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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (03) : 198 -201. doi: 10.3877/cma.j.issn.1674-0793.2019.03.007

所属专题： 文献；

论著

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
倪航航1, 胡泽民2, 刘书强1, 华伟1, 江雪峰1, 宋林泉1, 梁志宏1,†()   
  1. 1. 528415　中山，南方医科大学附属小榄医院普外一区
    2. 528400　中山市人民医院肝胆外科
  • 收稿日期:2019-02-21 出版日期:2019-06-01
  • 通信作者: 梁志宏
  • 基金资助:
    广东省中山市医学科研项目(2016A020255)

Effect of artificial pneumoperitoneal lavage on shoulder pain after laparoscopic cholecystectomy

Hanghang Ni1, Zemin Hu2, Shuqiang Liu1, Wei Hua1, Xuefeng Jiang1, Linquan Song1, Zhihong Liang1,†()   

  1. 1. TheFirst Department of General Surgery, Xiaolan Hospital Affiliated to Southern Medical University, Zhongshan528415, China
    2. Department of Hepatobiliary Surgery, Zhongshan City People’s Hospital, Zhongshan 528400, China
  • Received:2019-02-21 Published:2019-06-01
  • Corresponding author: Zhihong Liang
  • About author:
    Corresponding author: Liang Zhihong, Email:
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引用本文：

倪航航, 胡泽民, 刘书强, 华伟, 江雪峰, 宋林泉, 梁志宏. 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[J/OL]. 中华普通外科学文献(电子版), 2019, 13(03): 198-201.

Hanghang Ni, Zemin Hu, Shuqiang Liu, Wei Hua, Xuefeng Jiang, Linquan Song, Zhihong Liang. Effect of artificial pneumoperitoneal lavage on shoulder pain after laparoscopic cholecystectomy[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(03): 198-201.

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 )
男 女 <23 ≥23
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
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