·外科护理·腹腔镜胆囊切除术后微波照射不同部位治疗颈肩痛效果比较王晓波1,叶茜2,徐琳2摘要:目的比较不同部位微波照射对改善腹腔镜胆囊切除术(LC)后颈肩痛的效果。方法将腹腔镜胆囊切除术后6h内发生颈肩痛的84例患者随机分为投影组(n=28)、颈肩组(n=31)、对照组(n=25)三组。投影组、颈肩组患者于手术后6h起采用HB2W2L微波多功能治疗机照射治疗,投影组照射探头置于膈肌背部的体表投影区域,颈肩组照射探头置于患者颈肩部;对照组不做任何部位照射。结果3组患者手术后不同时间点的颈肩痛VAS评分比较,干预主效应、时间主效应均存在统计学差异(均P<0.01)。其中投影组、颈肩组的颈肩痛VAS评分显著低于对照组(P<0.01),投影组手术后肩颈痛缓解最迅速。结论微波背部照射较颈肩部照射对缓解LC术后肩颈痛更迅速有效。关键词:微波;腹腔镜胆囊切除术;二氧化碳气腹;颈肩痛中图分类号:R473.6文献标识码:A文章编号:1001-4152(2010)04-0018-03DOI:10.3870/hlxzz.2010.04.018Effectofdifferentmicrowaveirradiationsitesonrelievingneckandshoulderpainafterlaparoscopiccholecystectomy∥WangXi2aobo,YeQian,XuLin∥(DepartmentofNursing,theSecondPeople′sHospitalofChengdu,Chengdu610017,China)Abstract:ObjectiveTocomparetheeffectofdifferentmicrowaveirradiationsitesonrelivingneckandshoulderpainafterlaparoscopiccholecystectomy.MethodsAtotalof84patientsexperiencingneckandshoulderpainafterlaparoscopiccholecystectomywererandomlydi2videdintoaprojectiongroup(n=28),aneckandshouldergroup(n=31)andacontrolgroup(n=25).Patientsinthepreviousgroupsreceivedmicrowaveirradiation6hafterthesurgery,theprobesofthemicrowavemachinewereplacedatthedorsalprojectionsiteofthedi2aphragmfortheprojectiongroup,andattheneckandshoulderareafortheneckandshouldergroup.Patientsinthecontrolgroupdidn′thaveanysortofirradiation.ResultsTheVASscoresfortheneckandshoulderpainatdifferenttimepointshadsignificantdifferencesa2mongthe3groups,withtheVASscoresoftheprojectiongroupandtheneckandshouldergroupbeingsignificantlylowerthanthoseofthecontrolgroup.Neckandshoulderpainwasmostrelievedintheprojectiongroup.ConclusionMicrowavedorsalirradiationcanbetterre2lieveneckandshoulderpainthanirradiationofneckandshoulderafterlaparoscopiccholecystectomy.Keywords:microwave;laparoscopiccholecystectomy;carbon2dioxide2inducedpneumoperitoneum;neckandshoulderpain腹腔镜胆囊切除术(LaparoscopicCholecystecto2my,LC)因其创伤小、恢复快等优点,在各级医院迅速普及。但LC术后12h内颈肩部疼痛的发生率为30%～40%,也有高达80%的报道[1],成为困扰患者术后生理及躯体舒适的因素之一,也成为临床护理工作中迫切需要解决的难题。为了解不同部位微波治疗对LC术后患者肩部疼痛的改善效果,笔者进行了实验对照研究,现将方法与结果报告如下。1资料与方法1.1一般资料我院2008年6月至2009年9月,经B超诊断为胆囊结石或胆囊息肉行LC术后的患者300例,由同一组医生完成手术,麻醉师采用统一麻醉药物处方,手术采用标准“四孔法”LC,由气腹机自动充入CO2,充气速度为12～14L/min,气腹压力为12mmHg,术中采用头高足低左斜15°～30°体位,取出胆囊后均尽量排出腹腔CO2气体。无中转开腹病例,无明显手术并发症。术后6h使用视觉模拟评分(VisualA2nalogueScale,VAS)[2]评价颈肩部疼痛情况,结果发生颈肩痛84例(VAS≥1)。将84例患者按完全随机数字表法分为投影组(n=28)、颈肩组(n=31)、对照组(n=25)。三组一般资料比较,差异无统计学意义(均P>0.05),见表1。表1三组一般资料比较组别例数性别(例)男女年龄(岁,�x±s)手术时间(min,�x±s)气腹时间(min,�x±s)腹部手术史(例)对照组25121347.32±27.0148.56±21.0841.39±15.214投影组28111742.91±19.7554.32±19.3244.28±12.097颈肩组31141751.26±18.9944.33±24.0137.07±10.994F/χ20.4230.9940.5990.4781.551P0.8690.3010.3790.6110.460作...
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