3种方法治疗妇科腹腔镜术后肩痛患者的效果观察

目的探讨3种方法治疗妇科腹腔镜术后肩痛患者的效果。方法将180例妇科腹腔镜术后患者随机分为3组,分别采取肩部热敷（热敷组57例）、氧气吸入治疗（氧疗组65例）和常规护理（对照组58例）。3组患者在手术后马上给予3 h氧气吸入,对照组给予心理护理、安慰支持、按摩等常规护理,热敷组与氧疗组在术后第1 d上午8：00（首次干预）及下午16：00（第2次干预）,分别给予肩部热水袋热敷（每次30 min）和鼻导管氧气吸入（流量2 L/min,每次2 h）。比较3组患者术后第1 d不同时段（8：00、16：00、20：00）肩痛评分,热敷组与氧疗组不同时段干预前后肩痛评分情况。结果干预后热敷组和氧疗组在同一时段的肩痛评分均低于对照组,组间比较,差异具有统计学意义（均P＜0？05）,但两组同一时段肩痛评分比较,差异无统计学意义（P＞0？05）;热敷组与氧疗组干预前后肩部视觉模拟评分（vision analogue score,VAS）评分组间比较,差异具有统计学意义（均P＜0？001）,干预后评分明显低于干预前。结论术后热敷、氧疗均能有效改善妇科腹腔镜术后患者肩痛情况,但两者的治疗效果没有明显差异,临床可以根据患者经济条件、术后恢复情况选择适宜的方法。     

针对性护理干预对缓解妇科腹腔镜术后患者肩痛的效果研究

目的探讨研究针对性护理干预对缓解妇科腹腔镜术后患者肩痛的效果。方法选取2015年6月至2017年6月本院妇科行腹腔镜手术患者98例为研究对象,将其随机等分为研究组与对照组。对照组患者给予常规护理干预,研究组在此基础上给予针对性护理干预,比较两组患者术后疼痛程度与疼痛持续时间。结果研究组患者疼痛程度明显低于对照组,比较差异有统计学意义(P<0.05);研究组患者术后疼痛持续时间明显短于对照组,两组比较差异有统计学意义(P<0.05)。结论采用针对性护理干预有利于预防术后肩痛,减轻患者术后疼痛程度,缩短术后肩痛持续时间,促进患者术后康复,具有临床推广价值。     

针对性训练缓解妇科腹腔镜手术后肩痛观察

目的探讨缓解妇科腹腔镜手术后患者肩痛、膈下疼痛的护理方法。方法妇科腹腔镜术后肩痛、膈下疼痛的患者90例,随机分为观察组与对照组各45例。对照组给予吸氧等常规护理。观察组在对照组护理的基础上,对患者呼吸方式、姿势进行指导。结果观察组术后24 h、48 h视觉模拟评分(VAS)显著低于对照组(P<0.05),且观察组患者满意度为82.22%,显著高于对照组的31.11%(P<0.05)。结论通过针对性训练,妇科腹腔镜手术后患者肩痛、膈下疼痛可缓解,患者满意度高。     

体位和气腹压力对腹腔镜术后肩痛的影响

目的 探讨腹腔镜不同手术体位和气腹压力对术后肩痛的影响.方法 随机选择腹腔镜手术277例,术中采取头高足低位142例,气腹压力设定A组14 mm Hg,B组10 mm Hg.头低足高位135例,气腹压力设定C组14 mm Hg,D组10 mm Hg.比较4组患者术后肩痛的发生率.结果 两种手术体位对术后肩痛发生率有显著差异(P<0.05),低气腹压力组术后肩痛发生率明显低于高气腹压力组.结论 体位和气腹压力均对腹腔镜术后肩痛有影响,高气腹压力或头低足高位可致腹腔镜术后肩痛.     

妇科腹腔镜术后体位与肩痛的相关性研究

[目的]探讨妇科腹腔镜不同术后体位对肩痛的影响。[方法]选择妇科腹腔镜术后病人120例,按住院时间分为观察组和对照组,每组60例。观察组病人于术后第1天07:00,14:00,20:00取臀高卧位,每次1h,对照组病人取自由体位。在干预前、第3次干预后均使用视觉模拟评分法(VAS)评估两组病人肩部疼痛情况。[结果]两组病人干预前肩痛VAS评分比较差异无统计学意义(P>0.05),第3次干预后观察组肩部VAS评分明显低于对照组(P<0.05)。[结论]术后采取臀高卧位可有效缓解病人肩部疼痛。     

两种不同吸氧方式缓解腹部术后低氧血症的效果观察

[目的 ]探讨面罩给氧和鼻塞给氧缓解腹部手术后低氧血症的效果。 [方法 ]择期上中腹部手术病人 ,术后回病房第一时间监测血氧饱和度 (SpO2 )≤ 90 %的病人 44例 ,将其随机分为面罩组及鼻塞组 ,分别给予面罩和鼻塞给氧方式 ,观察给氧 4h、6h、8h病人血氧饱和度的变化及病人舒适度反应。 [结果 ]面罩组的氧疗效果明显优于鼻塞组 (P <0 .0 5 ) ;而病人舒适度鼻塞组明显优于面罩组 (P <0 .0 5 )。 [结论 ]面罩给氧较鼻塞给氧改善术后低氧血症的治疗效果好。     

膝胸卧位对妇科腹腔镜术后肩痛的影响

目的 观察膝胸卧位对缓解妇科腹腔镜术后患者第2天肩痛的效果.方法 按患者意愿,将100例妇科腹腔镜手术患者分为观察组和对照组各50例.术后第2天,对照组常规予垫枕平卧位,观察组在常规体位基础上给予膝胸卧位2次,20 min/次,采用视觉模拟评分对两组患者肩痛进行评估.结果 肩痛评分观察组(2.37±1.42)分、对照组(3.47±1.51分),t=3.75,P<0.01.结论 妇科腹腔镜手术患者术后第2天予膝胸卧位2次能减轻肩痛.     

延长吸氧时间对腹腔镜手术后气腹所致肩部疼痛的影响

目的探讨延长吸氧时间对妇科恶性肿瘤腹腔镜手术后CO2气腹后遗疼痛的影响。方法全麻下行腹腔镜广泛全子宫切除加盆腔淋巴结清扫病人76例,根据手术单双日分为2组,对照组40例,观察组36例。对照组术毕返回病房予双鼻孔低流量吸氧3h,观察组予双鼻孔低流量吸氧6h,观察2组肩部疼痛、血压、脉搏血氧饱和度(SpO2)、二氧化碳结合力情况。结果观察组术后肩痛的发生率低于对照组(p<0.01),且疼痛程度也较对照组轻;观察组二氧化碳结合力明显低于对照组(p<0.001);术后2组各时间段生命体征及SpO2均无明显差异(p>0.05)。结论延长吸氧时间能减轻腹腔镜术后CO2气腹引起的肩部疼痛。     

吸氧对妇科腹腔镜术后疼痛的影响

目的分析持续低流量吸氧对妇科腹腔镜手术后减轻疼痛的影响。方法将妇科150例腹腔镜手术的患者随机分为:干预组80例,术后给予持续低流量(2L/min)吸氧4~6h;对照组70例,术后无吸氧支持。观察腹腔镜术后患者非切口疼痛的表现。结果妇科腹腔镜术后给予吸氧干预的患者非切口疼痛的发生率为明显低于无吸氧干预的对照组。结论给予持续低流量吸氧能减轻妇科腹腔镜术后非切口疼痛。     

腹腔镜手术发生颈肩痛的循证护理效果探究

目的：探讨腹腔镜手术发生颈肩痛的循证护理效果。方法将236例腹腔镜手术患者随机分为研究组和对照组,每组118例。对照组患者给予常规护理,研究组患者给予循证护理,比较两组患者的颈肩疼痛发生率、疼痛情况和其他不良反应发生率。结果研究组患者术后颈肩疼痛发生率为20.3％（24／118）,显著低于对照组的64.4％（76／118）,两组间差异极显著（χ2＝44.17,P＜0.01）。在两组发生术后颈肩疼痛的患者中,研究组和对照组的疼痛持续时间分别为（21.2±4.2）h和（24.4±5.1）h,存在统计学差异（t＝－3.08,P＜0.01）,VAS评分分别为（1.7±0.5）分和（2.4±0.8）分,存在统计学差异（t＝－5.01,P＜0.01）。研究组患者发生呼吸系统受限和下肢静脉血栓的概率显著低于对照组（ P＜0.05）。结论通过循证护理可以有效降低腹腔镜术后颈肩疼痛和其他不良反应的发生概率,同时可以有效改善术后颈肩疼痛的疼痛持续时间和疼痛水平,具有临床推广价值。     

腹腔镜手术护理流程图在腹腔镜手术围术期护理中的运用

目的：通过临床观察和实践,在腹腔镜手术期和围术期护理中灵活运用腹腔镜手术护理流程图。方法根据现有的腹腔镜手术护理的具体内容,制订了一套临床上行之有效的护理方法。整理成系统有序的腹腔镜手术护理流程图。随机选取了60名腹腔镜手术患者,将他们随机分为实验组和对照组,实验组人员为30名,对他们实行最新制定的腹腔镜手术护理流程图的护理标准。对照组人员同样为30名,对他们采用现行的常规治疗和护理方法。对这两组人员进行长期的跟踪观察和回访,在术前患者心理状况,术中治疗效果,器械采用,创口大小以及患者感受,术后治疗效果,并发症等方面进行系统比较。结果术前患者心理紧张焦虑状况大致相似,但实验组的焦虑状况低于对照组（P＜0.05）,术中实验组的器械准备采用优于对照组（P＜0.05）,实验组的发生意外状况的概率明显低于对照组（P＜0.05）,在创口的大小方面,实验组明显小于对照组（P＜0.05）,实验组患者对护理服务的满意度明显高于对照组（P＜0.05）。术后实验组的不良反应明显低于对照组（P＜0.05）,实验组的治疗效果也明显优于对照组（ P＜0.05）。结论通过对照分析,实验组的效果明显优于对照组,腹腔镜手术护理流程图在腹腔镜手术围术期护理中的运用有很好的效果,有助于护理质量的提高。     

膝胸卧位、氧疗对妇科腹腔镜术后患者肩痛的影响

目的探讨膝胸卧位、氧疗对妇科腹腔镜术后患者肩痛的影响。方法将150例妇科腹腔镜术后患者随机分为3组,每组50例,分别采取膝胸卧位(试验1组)、氧疗(试验2组)和除氧疗和膝胸卧位以外的常规护理(对照组)。3组均采用通用的视觉模拟评分(VAS)于术后第1天的不同时段(8:00、16:00、20:00)进行肩痛评分,两个试验组还于干预前、后分别进行肩痛评分。结果3组患者首次干预前肩痛VAS评分无显著性差异(P0.05)。第1次干预后,试验1组和试验2组在同一时段的肩痛评分均低于对照组,差异有统计学意义(P0.01)。2个试验组干预前、后肩部VAS评分的变化明显,差异均有统计学意义(P0.001)。结论术后膝胸卧位、氧疗能够显著改善妇科腹腔镜术后患者肩痛的情况。     

调整二氧化碳气腹压力对妇科腹腔镜手术后肩痛的影响

目的:探讨二氧化碳(CO2)气腹压力对妇科腹腔镜手术后肩痛的影响。方法:选取2013年1～6月我院行妇科腹腔镜手术患者80例,随机等分为两组,对照组常规手术,CO2气腹压力14 mmHg;试验组采取调节CO2气腹压力10 mmHg,观察两组颈肩痛发生情况和颈肩痛程度。结果:两组手术时间比较无统计学意义,试验组CO2用气量明显减少,颈肩痛发生率低于对照组。结论:合理调节气腹压力能有效减少CO2用气量,减轻妇科腹腔镜手术肩痛的发生率。     

不同气腹压对腹腔镜胆囊切除术后肩痛的影响

目的探讨腹腔镜胆囊切除手术不同气腹压对术后肩痛的影响。方法于全身麻醉下为100例患者行腹腔镜胆囊切除术,术中气腹压分两组,A组(低气腹压组,50例)气腹压8～9 mmHg,B组(常规气腹压组,50例)气腹压13～14 mmHg,分别记录术后8 h、24 h、48 h肩背部疼痛的人数,并让患者术后8 h、24 h、48 h用疼痛分级(VAS评分法)评分。结果术后A组不同时间段出现肩痛的人数比率明显低于B组,在术后8 h、24 h、48 h,A组患者肩痛的评分均低于B组患者,差异均有统计学意义(P<0.05)。结论腹腔镜胆囊切除术中低气腹压出现肩痛的人数明显较常规气腹压少,且术中低气腹压出现肩痛的程度明显较常规气腹压轻。     

应用膝胸卧位对妇科腹腔镜术后肩部疼痛影响的研究

目的 研究膝胸卧位对妇科腹腔镜术后肩部疼痛的缓解效果,为妇科腹腔镜手术患者的术后护理提供参考.方法 本研究选择60例妇科腹腔镜术后存在肩部疼痛的患者,分为实验组和对照组,实验组在常规护理的基础上给予3次膝胸卧位治疗,对照组只给予常规术后护理.在术后20 h、48 h采用疼痛视觉模拟量表法,评估肩部疼痛的程度,评价膝胸卧位对肩部疼痛的影响.结果 术后20 h实验组疼痛评分(6.90±1.42),对照组疼痛评分(6.70±1.32),2组患者疼痛评分比较无统计学意义,术后48 h实验组疼痛评分(2.33±1.51),对照组疼痛评分(3.37±1.75),2组疼痛评分比较有统计学意义.在实施过程中患者未出现明显不良反应.结论 膝胸卧位对腹腔镜术后肩部疼痛有明显的缓解效果.     

Increases in local pressure pain thresholds after muscle exertion in women with chronic shoulder pain

OBJECTIVE: To examine the relation between muscular tenderness and local muscular fatigue. DESIGN: Before-after trial, measuring pressure pain thresholds and signs of local muscular fatigue by using surface electromyography before, after, 10 minutes after, and 20 minutes after intervention. SETTING: University rehabilitation department in Sweden. PARTICIPANTS: Nineteen female hospital cleaners with unilateral chronic shoulder pain for 1 year. No previous trauma, surgery, or signs of systemic or neurologic disease. INTERVENTION: Static abduction endurance test with submaximal unilateral activation of the trapezius and deltoid muscles. MAIN OUTCOME MEASURES: Pressure pain thresholds and electromyographic fatigue parameters (root mean square [RMS]; mean power frequency [MPF]). RESULTS: Mean normalized pressure pain threshold values increased significantly (95% confidence interval [CI]) and lasted for 20 minutes: in the trapezius, threshold values increased to 115% to 120% (95% CI, 100%-140%; P=.04-.05); and in the deltoid, the threshold increased to 112% to 115% (95% CI, 100%-130%; P=.02-.05). Development of significant electromyographically defined fatigue was seen: in the trapezius, the RMS increased to 130% (95% CI, 119%-141%), and in the deltoid, the MPF decreased to 78% (95% CI, 74%-82%), but normalized within 15 seconds to 10 minutes. CONCLUSION: Lasting bilateral increases in pressure pain thresholds but transient local muscular fatigue were seen after a unilateral static endurance test. The sensitivity of the sensory nervous system may change during a static muscle contraction and sometimes contributes to a localized sensation of numbness.     

Predictability of simple clinical tests to identify shoulder pain after stroke

OBJECTIVE: To identify simple diagnostic musculoskeletal tests that can be performed early after stroke to predict patients' likelihood of reporting early signs of hemiplegic shoulder pain. DESIGN: Case control. SETTING: Multicenter acute care hospitals. PARTICIPANTS: A total of 152 adults after a first episode of stroke, of whom 135 met the inclusion criteria. Thirty patients were assigned to the experimental group because they reported moderate intensity of hemiplegic shoulder pain at rest. The remaining 105 patients made up the control group. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Therapists measured the performance of combined upper-limb movement including the hand-behind-neck (HBN) maneuver, passive pain-free ranges of shoulder motion, 3 musculoskeletal tests, and the strength of deltoid muscles during each patient's hospital stay. The numeric rating scale (NRS) identified those who reported moderate or greater intensities of hemiplegic shoulder pain during rest and during assessment. RESULTS: In our study, 22.2% (95% confidence interval, 15.5-30.2) of the patients reported hemiplegic shoulder pain, on average 1 week after the onset of stroke. Positive Neer test (NRS score >or=5) during the HBN maneuver and a difference of more than 10 degrees of passive range of external rotation between shoulders had a 98% probability of predicting the presence of hemiplegic shoulder pain (receiver operating characteristic, .994; sensitivity, 96.7%; specificity, 99.0%; positive predictive value, 96.7%; negative predictive value, 99.0%; P<.001). CONCLUSIONS: Three diagnostic clinical tests that can be performed during a bedside evaluation increase the likelihood of determining those who complain of hemiplegic shoulder pain after an acute episode of stroke.     

腹腔镜胆囊切除术后疼痛的观察与护理

目的:探讨腹腔镜胆囊切除术(LC)术后疼痛的原因及有效的预防和护理措施。方法:对88例LC术后疼痛患者的临床资料进行回顾性分析,总结引起术后疼痛的原因及护理措施。结果:CO2气腹引起的颈肩痛占35%;手术创伤引起的疼痛占29.6%;术后腹腔内严重并发症引起的疼痛占3.4%;术后腹胀、呕吐等诱发的疼痛占27%;肠蠕动亢进引起的阵发性腹痛占5%。结论:LC术后疼痛的原因涉及围手术期的多个环节,应针对其原因采取综合性预防和护理措施。     

Persistent shoulder pain in the first 6 months after stroke: results of a prospective cohort study

Roosink M, Renzenbrink GJ, Buitenweg JR, Van Dongen RT, Geurts AC, IJzerman MJ. Persistent shoulder pain in the first 6 months after stroke: results of a prospective cohort study.

Objective

To identify factors associated with persistent poststroke shoulder pain (pPSSP) in the first 6 months after stroke.

Design

Prospective inception cohort study.

Setting

Stroke units of 2 teaching hospitals.

Participants

Patients (N=31) with a clinical diagnosis of stroke.

Interventions

Not applicable.

Main Outcome Measures

The development of pPSSP within the first 6 months after stroke. Clinical assessment of motor, somatosensory, cognitive, emotional, and autonomic functions, undertaken within 2 weeks (t0), at 3 months (t1), and at 6 months (t2) after stroke.

Results

Patients with pPSSP (n=9) were compared with patients without pPSSP (n=22). Bivariate logistic regression analyses showed that pPSSP was significantly associated with impaired voluntary motor control (t0, t1, t2), diminished proprioception (t0, t1), tactile extinction (t0), abnormal sensation (t1, t2), spasticity of the elbow flexor muscles (t1, t2), restricted range of motion (ROM) for both shoulder abduction (t2) and shoulder external rotation (t1, t2), trophic changes (t1), and type 2 diabetes mellitus (t0).

Conclusions

These findings suggest a multifactorial etiology of pPSSP. The association of pPSSP with restricted, passive, pain-free ROM and signs indicative of somatosensory sensitization may implicate a vicious cycle of repetitive (micro)trauma that can establish itself rapidly after stroke. Intervention should therefore be focused on maintaining and restoring joint ROM as well as preventing injury and somatosensory sensitization. In this perspective, strategies that aim to intervene simultaneously at various levels of function can be expected to be more effective than treatment directed at merely 1 level.