腹腔镜与剖腹胆囊切除术后患者在PACU并发症比较

目的比较腹腔镜胆囊切除术（LC）与剖腹胆囊切除术（OC）后患者在麻醉恢复室（PACU）的并发症的发生情况,探讨不同并发症的处理方法及护理策略。方法选取本院2009年12月～2012年12月胆囊炎、胆石症患者1754例,按术式不同,分为LC组和OC组。采用Roberta的麻醉恢复室并发症指标,对腹腔镜和剖腹胆囊切除术后患者在PACU内发生并发症进行比较。结果两组患者循环呼吸并发症无明显差异;恶心呕吐的发生率LC组明显高于OC组（P〈0.01）;疼痛的发生率OC组高于LC组（P〈0.05）;其他并发症的发生率两组间差异无统计学意义（P〉0.05）。ASAⅢ级患者并发症的发生率明显高于ASAⅠ、Ⅱ级患者,尤其是LC组。结论对于腹腔镜下胆囊切除术需注意消化道症状,剖腹胆囊切除术加强疼痛的观察和处理。对ASAⅢ级以上的患者尤其是腹腔镜手术的患者,需加强术中和术后的管理和护理,有助于及时发现和降低患者术后并发症。

Comparison of complication of laparoscopic and laparotomic cholecystectomy patients in PACU

Objective To compare the complication of Laparoscopic and laparotomic cholecystectomy patients in PACU, and investigate the treatment and nursing strategies according to different complication. Methods One thou- sand seven hundred and flfty-four cases with cholecystitis, eholelithiasis, they were divided into LC group and OC group in our hospital from December 2009 to December 2012. Used the roberta in PACU complications index com- pared the complication of Laparoscopic and laparotomic cholecystectomy patients in PACU. Results There were no significant difference between the two groups of patients with respiratory and circulatory complications, the incidence of nausea and vomiting was significantly higher in LC grop than that in OC group （P 〈 0.01）; The incidence of pain was higher in OC group than that in group LC （P 〈 0.05）; The incidence of other complications between the two groups had no significant difference （P 〉 0.05）. ASA m level in patients with the complication was significantly higher than that of ASA Ⅰ , Ⅱ patients, especially the LC group. Conclusion It should pay attention to gastrointestinal symp- toms for laparoscopic cholecysteetomy, and should observe and treat pain on patients of laparotomic cholecystectomy. The ASA Ⅲ above the level of the patients especially laparoscopic operation patients, need strengthen the intraopera- tive and postoperative management, it contribute to detect and reduce the postoperative complications timely.