Department of Anesthesiology, Yingshang County Hospital of Traditional Chinese Medicine, Fuyang, China.
Department of Anesthesiology, the Affiliated Jiangning Hospital of Nanjing Medical University, Nangjing, China.
Medicine (Baltimore). 2023 Jun 2;102(22):e33905. doi: 10.1097/MD.0000000000033905.
To observe the effect of using mild intraoperative hyperventilation on the incidence of postlaparoscopic shoulder pain (PLSP) in patients undergoing laparoscopic sleeve gastrectomy.
Eighty patients undergoing laparoscopic sleeve gastrectomy, aged 22 to 36 years, with American Society of Anesthesiologists grade I or II, were divided into 2 groups according to method of random number table. A mild hyperventilation was used in group A with controlling pressure of end-tidal carbon dioxide (PETCO2) of 30 to 33 mm Hg, while conventional ventilation was used in group B with PETCO2 35 to 40 mm Hg during the operation. The incidence and severity of PLSP, dosage of remedial analgesia and adverse reactions such as nausea and vomiting at 12, 24, 48, 72 hours and 1 week after surgery were recorded. Arterial blood gas was recorded before anesthesia induction, 20 minutes after pneumoperitoneum, during suture skin, and 24 hours after surgery.
Compared with 12, 24, 48, and 72 hours after operation, the incidence of PLSP at 1 week decreased significantly (P < .01). Compared with group B, the incidence of PLSP, pain score, and dosage of remedial analgesic at 12, 24,48, 72 hours, and 1 week after surgery were significantly decreased (P < .01). There was no significant difference between the 2 groups in arterial blood gas analysis before anesthesia induction, 20 minutes after pneumoperitoneum, during suture skin, and 24 hours after surgery (P > .05). There were no significant difference of the occurrence of adverse reactions such as nausea and vomiting between the 2 groups within 1 week after surgery (P > .05).
Mild hyperventilation can reduce the incidence and severity of PLSP after laparoscopic sleeve gastrectomy without increasing the associated adverse effects.
观察术中轻度过度通气对腹腔镜袖状胃切除术患者术后腹腔镜肩部疼痛（PLSP）发生率的影响。
选择年龄 22 至 36 岁、美国麻醉医师协会（ASA）分级Ⅰ或Ⅱ级的 80 例行腹腔镜袖状胃切除术患者，按随机数字表法分为 2 组，A 组术中采用控制呼气末二氧化碳分压（PETCO2）30 至 33mmHg 的轻度过度通气，B 组采用 PETCO2 35 至 40mmHg 的常规通气。记录术后 12、24、48、72 小时及 1 周时 PLSP 的发生率和严重程度、补救性镇痛药物剂量及恶心呕吐等不良反应。记录麻醉诱导前、气腹后 20min、缝合皮肤时及术后 24h 的动脉血气。
与术后 12、24、48、72h 比较，术后 1 周时 PLSP 发生率明显降低（P<0.01）；与 B 组比较，A 组术后 12、24、48、72h 及 1 周时 PLSP 发生率、疼痛评分及补救性镇痛药物剂量明显降低（P<0.01）；2 组麻醉诱导前、气腹后 20min、缝合皮肤时及术后 24h 动脉血气分析比较差异无统计学意义（P>0.05）；2 组术后 1 周内恶心呕吐等不良反应发生率比较差异无统计学意义（P>0.05）。
腹腔镜袖状胃切除术术中采用轻度过度通气可降低术后 PLSP 的发生率和严重程度，且不增加相关不良反应。
