术中轻度过度通气对妇科腹腔镜手术患者术后肩痛的影响

Effects of intraoperative mild hyperventilation on shoulder pain in patients undergoing gynecologic laparoscopic surgery

中文关键词: 过度通气  妇科腔镜手术  腹腔镜术后肩痛  镇痛

英文关键词: Hyperventilation  Gynecological laparoscopic surgery  Postlaparoscopic shoulder pain  Analgesia

中文摘要:

      
目的：探讨术中采用轻度过度通气对妇科腹腔镜手术患者术后肩痛（PLSP）的影响。
方法：选择2023年1—9月行妇科腹腔镜手术的患者82例，年龄18～64岁，BMI 18.5～32.0 kg/m²，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：观察组和对照组，每组41例。术中观察组予轻度过度通气，维持P_ETCO₂ 30～33 mmHg；对照组予常规机械通气，维持P_ETCO₂ 35～40 mmHg。记录术后12、24、48、72 h及术后1周PLSP例数、PLSP的VAS疼痛评分。记录麻醉诱导前、气腹后15 min、术毕即刻及术后24 h的动脉血气分析结果。记录术中丙泊酚和瑞芬太尼用量、拔管时间、心动过缓（HR<50次/分）和低血压（SBP<90 mmHg）的发生情况。记录术后72 h内恶心呕吐等不良反应发生情况以及术后1周内补救镇痛情况。
结果：与对照组比较，观察组术后12、24、48、72 h及术后1周PLSP发生率和PLSP的VAS疼痛评分明显降低（P<0.05）；气腹后15 min、术毕即刻PaCO₂明显降低（P<0.05）。两组术中丙泊酚和瑞芬太尼用量、拔管时间、术中心动过缓和低血压发生率、术后72 h内恶心呕吐发生率以及术后1周内补救镇痛率差异无统计学意义。
结论：妇科腹腔镜手术中采用轻度过度通气，可有效降低术后1周PLSP发生率以及疼痛程度，且不增加术后72 h内相关不良反应。

英文摘要:

      
Objective: To explore the effect of intraoperative mild hyperventilation on postoperative shoulder pain (PLSP) in patients undergoing gynecological laparoscopic surgery.
Methods: Eighty-two patients, aged 18-64 years, BMI 18.5-32.0 kg/m², ASA physical status Ⅰ or Ⅱ, who underwent gynecological laparoscopic surgery from January to September 2023 were selected. According to the random number table method, the patients were divided into two groups: observation group and control group, 41 patients in each group. The observation group was given mild hyperventilation during the operation to maintain P_ETCO₂ 30-33 mmHg, and the control group was treated with conventional mechanical ventilation to maintain P_ETCO₂ 35-40 mmHg. The incidence of PLSP and VAS pain score of PLSP were recorded 12, 24, 48, 72 hours, and 1 week after operation. The results of arterial blood gas analysis were recorded before anesthesia induction, 15 minutes after pneumoperitoneum, at the end of operation, and 24 hours after operation. The intraoperative consumption of propofol and remifentanil, extubation time, bradycardia (HR < 50 beats/minute), and intraoperative hypotension (SBP < 90 mmHg) were recorded. The occurrence of adverse reactions such as nausea and vomiting within 72 hours after operation and the requirement for rescue analgesia within 1 week after operation were recorded.
Results: Compared with the control group, the incidence of PLSP and VAS pain scores 12, 24, 48, 72 hours, and 1 week after operation in the observation group were significantly reduced (P < 0.05), and PaCO₂ 15 minutes after pneumoperitoneum and at the end of operation were significantly reduced (P < 0.05). There were no significant differences between the two groups in intraoperative consumption of propofol and remifentanil, extubation time, incidence of intraoperative bradycardia and hypotension, incidence of nausea and vomiting within 72 hours after surgery, and requirement for rescue analgesia within 1 week after surgery.
Conclusion: Mild hyperventilation in gynecological laparoscopic surgery can effectively reduce the incidence of PLSP and the degree of pain within 1 week after surgery, and does not increase the related adverse reactions within 72 hours after surgery．