不同术中 CO 压力水平（8mmHg 和 15mmHg）对良性子宫病变行腹腔镜子宫切除术术后疼痛和动脉 pCO 的影响：一项前瞻性随机对照临床试验。
Impact of different intraoperative CO pressure levels (8 and 15 mmHg) during laparoscopic hysterectomy performed due to benign uterine pathologies on postoperative pain and arterial pCO : a prospective randomised controlled clinical trial.
机构信息
Department of Obstetrics and Gynaecology, Saarland University Hospital, Homburg/Saar, Germany.
Department of Gynaecology, University Hospital of Leipzig, Leipzig, Germany.
出版信息
BJOG. 2019 Sep;126(10):1276-1285. doi: 10.1111/1471-0528.15826.
OBJECTIVE
To compare the effects of two different intraoperative CO pressures (8 and 15 mmHg) during laparoscopic hysterectomy for benign uterine pathologies in terms of postoperative abdominal and shoulder pain, laparoscopy-mediated vegetative alterations, pain medication requirement, arterial CO pressure (pCO ), surgical parameters, and safety.
DESIGN
Prospective randomised controlled study.
SETTING
German university hospital.
POPULATION
Female patients undergoing laparoscopic hysterectomy for benign uterine pathologies.
METHODS
Patients were randomised to a standard pressure (SP; 15 mmHg, control) or low-pressure (LP; 8 mmHg, experimental) group.
MAIN OUTCOME MEASURES
Primary outcomes were postoperative abdominal and shoulder pain intensities, measured via numeric rating scale (NRS) and vegetative parameters (fatigue, nausea, vomiting, bloating) at 3, 24, and 48 hours postoperatively. Secondary outcomes were pain medication requirement (mg) and arterial pCO (mmHg). Surgical parameters and intra- and postoperative complications were also recorded.
RESULTS
In total, 178 patients were included. Patients in the LP group (n = 91) showed significantly lower postoperative abdominal and shoulder pain scores, fewer vegetative alterations, lower pain medication requirements, a shorter postoperative hospitalization, and lower intra- and postoperative arterial pCO values compared with the SP group (n = 87; P ≤ 0.01). No differences in intra- and postoperative complications were observed between groups.
CONCLUSIONS
Low-pressure laparoscopy seems to be an effective and safe technique for the reduction of postoperative pain and laparoscopy-induced metabolic and vegetative alterations following laparoscopic hysterectomy for benign indications.
TWEETABLE ABSTRACT
Low-pressure laparoscopy seems to be an effective and safe technique for reduction of pain following laparoscopic hysterectomy.
目的
比较两种不同术中 CO 压力（8mmHg 和 15mmHg）在腹腔镜下良性子宫病变子宫切除术中对术后腹部和肩部疼痛、腹腔镜介导的植物神经改变、疼痛药物需求、动脉 CO 压力（pCO ）、手术参数和安全性的影响。
设计
前瞻性随机对照研究。
地点
德国大学医院。
人群
接受腹腔镜下良性子宫病变子宫切除术的女性患者。
方法
患者随机分为标准压力（SP；15mmHg，对照组）或低压力（LP；8mmHg，实验组）组。
主要观察指标
术后腹部和肩部疼痛强度的主要结局指标，通过数字评分量表（NRS）和术后 3、24、48 小时的植物神经参数（疲劳、恶心、呕吐、腹胀）进行测量。次要结局指标为疼痛药物需求（mg）和动脉 pCO（mmHg）。还记录了手术参数和术中及术后并发症。
结果
共纳入 178 例患者。与 SP 组（n=87）相比，LP 组（n=91）患者术后腹部和肩部疼痛评分显著降低，植物神经改变更少，疼痛药物需求更低，术后住院时间更短，术中及术后动脉 pCO 值更低（P≤0.01）。两组患者的术中及术后并发症无差异。
结论
对于腹腔镜下良性指征子宫切除术，低压腹腔镜似乎是一种有效且安全的技术，可减少术后疼痛和腹腔镜引起的代谢和植物神经改变。
推文摘要
低压腹腔镜似乎是一种有效且安全的技术，可减少腹腔镜子宫切除术后的疼痛。
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