妇科腹腔镜手术后疼痛60例分析

Analysis on the pain after laparoscopic gynecological surgery:a report of 60 cases

目的观察妇科腹腔镜术后疼痛的发生部位及镇痛方法。方法观察60例择期妇科腹腔镜术后疼痛患者,术后采用视觉模拟评分法(VAS)评价内脏、肩部、腹壁切口的疼痛情况,术后采用局部阻滞镇痛或口服非类固醇类抗炎药(消炎痛、芬必得等)或胸膜腔注入0.5%布比卡因的疗效。结果术后上腹部疼痛在术后第1天发生率最高达77.0%,术后第2天或第3天又出现第2个或第3个疼痛高峰。肩痛通常在第1天轻微,多在第2天逐渐转明显,有36例(42.6%)。疼痛发生在腹部和背部或肩部两处者有49例(81.7%)。疼痛发生在下腹部术后第1天发生率最高,持续时间约1-2d,有11例,占18.3%。局部阻滞镇痛有效率达100%,非类固醇类抗炎药有效率达82.2%。结论腹腔镜术后疼痛主要发生在上腹部、下腹部、背部或肩部等处,局部阻滞镇痛及非类固醇类抗炎药均有较好镇痛效果。

Objective To investigate the pain site after laparoscopic gynecological surgery and the analgesic method. Methods The postoperative pains of internal organs, shoulders and abdomen were evaluated in 60 patients with laparoscopic gynecological surgery by visual analog scale（VAS） ,and the effect of local block anesthesia,oral non＋steroidal anti-inflammatory drugs or 0.5% bupivacain into the pleural was observed. Results The postoperative pain of the upper abdomen was the highest, 77.0%, in the first postoperative day, and the second and third peak pain occurred in the second and third postoperative days. Thirty-six patients （ 42.6% ） felt slight shoulder ache in the first postoperative day, and felt painful in the next day. Forty-nine patients（ 81.7% ）felt pain on both the abdomen and the backside or shoulders. The lower abdominal ache mostly occurred in another 11 cases （ 18.3% ） in the first postoperative day, and lasted for 1 - 2 days. The effective rate of local analgesic block was 100%. The efficiency of non-steroidal and anti-inflammatory drugs was 82.2%. Conclusion Laparoscopic postoperative pain mostly occurs on the upper abdomen, lower abdomen, backside or shoulders of the patients. Both the local analgesic block and non-steroidal, anti-inflammatory drugs have a better analgesic effect.