Kietpeerakool Chumnan, Rattanakanokchai Siwanon, Yantapant Aranya, Roekyindee Ratchadaporn, Puttasiri Songphol, Yanaranop Marut, Srisomboon Jatupol
Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, 123 Mitraparb Road, Amphur Muang, Khon Kaen 40002, Thailand.
Department of Obstetrics and Gynecology, Rajavithi Hospital, College of Medicine, Rangsit University, Phayathai Road, Ratchathewi District, Bangkok 10400, Thailand.
Minim Invasive Surg. 2020 Jul 20;2020:7154612. doi: 10.1155/2020/7154612. eCollection 2020.
Shoulder pain is a common symptom following laparoscopic surgery. This systematic review was undertaken to assess updated evidence regarding the effectiveness and complications of the pulmonary recruitment maneuver (PRM) for reducing shoulder pain after laparoscopic gynecologic surgery.
A number of databases for randomized controlled trials (RCTs) investigating PRM for reducing shoulder pain were searched up to June 2019. Two authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, and compared results. Network meta-analyses were employed to simultaneously compare multiple interventions. Effect measures were presented as pooled mean difference (MD) or risk ratio (RR) with corresponding 95% confidence intervals (CI).
Of the 44 records that we identified as a result of the search (excluding duplicates), eleven RCTs involving 1111 participants were included. Three studies had an unclear risk of selection bias. PRM with a maximum pressure of 40 cm HO was most likely to result in the lowest shoulder pain intensity at 24 hours (MD -1.91; 95% CI -2.06 to -1.76) while PRM with a maximum pressure of 40 cm HO plus intraperitoneal saline (IPS) appeared to be the most efficient at 48 hours (MD -2.09; 95% CI -2.97 to -1.21). The estimated RRs for analgesia requirement, nausea/vomiting, and cardiopulmonary events were similar across the competing interventions.
PRM with 40 cm HO performed either alone or accompanied by IPS is a promising intervention for alleviating shoulder pain within 48 hours following gynecologic laparoscopy.
肩痛是腹腔镜手术后的常见症状。本系统评价旨在评估有关肺复张手法（PRM）减轻腹腔镜妇科手术后肩痛的有效性和并发症的最新证据。
检索了多个关于研究PRM减轻肩痛的随机对照试验（RCT）数据库，截至2019年6月。两位作者独立选择潜在相关的RCT，提取数据，评估偏倚风险，并比较结果。采用网状Meta分析同时比较多种干预措施。效应量以合并平均差（MD）或风险比（RR）及相应的95%置信区间（CI）表示。
在检索到的44条记录（不包括重复记录）中，纳入了11项涉及1111名参与者的RCT。三项研究的选择偏倚风险不明确。最大压力为40 cm H₂O的PRM最有可能在24小时时导致最低的肩痛强度（MD -1.91；95%CI -2.06至-1.76），而最大压力为40 cm H₂O的PRM加腹腔内生理盐水（IPS）在48小时时似乎最有效（MD -2.09；95%CI -2.97至-1.21）。在各种相互竞争的干预措施中，镇痛需求、恶心/呕吐和心肺事件的估计RR相似。
单独使用或联合IPS的40 cm H₂O的PRM是减轻妇科腹腔镜检查后48小时内肩痛的一种有前景的干预措施。
