腹腔镜术后肩痛的中医外治法研究进展  

A review on the TCM external treatment of shoulder pain after laparoscopic surgery

作　　者：黄湘粤 张新明 卞吉雯 HUANG Xiangyue;ZHANG Xinming;BIAN Jiwen

机构地区：[1]山东中医药大学,山东济南250013 [2]青岛市中医医院,山东青岛266033 [3]青岛市第六人民医院,山东青岛266033

出　　处：《中医临床研究》2024年第33期75-78,共4页Clinical Journal Of Chinese Medicine

摘　　要：腹腔镜手术因其创伤小、手术时间短、愈合速度快、并发症少等优点逐渐成为患者优先选择的手术方式。然而,随着临床腹腔镜手术的大量应用,腹腔镜术后肩痛发生率逐年升高,其发病机制不明确,可能是残留二氧化碳(CO_(2))对膈神经的刺激,或手术过程中对膈神经的牵拉。临床主要采用镇痛药物缓解肩痛,但治疗效果不佳,且镇痛药对消化系统及中枢系统有一定的不良反应,加重患者痛苦。中医外治法因其简、便、廉、验的特点逐渐应用于治疗各科腹腔镜术后肩背疼痛。鉴于其气滞血瘀为标,脾胃虚弱为本的病机特点,多采用“通则不痛”“荣则不痛”的治疗原则。文章收集整理近年来相关文献研究资料,对腹腔镜术后肩痛的中医病因病机、外治疗法进展进行归纳、总结,发现针刺、穴位按摩、艾灸、穴位贴敷、耳穴压豆等治疗均可有效缓解肩痛,且均有其适应证型。其机制可能是多通路调控炎症因子、启动内源性痛觉调节机制、增强机体免疫力等,从而有效降低术后肩痛程度和发生率。所以归纳为此综述,以期为腹腔镜术后肩痛治疗提供更多更有效的备选方案,减轻患者肩痛程度,希望在今后临床实践和研究中进一步加强中医外治法镇痛机制的研究,充分发挥中医外治法在临床各科镇痛治疗中的特殊优势。Laparoscopic surgery has gradually become the preferred surgical method for patients because of its advantages of less trauma,short operation time,fast healing speed and few complications.However,with the extensive application of laparoscopic surgery in clinical practice,the incidence of postoperative shoulder pain in patients received laparoscopic surgery has increased year by year,and its pathogenesis is unclear,which may be caused by the stimulation of the phrenic nerve by residual CO_(2) or the pulling of the phrenic nerve during surgery.Analgesics are mainly used in clinical practice to relieve shoulder pain,but the therapeutic effect is not good,and analgesic drugs have certain adverse reactions on the digestive system and the central system,and aggravate the pain of patients.The external treatment of tradi-tional Chinese medicine is gradually applied in the treatment of shoulder and back pain after laparoscopic surgery because of its characteristics of simplicity,convenience,affordability,and effectiveness.In view of the pathogenesis characteristics of Qi(气)stagnation and blood stasis as the symptoms and spleen and stomach deficiency as the root cause,the treatment principles of‘passability relieves pain’and‘nourishment relieves pain’are generally adopted.By collecting relevant literature and research data in recent years,this paper sorts out and summarizes the etiology,pathogenesis of traditional Chinese medicine and the progress of external treatment of shoulder pain after laparoscopic surgery.It is found that acupuncture,acupressure,moxibustion,acupoint application,ear point pressure and other treatments can effectively relieve shoulder pain,and all have their indications.The mechanism may be multi-channel regulation on inflammatory factors,initiation of endogenous pain regulation mechanism,and enhancement of body immunity,so as to effectively reduce the degree and incidence of postoperative shoulder pain.Therefore,this review is given to provide more effective alternatives for the treatment o

关 键 词：腹腔镜术后肩痛 中医外治 综述 

分 类 号：R441.1[医药卫生—诊断学]