腹腔镜术后肩痛的研究进展

腹腔镜术后患者常出现肩痛,大多数学者认为其发生机制是气腹或气腹使用的二氧化碳(carbon dioxide,CO2)形成碳酸刺激膈神经导致的。气腹压力过高、残留膈下CO2过多、维持气腹的CO2充气速度过快等都可能引发术后肩痛。腹腔镜术后肩痛(post-laparoscopic shoulder pain,PLSP)以钝痛为主,没有明显的位点,多为轻到中度的疼痛。预防及降低腹腔镜术后肩痛的措施很多,包括外科、药物及护理等方面的措施,但效果各异,目前仍没有一个公认且效果确切的方法。该文就PLSP的发生机制、危险因素及降低术后肩痛方法的研究进展进行综述。

Research progress of shoulder pain after laparoscopic surgery

Some patients receiving laparoscopic surgery often experience shoulder pain after the surgery.Most scholars believe that the shoulder pain is caused by pneumoperitoneum or carbon dioxide(CO2)which is used to build up pneumoperitoneum forming carbonic acid to stimulate the phrenic nerve.Too high pneumoperitoneum pressure,too much CO2 left under the diaphragm and too fast CO2 inflation rate maintaining pneumoperitoneum may cause postoperative shoulder pain.A variety of post-laparoscopic shoulder pain(PLSP)are mainly dull pain,without obvious sites,most of which are mild to moderate pain.There are many measures to prevent and relieve the shoulder pain after laparoscopic surgery,including surgical,pharmaceutical and nursing measures,but the effects of various methods are different.At present,there is not an accepted method with definite effect.In this paper,the occurrence mechanisms,risk factors and methods of relieving PLSP are reviewed.