子宫肌瘤切除术后腹胀痛与肩颈痛的影响因素分析

Analysis of Influencing Factors of Abdominal Distension and Pain and Shoulder and Neck Pain after Myomectomy

摘要: 目的：探讨腹腔镜子宫肌瘤切除术后患者腹胀痛与肩颈痛的发生情况及其影响因素，为临床制定针对性镇痛策略提供依据。方法：采用回顾性研究方法，收集2022年1月至2025年8月于珠海市中西医结合医院妇科行腹腔镜子宫肌瘤切除术的70例患者的临床资料。记录患者术后72小时内腹胀痛与肩颈痛的发生率、疼痛峰值数字评分法(NRS)评分及疼痛持续时间。采用单因素分析和多因素Logistic回归分析筛选术后中重度疼痛(NRS ≥ 4分)的独立影响因素。结果：70例患者中，术后腹胀痛发生率为82.86% (58/70)，肩颈痛发生率为64.29% (45/70)。多因素Logistic回归分析显示，年龄 ≥ 40岁(OR = 3.46, 95% CI: 1.27~9.41)、手术时间延长(每增加10分钟，OR = 1.46, 95% CI: 1.07~2.00)、术后下床活动时间延迟(每延迟1小时，OR = 1.36, 95% CI: 1.08~1.72)是术后发生中重度疼痛的独立危险因素(P < 0.05)。结论：腹腔镜子宫肌瘤切除术后腹胀痛与肩颈痛发生率高，且受年龄、手术时间、术后下床活动时间等多种因素影响。针对高龄、手术复杂或预计恢复期较长的患者，应采取优化气腹参数、鼓励术后早期活动等综合干预措施，以减轻疼痛，促进康复。

Abstract: Objective: To explore the occurrence and influencing factors of abdominal distension and pain and shoulder and neck pain in patients after laparoscopic myomectomy, and to provide a basis for formulating targeted analgesic strategies in clinical practice. Methods: A retrospective study was conducted to collect the clinical data of 70 patients who underwent laparoscopic myomectomy in the Gynecology Department of Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine from January 2022 to August 2025. The incidence of abdominal distension and pain and shoulder and neck pain within 72 hours after the operation, the peak Numerical Rating Scale (NRS) score for pain, and the duration of pain were recorded. Univariate analysis and multivariate Logistic regression analysis were used to screen the independent influencing factors of moderate to severe postoperative pain (NRS ≥ 4 points). Result: Among the 70 patients, the incidence of postoperative abdominal distension and pain was 82.86% (58/70), and the incidence of shoulder and neck pain was 64.29% (45/70). Multivariate Logistic regression analysis showed that age ≥ 40 years (OR = 3.46, 95% CI: 1.27~9.41), prolonged operation time (for every additional 10 minutes, OR = 1.46, 95% CI: 1.07~2.00) and delayed postoperative ambulation time (for every 1-hour delay, OR = 1.36, 95% CI: 1.08~1.72) were independent risk factors for moderate to severe postoperative pain (P < 0.05). Conclusion: The incidence of abdominal distension and pain and shoulder and neck pain after laparoscopic myomectomy is high, and it is affected by multiple factors such as age, operation time, and postoperative out-of-bed activity time. For elderly patients, those with complex surgeries or those expected to have a long recovery period, comprehensive intervention measures such as optimizing pneumoperitoneum parameters and encouraging early postoperative activities should be adopted to alleviate pain and promote recovery.