人工气腹前腹腔灌洗对腹腔镜胆囊切除术后肩痛的疗效分析

doi:10.3877/cma.j.issn.1674-0793.2019.03.007

目的

比较腹腔充入CO₂气体建立人工气腹前、后不同时间段进行腹腔灌洗，对腹腔镜胆囊切除术（LC）术后肩痛的疗效。

方法

选择2016年3月至2018年6月南方医科大学附属小榄医院诊治的LC患者120例，按照数字表法随机分为A、B、C组，每组40例。A组为对照组，术后尽量吸尽膈下气体关腹，不进行腹腔灌洗；B组术后用温生理盐水（37.5℃的0.9%氯化钠溶液）进行腹腔灌洗；C组为充入CO₂气腹前先进行膈下温生理盐水灌洗，术后再次行腹腔灌洗。比较3组患者术后6、12、24、48 h的术后肩痛评分（VAS）和中、重度肩痛发生率。

结果

3组患者在术后48 h不同时间点的肩痛VAS评分比较及两两比较，差异均有统计学意义（P<0.05），其中C组的肩痛程度最轻。A、B、C组患者中、重度肩痛发生率分别为27.5%（11/40）、7.5%（3/40）、2.5%（1/40），整体比较差异有统计学意义（χ²=12.708，P=0.002），其中A组发生率显著高于B组和C组（χ²=4.242、7.941，P=0.039、0.005），而B、C两组发生率差异无统计学意义（χ²=0.263，P=0.608）。

结论

温生理盐水灌洗腹腔可明显降低LC术后疼痛的发生率和减轻术后肩痛的强度，其中人工气腹前灌洗温生理盐水的患者术后发生肩痛程度最轻。

关键词: 氯化钠, 胆囊切除术，腹腔镜, 腹腔灌洗, 滴注，药物, 肩痛

Objective

To investigate the effect of peritoneal lavage on shoulder pain after laparoscopic cholecystectomy (LC).

Methods

From March 2016 to June 2018, one hundred and twenty patients with LC in Xiaolan Hospital Affiliated to Southern Medical University were randomly divided into groups A, B and C, with 40 cases in each group. As the control group, Group A didn’t perform abdominal lavage; Group B underwent peritoneal lavage with warm saline (0.9% sodium chloride solution at 37.5 C); Group C underwent subphrenic warm saline lavage before CO₂ pneumoperitoneum filling, then abdominal lavage was performed again after operation. The postoperative shoulder tip pain score (VAS) and incidence of moderate to severe pain were compared among the three groups at 6, 12, 24 and 48 hours after operation.

Results

The VAS scores of shoulder pain in three groups at different time points 48 hours after operation showed significant differences (all P<0.05), and the degree of shoulder pain in group C was the lightest. The incidence of moderate to severe shoulder pain in group A, B and C were 27.5% (11/40), 7.5% (3/40) and 2.5% (1/40) respectively, the overall difference was statistically significant (χ²=12.708, P=0.002). The incidence of shoulder pain in group A was significantly higher than that in group B and C (χ²=4.242, 7.941; P=0.039, 0.005), while the incidence of shoulder pain in group B and C showed no significantly difference (χ²=0.263, P=0.608).

Conclusion

Warm saline lavage can obviously reduce the incidence of postoperative pain, reduce the intensity of shoulder tip pain after operation, and the degree of shoulder pain after warm saline lavage performed before pneumoperitoneum is the lightest.

Key words: Sodium chloride, Cholecystectomy, laparoscopic, Peritoneal lavage, Instillation, drug, Shoulder pain

图1 注入温生理盐水的位置

图2 气腹前注入温生理盐水

表1 3组腹腔镜胆囊切除术患者基线资料比较

组别	例数	年龄(岁, ±s)	性别(例)		气腹压力(mmHg, ±s)	体质量指数(kg/m²)		手术时间(min, ±s )
组别	例数	年龄(岁, ±s)	男	女	气腹压力(mmHg, ±s)	<23	≥23	手术时间(min, ±s )
A组	40	51.8±12.6	12	28	11.8±1.1	15	25	51.1±17.4
B组	40	52.4±16.7	19	21	11.6±0.9	18	22	54.5±19.1
C组	40	52.4±14.4	17	23	11.7±0.9	19	21	55.2±21.2
统计值	?	F=0.023	χ²=2.708		F=0.390	χ²=0.882		F=0.516
P值	?	0.977	0.258		0.678	0.643		0.598

表1 3组腹腔镜胆囊切除术患者基线资料比较

组别	例数	年龄(岁, ±s)	性别(例)		气腹压力(mmHg, ±s)	体质量指数(kg/m²)		手术时间(min, ±s )
组别	例数	年龄(岁, ±s)	男	女	气腹压力(mmHg, ±s)	<23	≥23	手术时间(min, ±s )
A组	40	51.8±12.6	12	28	11.8±1.1	15	25	51.1±17.4
B组	40	52.4±16.7	19	21	11.6±0.9	18	22	54.5±19.1
C组	40	52.4±14.4	17	23	11.7±0.9	19	21	55.2±21.2
统计值	?	F=0.023	χ²=2.708		F=0.390	χ²=0.882		F=0.516
P值	?	0.977	0.258		0.678	0.643		0.598

表2 3组患者腹腔镜胆囊切除术后不同时间点的VAS评分比较（±s）

组别	例数	6 h	12 h	24 h	48 h
A组	40	2.3±1.3	2.5±1.3	1.9±0.9	1.1±0.7
B组	40	1.6±1.0	1.8±0.9	1.3±0.6	0.9±0.2
C组	40	1.0±0.6	1.2±0.7	0.5±0.2	0.3±0.3
整体比较F,P	?	16.724, <0.001	15.877, <0.001	39.259, <0.001	29.062, <0.001
组间比较t值^a,b,c	?	2.687, 5.846, 3.216	2.661, 5.388, 3.280	3.151, 8.736, 6.770	2.312, 6.550, 7.913
组间比较P值^a,b,c	?	0.009, <0.001, 0.002	0.009, <0.001, 0.002	0.002, <0.001, <0.001	0.023, <0.001, <0.001

表2 3组患者腹腔镜胆囊切除术后不同时间点的VAS评分比较（±s）

组别	例数	6 h	12 h	24 h	48 h
A组	40	2.3±1.3	2.5±1.3	1.9±0.9	1.1±0.7
B组	40	1.6±1.0	1.8±0.9	1.3±0.6	0.9±0.2
C组	40	1.0±0.6	1.2±0.7	0.5±0.2	0.3±0.3
整体比较F,P	?	16.724, <0.001	15.877, <0.001	39.259, <0.001	29.062, <0.001
组间比较t值^a,b,c	?	2.687, 5.846, 3.216	2.661, 5.388, 3.280	3.151, 8.736, 6.770	2.312, 6.550, 7.913
组间比较P值^a,b,c	?	0.009, <0.001, 0.002	0.009, <0.001, 0.002	0.002, <0.001, <0.001	0.023, <0.001, <0.001

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Effect of artificial pneumoperitoneal lavage on shoulder pain after laparoscopic cholecystectomy

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Effect of artificial pneumoperitoneal lavage on shoulder pain after laparoscopic cholecystectomy