腹股沟疝患者行腹腔镜无张力修补术后疼痛及血气指标的研究  

Study on pain and blood gas indexes of patients with inguinal hernia after laparoscopic tension-free repair

作　　者：贺杰[1] 高树全[2] 赵永东 He Jie;Gao Shuquan;Zhao Yongdong(Department of Laboratory,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075061,China;Department of General Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075061,China;Department of Laboratory,the Fourth Hospital of Zhangjiakou,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院检验科,张家口075061 [2]河北北方学院附属第一医院普外科,张家口075061 [3]张家口市第四医院检验科,河北省075000

出　　处：《中华疝和腹壁外科杂志（电子版）》2020年第2期175-179,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：河北省卫计委基金项目(20180868)。

摘　　要：目的探讨腹股沟疝患者行腹腔镜无张力修补术后疼痛及血气指标的变化情况。方法以2017年2月至2019年5月在河北北方学院附属第一医院普外科就诊的60例腹股沟疝患者为研究对象。采用随机数表法将其分为对照组和对照组。其中,对照组27例,对照组33例。对照组采用开放式无张力修补术进行治疗,对照组采用腹腔镜无张力修补术进行治疗。记录2组围术期情况,术后6、24、72 h的疼痛评分;使用血气分析仪观察2组患者气腹前、气腹后20 min及放气后动脉血氧分压(PaO2)、pH及动脉血二氧化碳分压(PaCO2)的变化;检测2组术前及术后24、72 h血清炎症因子的含量;统计2组术后不良反应发生情况。计量资料以(x±s)表示,用t检验作比较分析。不同时间测量指标用方差分析作比较。计数资料以率(%)表示,用χ^2检验作比较分析。结果对照组手术时间、住院时间均短于对照组,术中出血量低于对照组,差异有统计学意义(t=3.660,13.857,18.661;P<0.05)。与治疗前比,术后24、72 h,2组疼痛评分呈逐渐降低趋势,且对照组低于对照组,差异有统计学意义(t=3.660,19.351,16.096;P<0.05)。与气腹前比,气腹后20 min,2组pH、PaO2水平均降低,PaCO2水平均升高,且对照组pH、PaO2水平均低于对照组,PaCO2水平高于对照组,差异有统计学意义(F=4.545,28.441,59.922;P<0.05)。与术前比,术后24 h、72 h,2组血清C-反应蛋白、白介素-6水平均降低,且对照组低于对照组,差异有统计学意义(F=69.629,13.489,292.441,65.421;P<0.05)。对照组术后总不良反应率为6.06%,低于对照组的25.93%,差异有统计学意义(χ^2=4.596;P<0.05)。结论对腹股沟疝患者行腹腔镜无张力修补术治疗,可显著改善患者围手术期的情况及血气指标水平,并可抑制患者炎症反应,缓解疼痛。此外,该手术具有较高安全性,值得推广。Objective To investigate the changes of pain and blood gas indexes in patients with inguinal hernia after laparoscopic tension-free repair.Methods A total of 60 patients with inguinal hernia were treated in the first affiliated hospital of Hebei north university between February 2017 and May 2019.The patients were divided into the study group and control group,according to random number table.The control group was treated with open tension-free repair.The study group was treated with laparoscopic tension-free repair.The perioperative conditions,and the pain scores at 6,24,and 72 hours after operation in the two groups were recorded;observing the changes of arterial blood oxygen partial pressure(PaO2),pH and arterial blood carbon dioxide partial pressure(PaCO2)before and after pneumoperitoneum using a blood gas analyzer;the levels of serum inflammatory factors before and after operation in two groups at 24 and 72 hours were detected;the incidence of postoperative adverse reactions in the two groups was counted.The measurement data is represented by(x±s),and the t test is used for comparative analysis.The measurement indexes at different times were compared by analysis of variance.The count data is expressed as a rate(%),and the χ^2 test is used for comparative analysis.Results The operation time and hospitalization time in the study group were shorter than that in the control group,and the intraoperative blood loss was smaller than that in the control group,the differences were statistically significant(t=3.660,13.857,18.661;P<0.05).Compared with before treatment,the scores of VAS in the two groups gradually decreased at 24 h and 72 h after operation,and the study group was lower than the control group,the differences were statistically significant(t=3.660,19.351,16.096;P<0.05).Compared with the before pneumoperitoneum,the levels of pH and PaO2 in the two groups decreased at 20 min after pneumoperitoneum,the level of PaCO2 increased,and the levels of pH and PaO2 in the study group were lower than those in the co

关 键 词：疝 腹股沟 腹腔镜无张力修补术 疼痛 血气指标 炎症因子 不良反应 

分 类 号：R656.21[医药卫生—外科学]