妇科腹腔镜术后非手术部位急性疼痛的临床观察性研究.doc

妇科术后肩痛及手术部位疼痛的临床分析 税敏 彭丽桦 张东 闵苏((（400016重庆，重庆医科大学附属第一医院麻醉科） 【摘要】目的 详细了解妇科术后肩痛及手术部位疼痛现状。 方法 序贯纳入手术时间1h-3h的妇科手术患者，严格按照各观察时点进行随访，记录患者肩痛及手术部位疼痛评分、补救镇痛及镇痛副反应。双人录入数据；在统计学教研室老师指导下，以开腹组、腹腔镜组进行对比分析。 结果 共纳入合格病例201例，其中腹腔镜手术97例，开腹手术104例。腹腔镜组肩痛发生率(33.0%)高于开腹组(11.5%)(P0.01)；肩痛程度两组对比无统计学差异。腹腔镜手术中左肩痛14例（14.4%），右肩痛7例（7.2%），双肩痛11例（11.3%）。肩痛出现时间主要在术后12h（10.3%）、24h（17.5%）内，缓解时间主要在术后24h（8.3%）、48h（11.3%）、72h（8.3%）以后。其中15例（15.5%）患者肩痛程度超过手术部位疼痛。手术部位疼痛腹腔镜组较开腹组轻，术后2h（P0.01）、12h(P0.05)静息NRS评分，72h(P0.01)活动NRS评分有统计学差异。腹腔镜组术后PCIA使用率、PACU恢复时间、首次肛门排气时间、术后住院日均少于开腹组(P0.01)。两组术后恶心呕吐发生率、补救镇痛、补救止吐、感染率无明显差异。结论 开腹手术也存在术后肩痛，术后肩痛发生机制有待进一步探索。腹腔镜手术虽有较高的术后肩痛发生率，但难以掩盖其创伤小、出血少、术后恢复快的优点。 【关键词】妇科手术；术后肩痛；手术部位疼痛 【中图分类号】R619+.9 【文献标志码】A A clinical analysis of postoperative shoulder pain and surgical site pain after gynecological surgery Shui Min, Peng Lihua, Zhang Dong, Min Su（Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China） 【Abstract】Objective This study aimed to elaborate the postoperative shoulder pain and surgical site pain after gynecological surgery. Methods Gynecologic operations, which lasted one to three hours, been included sequentially. The patients were followed up in strict accordance with the established time points. We mainly recorded their pain sites and severity which was accessed using a Numerical Rating Scale (NRS) from 0 to 10.And their rescue analgesia, side effects of analgesia and postoperative recovery indicators were also recorded. To avoid input error, data entry were implemented by two researchers. The data was analyzed under the guidance of statistician. Results We totally collected 201 qualified patients’ data, which included 97 laparoscopic surgery and 104 open surgery. The incidence of shoulder pain in group L (Laparoscopic surgery) (33.0%)was higher than group O(open surgery)(11.5%) (P0.01),and severity was no significant statistical difference. In group L, 14(14.4%) patients complained