摘要
目的腹腔镜胆囊切除术后上腹痛、肩痛及切口痛是造成患者术后不适的常见原因。文中观察腹腔镜胆囊切除术后实施膨肺策略对患者上腹痛、肩痛及切口痛的影响。方法选取2010年1月至2013年12月实行腹腔镜胆囊切除术138例患者,随机分为干预组(n=67)和对照组(n=71)。干预组在术后实施连续5次不超过40 cm H2O的人工正压力通气,每次持续时间为5 s,促使腹腔内的CO2排出;对照组术后腹腔内的CO2通过腹壁孔道被动排除。在术后6、12、24 h及48 h评估上腹痛、肩痛及切口疼痛发生率,并通过视觉模拟评分法(visual analogue scale,VAS)评分确定疼痛严重程度。结果与对照组比较,干预组术后12、24 h上腹痛发生率明显降低(90.14%vs 74.63%、91.55%vs 73.13%,P<0.05),上腹痛VAS评分明显降低[(4.32±2.73)分vs(2.72±1.67)分、(4.04±2.55)分vs(2.67±1.49)分,P<0.05];肩痛的发生率明显降低(56.34%vs 47.76%、74.65%vs 56.72%,P<0.05)、肩痛的VAS评分亦明显降低[(3.68±3.10)分vs(2.61±1.97)分、(4.15±3.23)分vs(2.78±1.88)分,P<0.05]。对照组及干预组术后各时间点切口疼痛的发生率及VAS评分的差异均无统计学意义(P>0.05)。结论膨肺可降低腹腔镜胆囊切除术后患者上腹痛和肩痛的发生率和严重程度,但其对切口痛的缓解无效。
Objective Abdominal pain, shoulder pain, and incision pain after laparoscopic cholecystectomy （ LC） are com-mon complaints of the patients.This study was to observe the effects of pulmonary recruitment （ PR） in reducing post-LC abdominal pain, shoulder pain, and incision pain. Methods A total of 138 patients treated by LC were randomly assigned to a PR （ n=67） and a control group （n=71）.The former underwent postoperatively five 5-second-long manual inflations of the lungs by positive pres-sure ventilation with 40 cmH2 O to discharge CO2 from the abdominal cavity, while the latter received traditional passive deflation of CO2 .At 6, 12, 24, and 48 h after surgery, we recorded the incidences of abdominal pain, shoulder pain, and incision pain and as-sessed the pain intensity using the visual analogue scale （ VAS） . Results Compared with the control group at 12 and 24 h after sur-gery, the PR group showed significant decreases in the incidence rate of upper abdominal pain （90.14%vs 74.63%and 91.55%vs 73.13%, both P0.05）. Conclusion Pulmonary recruitment can re-duce the incidence rates and severity of upper abdominal pain and shoulder pain, but has no effect in alleviating incision pain following laparoscopic cholecystectomy.
出处
《医学研究生学报》
CAS
北大核心
2015年第7期741-744,共4页
Journal of Medical Postgraduates
关键词
膨肺
腹腔镜
疼痛
二氧化碳
气腹
Pulmonary recruitment
Laparoscopic cholecystectomy
Pain
Carbon dioxide
Pneumoperitoneum
