肝动脉化疗栓塞术中使用碘油所致疼痛的相关因素分析及应对措施  

Factors related to lipiodol-induced pain during TACE and measures for pain relief

作　　者：焦旭东[1] 吴金平[1] 朱梅珍[1] 张璐西[1] 陈正侃[1] 李云华[1] 潘逸峰[1] 

机构地区：[1]常州市第三人民医院放射科,江苏常州213001

出　　处：《实用肿瘤杂志》2014年第5期450-453,共4页Journal of Practical Oncology

摘　　要：目的探讨肝动脉化疗栓塞术(transarterial chemoembolization,TACE)中使用碘油所致肝区疼痛的相关因素及减轻疼痛的措施。方法选取137例行TACE患者,记录患者术中疼痛的程度,并对可能导致疼痛的相关因素进行临床分析;分析减轻术中疼痛的措施。结果术中患者疼痛程度与年龄、性别无相关性(均P>0.05);与瘤体大小、数量、血供程度、栓塞剂注射速率呈正相关(均P<0.05);与碘化油用量、导管的超选位置呈明显正相关(均P<0.05);与肝内有瘤组比较,肝内无瘤组总体疼痛程度更高(P<0.05)。术前注射利多卡因组疼痛发生率低于未注射组,且疼痛程度更低,栓塞时疼痛出现时间迟于术前未注射组(均P<0.05)。术中出现中度以上疼痛时注射利多卡因后疼痛评分明显降低(P<0.05)。TACE术中辅以音乐疗法能有效减轻患者的疼痛感(P<0.05)。结论术前经导管注射利多卡因、精细手术操作方式、弹丸式缓慢注射、把握好碘化油用量、术中辅以音乐疗法均能减轻术中疼痛;疼痛发生时经导管注射利多卡因有助于减轻疼痛感。Objective To investigate the related factors of liver pain caused by lipiodol during transarterial chemoembolization（ TACE） and measures for pain relief. Methods One-hundred-thirty-seven patients undergoing TACE were included in the study. The degree of pain was recorded during the procedures. The related factors of pain were analyzed. Results The liver pain during TACE was correlated with tumor size,number,degree of blood supply,embolic agent injection rate,volume of lipiodol,and ultra-election position of the catheter（ all P〈 0. 05）,not correlated with age and gender（ both P〉 0. 05）. The degree of pain in liver tumor-free patients was severer than that in patients with liver tumor（ P〈 0.05）. The incidence of pain in patients having preoperative injection of lidocaine was lower and appeared later than that in patients without preoperative injection（ both P〈 0. 05）. During TACE,pain was significantly reduced after the injection of lidocaine（ P 〈0. 05）. Music therapy effectively relieved pain during TACE（ P〈 0. 05）. Conclusion Preoperative transcatheter injection of lidocaine,fine surgical operation,slow bolus injection,reasonable amount of lipiodol,combined with intraoperative music therapy can relieve pain during TACE. Lidocaine injection via catheter during the procedure may effectively relieve pain.

关 键 词：肝肿瘤 碘化油 肝动脉 化学栓塞 治疗性 化学栓塞 治疗性/副作用 疼痛 

分 类 号：R735.7[医药卫生—肿瘤]