吗啡注射液复合右美托咪定在肝动脉灌注化疗栓塞治疗肝癌术中的应用  

The application of morphine injection plus dexmedetomidine in hepatic artery infusion chemoembolization for hepatocellular carcinoma

作　　者：杨学刚[1] 吴戈[1] 何乾文[2] 张伟[3] 刘源[4] 周晓龙 敖伟[6] 徐兴明[7] 刘启榆[8] 何晓明 李政文[1] 文华长[1] 孙颜媛[1] 文永均[1] 曹蓉[1] 庞华容[1] 吴辉[1] 许国辉[1] YANG Xuegang;WU Ge;HE Qianwen;ZHANG Wei;LIU Yuan;ZHOU Xiaolong;AO Wei;XU Xingming;LIU Qiyu;HE Xiaoming;LI Zhengwen;WEN Huachang;SUN Yanyuan;WEN Yongjun;CAO Rong;PANG Huarong;WU Hui;XU Guohui(Department of Interventional Radiology,Sichuan Provincial Caner Hospital,Chengdu,Sichuan Province 610041,China)

机构地区：[1]四川省肿瘤医院介入科,成都610041 [2]成都军区总医院放射科 [3]成都市第五人民医院放射科 [4]成都中医药大学附属医院血管外科 [5]内江市第二人民医院放射科 [6]自贡市第四人民医院放射科 [7]攀枝花市中心医院放射科 [8]绵阳市中心医院放射科 [9]绵阳市四零四医院放射科

出　　处：《介入放射学杂志》2019年第8期738-741,共4页Journal of Interventional Radiology

基　　金：四川省科技计划项目(18YYJC0665)

摘　　要：目的探讨TACE治疗原发性肝癌吗啡注射复合右美托咪定的镇痛效果及安全性。方法9个中心纳入361例原发性肝癌患者,数字随机表法分为研究组(右美托咪定)181例和对照组(0.9%NaCl溶液)180例。两组TACE术前10min均给予吗啡注射液10mg皮下注射。研究组TACE术前10min单次静脉泵入右美托咪定负荷剂量0.6μg·kg^-1·h^-1,10min后以维持剂量0.4~0.8μg·kg^-1·h^-1至术后6h结束;对照组以同样方式泵入0.9%NaCl溶液。记录入手术室(T0)、栓塞前(T1)、栓塞结束时(T2)、TACE结束动脉压迫止血时(T3)、TACE后1h(T4)、TACE后3h(T5)、TACE后6h(T6)各时间点的生命体征、镇静评分、镇痛评分的变化。结果两组患者各时间点的平均动脉压、心率、呼吸频率、脉氧饱和度差异无统计学意义(P>0.05)。两组患者警觉/镇静评分(OAA/S)从T0~T6变化趋势均无统计学意义(P>0.05)。T1~T6时研究组的VAS评分均小于对照组,差异有统计学意义(P<0.05)。恶心呕吐和术中体动的发生率研究组明显低于对照组(P<0.05)。结论吗啡复合右美托咪定可有效改善TACE术中及术后疼痛,提高疼痛控制满意度,不良反应轻,值得临床推广。Objective To explore the analgesic effect and safety of morphine combined with dexmedetomidine used in transcatheter arterial chemoembolization(TACE) for primary hepatocellular carcinoma. Methods A total of 361 HCC patients,who were collected from 9 medical centers,were enrolled in this study.Using digital random table method,the patients were divided into study group(n=181,using dexmedetomidine) and control group(n=180,using 0.9%NaCl solution).Ten minutes before TACE,subcutaneous injection of 10 mg morphine was carried out in all patients of both groups.For the patients of the study group,10 minutes before TACE a single intravenous infusion of dexmetidine with a loading dose of 0.6 μg·kg^-1·h^-1 was performed,and 10 minutes later maintenance dose of 0.4-0.8 μg·kg^-1·h^-1 was used,which lasted for 6 hours after TACE.For the patients of the control group,0.9%NaCl solution was infused in the same way as described above.The changes of vital signs,including mean arterial pressure (MAP),heart rate (HR),respiratory rate (RR) and pulse oxygen saturation(SPO2),were recorded at the following points of time:patient's entering the operating room(T0), pre- embolization(T1),immediately after embolization(T2),arterial compression to stop bleeding after TACE (T3),one hour after TACE(T4),3 hours after TACE(T5),and 6 hours after TACE(T6).The observer's assessment of alertness/sedation scale(OAA/S) scores and visual analogue scale(VAS) scores were also recorded at each point of time from T0 through T6.Results At each point of time from T0 through T6,the differences in MAP,HR,RR and SPO2 between the two groups were not statistically significant (P>0.05),and the difference in OAA/S score between the two groups was also not statistically significant(P>0.05).At each point of time from T1 through T6,the mean VAS scores in the study group were smaller than those in the control group,the differences between the two groups were statistically significant(P<0.05).The occurrences of nausea,vomiting,and intraoperative body movement in t

关 键 词：原发性肝癌 化疗栓塞 右美托咪定 疼痛 

分 类 号：R735.7[医药卫生—肿瘤]