腹腔镜胆囊切除术中右肩酸痛、躁动与阻滞平面关系的研究  

The relationship between blocking level and right shoulder aching pain and restlessness during laparoscopic cholecystectomy

作　　者：陈淮芳[1] 王刚[1] 田欣[1] 

机构地区：[1]解放军第105医院,安徽合肥230031

出　　处：《腹腔镜外科杂志》2010年第12期954-957,共4页Journal of Laparoscopic Surgery

摘　　要：目的:研究腹腔镜胆囊切除术中硬膜外麻醉患者右肩酸痛、躁动与阻滞平面之间的关系。方法:连续选取ASAⅠ～Ⅱ级择期行硬膜外麻醉的120例腹腔镜胆囊切除术患者,随机分为4组,每组30例,控制不同阻滞平面上界。A组无痛平面控制在手腕尺侧(胸1);B组无痛平面控制在腋窝及臂内侧(胸2);C组无痛平面控制在乳头连线与胸骨角之间的中点(胸3);D组无痛平面控制在乳头(胸4)。观察每组肩痛、躁动的控制效果。结果:A组30例均优(100%),B组7例优(23%),23例差(77%),C组、D组各30例均为极差(100%)。结论:腹腔镜胆囊切除术中硬膜外麻醉右肩酸痛、躁动的发生与阻滞平面高低关系密切。将无痛平面精确控制在胸1,再辅以少量镇痛镇静剂,可避免术中肩痛、躁动的发生,使患者安静地配合手术。Objective：To investigate the relationship between blocking level with right shoulder aching pain and restlessness during laparoscopic cholecystectomy（LC） under epidural anesthesia.Methods：One hundred and twenty patients with ASA Ⅰ-Ⅱ,continuously scheduled for LC under epidural anesthesia,were randomly divided into four groups （each group included 30 cases）.Group A：Painless level was controlled at ulnaris of wrist（T1 level）.Group B：Painless level was at axillary fossa and medial side of arm （T2 level）.Group C：Painless level was at the center between nipple line and sternal angle （T3 level）.Group D：Painless level was at nipple line （T4 level）.The controlling effect of right shoulder aching pain and restlessness during operation were observed.Results：In group A the anesthesia effect was evaluated as good in all 30 patients （100%）.In group B effect of seven patients were good （23%） and 23 cases were poor （77%）.In group C and D the anesthesia effect was evaluated as very poor in all 30 patients （100%）.Conclusions：The right shoulder aching pain and restlessness are closely related to blocking level.If only painless level is accurately controlled at T1 with assistance of small doses of analgetic and sedative,patients could spend operation time calmly without shoulder and arm pain or restlessness.

关 键 词：麻醉 硬膜外 胆囊切除术 腹腔镜 肩臂疼痛 躁动 阻滞平面 

分 类 号：R614[医药卫生—麻醉学]