause a very protracted hospital stay)--it can be life-threatening. With today's current knowledge, surgeons undertaking prolonged surgery in abnormal positions must be aware of this, fortunately rare, complication. Practice guidelines within perioperative care should reflect current knowledge and ensure that risk is minimized. Patients who take legal action if they have experienced this condition may be awarded substantial costs against negligence if lack of care can be proven or diagnosis has been delayed.