胃镜下观察胆汁十二指肠胃反流对腹腔镜胆囊切除术术后恶心呕吐的影响  

Effect of bile duodenogastric reflux on postoperative nausea and vomiting in laparoscopic cholecystectomy

作　　者：蒋飞[1] 吴爱玲[1] 颜渊[1] 黄辉[1] 张方宇[2] 钟小明[3] JIANG Fei;WU Ai-ling;YAN Yuan;HUANG Hui;ZHANG Fang-yu;ZHONG Xiao-ming(Department of Anesthesiology,the First People忆s Hospital of Neijiang City in Sichuan Province,Neijiang 641000,China;Department of Gastroenterology,the First People忆s Hospital of Neijiang City in Sichuan Province,Neijiang 641000,China;Department of clinical laboratory,the First People忆s Hospital of Neijiang City in Sichuan Province,Neijiang 641000,China)

机构地区：[1]四川省内江市第一人民医院医院麻醉科,四川内江641000 [2]四川省内江市第一人民医院医院消化内科,四川内江641000 [3]四川省内江市第一人民医院医院检验科,四川内江641000

出　　处：《中国当代医药》2018年第10期34-37,共4页China Modern Medicine

基　　金：四川省内江市科技支撑计划项目(内市科知计函{2015}126号)

摘　　要：目的通过胃镜观察腹腔镜胆囊切除术术中胆汁十二指肠胃反流的发生情况,探讨术中胆汁十二指肠胃反流对术后恶心呕吐的影响。方法选取2015年3月~2017年5月我院收治的90例腹腔镜胆囊切除术患者作为研究对象,采用随机数字表法将患者分为A组(胃镜组1)、B组(胃镜组2)、C组(对照组),每组各30例。三组患者均进行气管插管全身麻醉。A、B两组在麻醉诱导插管后即刻(T_1)及手术结束即刻(T_2)置入胃镜,胃镜置入时间不超过2 min,置入胃镜后观察十二指肠胃反流的发生情况,并提取反流物进行生化分析;B组在T_2时,若胃镜下观察有十二指肠胃反流的发生,则对反流物进行充分吸引。C组患者不置入胃镜。观察并比较患者术后6 h(T_3)、12 h(T_4)、24 h(T_5)三个时间点恶心呕吐的VAS评分及中到重度恶心呕吐(VAS>4分)的发生率。结果在T_1时,A、B两组患者胃镜下观察均无十二指肠、胃反流发生;在T_2时,A、B两组的十二指肠反流发生率均为100%,A组的胃反流发生率为83.3%,B组为86.7%,两组比较差异无统计学意义(P>0.05)。在T_3、T_4时,B组术后的恶心呕吐VAS评分[(2.90±1.30)、(1.63±1.03)分]低于A组[(5.90±1.58)、(3.80±1.42)分]和C组[(5.73±1.48)、(3.60±1.30)分],差异有统计学意义(P<0.05);B组中、重度恶心呕吐的发生率(13.3%、6.7%)低于A组(83.3%、40.0%)和C组(80.0%、30.0%),差异有统计学意义(P<0.05);在T_5时,各组术后恶心呕吐的VAS评分比较差异无统计学意义(P>0.05)。结论通过胃镜观察,腹腔镜胆囊切除术可导致胆汁急性十二指肠胃反流的发生,从而增加腹腔镜胆囊切除术术后恶心呕吐的发生率及程度。Objective To explore the effect of bile duodenogastric reflux on postoperative nausea and vomiting(PONV)in laparoscopic cholecystectomy by using gastroscope.Methods From March 2015 to May 2017,90 patients undergo laparoscopic cholecystectomy treated in our hospital were selected as the subjects,and divided into group A(gastroscope group A),group B(gastroscope group B)and group C(control group)by radom table method,30 cases in each group.They were all underwent general anesthesia.Gastroscope was inserted at the time of tracheal intubation(T1)and extubation(T2)immediately in group A and group B,the insertion time was less than 2 min.Bile duodenogastric reflux was observed in the two groups and the extracted reflux was biochemical analysed.The bile was sufficiently sucked if reflux occurred in group B at T2.No Gastroscope was inserted in group C.The VAS score of nausea and vomiting was recorded 6 h(T3),12 h(T4),24 h(T5)postoperative,the incidence rate of severe nausea and vomiting(VAS>4)was also recorded.Results At T1,no bile duodenogastric reflux observed by gastroscope in group A and group B.At T2,the incidence rate of bile duodenal reflux was 100%,the incidence rate of bile gastric reflux between group A(83.3%)and group B(86.7%)had no significant difference(P>0.05).Biochemical analyses showed no significant difference between group A and group B.At T3 and T4,the incidence rate of nausea and vomiting VAS score in group B([2.90±1.30],[1.63±1.03]points)was lower than group A([5.90±1.58],[3.80±1.42]points)and group C([5.73±1.48],[3.60±1.30]points)(P>0.05).The incidence rate of severe nausea and vomiting in group B(13.3%,6.7%)were lower than group A(83.3%,40.0%)and group C(80.0%,30.0%)(P<0.05).The nausea and vomiting VAS score had no difference at T5(P>0.05).Conclusion Laparoscopic Cholecystectomy(LC)can cause acute bile duodenogastric reflux,thus causing more postoperative nausea and vomiting.

关 键 词：胆汁十二指肠胃反流 胃镜 腹腔镜胆囊切除术 术后恶心呕吐 

分 类 号：R657.4[医药卫生—外科学]