术前筛查评估对预防胸腔镜手术患者术后同侧肩痛的指导作用

Effect of preoperative evaluation on the prevention of postoperative ipsilateral shoulder pain in patients undergoing thoracoscopic surgery

目的观察牛津大学关节评分(Oxford Shoulder Score,OSS)对胸腔镜手术患者术后同侧肩痛(ipsilateral shoulder pain,ISP)的评估效果。方法择期全麻下侧卧位胸腔镜手术患者500例,年龄18~78岁,分别于术前1 d和术后第1 d在病区面对面、术后4~6周电话随访获取OSS。对术前OSS≥19分患者数据进行独立分析,并在手术体位摆放时予以保护。结果最终纳入研究465例,术前OSS≥19分患者1%(9例),术后均未发生ISP;余456例患者中,发生ISP者3.44%(16例),其手术时间长于未发生ISP患者,术后OSS较高,术后第1 d肩关节活动受限,显著低于术前(P<0.05或0.01)。结论术中对术前OSS异常患者加以体位保护,可有效预防发生术后ISP。

Objective To investigate the efficacy of Oxford Shoulder Score(OSS)for preventing postoperative ipsilateral shoulder pain(ISP) in patients undergoing thoracoscopic surgery.Methods A total of 500 patients who underwent selective thoracoscopic surgery in the lateral position with general anesthesia were enrolled.Complete OSS data were questioned using in-depth interviews in the afternoon before the operation and the first postoperative day,and telephone was follow-up at 4-6 weeks after the operation.Special protections and statistical analysis were designed for the patients with preoperative OSS ≥19.Results A total of 465 patients were included in the study,16 cases presented ISP with a longer operative duration and higher postoperative OSS compared to those without ISP,and shown limitation of range of motion of ipsilateral shoulder in the first postoperative day(P<0.05 or 0.01).However,9 cases with preoperative OSS ≥19 didn't develop ISP.Conclusions The protective procedures of the lateral posture can minimize postoperative ISP for the patients with a high preoperative OSS.