刘宝林

[摘要] 目的 探讨不同CO2气腹压对腹腔镜胆囊切除患者术后肩部疼痛的影响。 方法 选择本院行腹腔镜胆囊切除患者90例，随机分为3组，每组30例，A组气腹压力为10 mm Hg，B组气腹压力为12 mm Hg，C组气腹压力为14 mm Hg，观察3组术后1、6、12、24、48、72 h肩部疼痛发生率及VAS。 结果 3组术后6、12、24、48 h肩部疼痛发生率比较差异有统计学意义（P＜0.05）。3组术后1、72 h肩部疼痛发生率比较差异无统计学意义（P＞0.05）。3组的VAS随着时间延长逐渐升高，术后24 h为高峰，随后逐渐降低，且不同时间点A组的VAS明显低于B、C组，差异有统计学意义（P＜0.05）。 结论 不同气腹压力对患者术后肩部疼痛发生率及疼痛程度有明显影响，在气腹压力10 mm Hg下行腹腔镜手术治疗可有效降低术后肩部疼痛发生率，值得临床推广应用。

[关键词] CO2气腹；腹腔镜胆囊切除；肩部疼痛

[中图分类号] R616.2[文献标识码] B[文章编号] 1674-4721（2014）05（a）-0169-03

Influence of different CO2 pneumoperitoneum pressure on postoperative shoulder pain of patient with laparoscopic cholecystectomy

LIU Bao-lin

Department of General Surgery,People′s Hospital of Changqing District in Jinan City,Jinan250300,China

[Abstract] Objective To investigate the influence of different CO2 pneumoperitoneum pressure on postoperative shoulder pain of patient with laparoscopic cholecystectomy. Methods 90 patients with laparoscopic cholecystectomy in our hospital were randomly divided into three groups,30 cases in each group,the pneumoperitoneum pressure was 10 mm Hg,12 mmHg,14 mm Hg in group A,B,C respectively,the incidence rate of shoulder pain and VAS in 1,6,12,24,48,72 hours after surgery in three groups was observed respectively. Results Incidence rate of shoulder pain in 6,12,24,48 hours after surgery of three groups was compared respectively,with statistical difference(P＜0.05).The incidence rate of shoulder pain in 1,72 hours of three groups was compared respectively,with no statistical difference(P＞0.05).VAS gradually increased with time extension,VAS was highest in 24 hours after surgery,then VAS decreased,but at different time points,VAS in group A was significantly lower than that in group B and group C respectively,with statistical difference(P＜0.05). Conclusion Different pneumoperitoneum pressure has significant influence on the incidence rate and degree postoperative shoulder pain,laparoscopic cholecystectomy under 10 mm Hg pneumoperitoneum pressure can effectively reduce the incidence of postoperative shoulder pain,is worthy of clinical promotion and application.

[Key words] CO2 pneumoperitoneum;Laparoscopic cholecystectomy;Shoulder pain

腹腔镜胆囊切除术是目前临床开展最广泛且比较成熟的微创手术方式，但手术需要在CO2气腹下进行，术后容易出现肩部疼痛等气腹并发症，造成患者术后不适。研究显示，CO2气腹后患者肩部疼痛并发症发生率可达80%[1]。多数研究报道认为，气腹产生的张力对膈肌纤维的牵拉作用与腹腔镜胆囊切除术后肩痛的发生有密切关系[2]。目前临床对CO2气腹并无有效的处理方法。有学者研究显示，降低气腹压力对改善患者术后肩部疼痛有较好作用，但关于最适宜的气腹压临床并无统一标准[3]。本文探讨不同CO2气腹压对腹腔镜胆囊切除术后患者肩部疼痛的影响，考察合理的气腹压水平，为临床提供参考。……