多模式综合镇痛方案在原发性肝癌介入手术中的应用效果?  

Application of Multi-mode Comprehensive Analgesia in Patients Undergoing Interventional Surgery for Primary Hepatocellular Cancer

作　　者：朱波[1] 刘少星[1] 曹德均 邓超[1] 刘凌[1] ZHU Bo;LIU Shao-xing;CAO De-jun(Second people's hospital of Chengdu Sichuan Chengdu 610016)

机构地区：[1]成都市第二人民医院麻醉科,四川成都610016

出　　处：《医学临床研究》2019年第9期1674-1676,共3页Journal of Clinical Research

基　　金：四川省医学会课题(编号:S17008).

摘　　要：[目的]探讨多模式镇痛在原发性肝癌(PHC)经肝动脉化疗栓塞(T ACE)术中的应用效果.[方法]行TACE治疗的PHC患者68例,随机分为两组,每组34例.对照组采用传统镇痛方式,观察组采用多模式镇痛.术前1 h 、给药时、术后即刻(T0 )、术后2 h(T2 )、4 h(T4 )、6 h(T6 )、12 h(T12 )、24 h(T24 )和48 h(T48 )采用视觉疼痛模拟评分(VAS)评估患者疼痛程度.于手术前1 d ,术后1 d ,术后3 d检测并比较两组白细胞介素‐6(IL‐6)、S100β蛋白水平.比较两组患者48 h内不良反应发生情况.[结果]T0 、T2 、T4 、T6 、T12和T24时刻观察组VAS评分均显著低于对照组( P <0 .05),T48时刻两组VAS评分比较差异无显著性( P >0 .05).手术前1 d ,两组血清IL‐6和S100β水平比较差异无显著性( P >0 .05);术后d1 ,术后d3 ,观察组血清IL‐6和S100β水平均显著低于对照组( P <0 .05).观察组总不良反应发生率为58 .8%(20/34),与对照组的67 .6%(23/34)比较差异无显著性( P>0 .05).[结论]多模式镇痛方案应用于TACE术有助于降低PHC患者术后疼痛程度及低炎性反应水平,且不增加不良反应.[Objective]To investigate the effect of multi‐modal analgesia on primary hepatocellular carcinoma (PHC) treated with hepatic arterial chemoembolization (T ACE).[M ethods]A total of 68 cases of PHC patients received T ACE treatment were randomly divided into two groups ,with 34 cases in each group .T he control group used traditional analgesia and the observation group used multimodal analgesia .Visual pain simulation score (VAS ) was used to assess the degree of pain in the patient at 1 h before surgery ,at the time of administration , immediately after surgery (T0 ) ,2 h after surgery (T2 ) ,4 h (T4 ) ,6 h (T6 ) ,12 h (T12 ) ,24 h (T24 ) and 48 h (T48 ) after surgery .T he levels of IL‐6 and S100β protein were detected and compared at 1 day before surgery and d1 ,d3 after operation .T he adverse reactions within 48 hours after surgery were recorded in both groups .[Results]T he VAS scores of the T0 ,T2 ,T4 ,T6 ,T12 ,and T24 in the observation group were significantly lower than those in the control group ( P <0 .05).T here was no significant difference in the VAS scores of the two groups at T 48 after surgery ( P >0 .05).T here was no significant difference in the levels of serum IL‐6 and S100β between the two groups at 1 day before operation ( P >0 .05).T he levels of serum IL‐6 and S100β in the observation group were significantly lower than those in the control group at 1d and 3d after operation ( P <0 .05).T he incidence of total adverse reactions in two group was no significant difference ( P >0 .05).[Conclusion]T he use of multimodal analgesia in T ACE can help reduce postoperative pain in PHC patients and reduce the level of inflammatory re‐sponse without increasing adverse reactions .

关 键 词：肝肿瘤/外科学 疼痛 手术后 导管消融术 

分 类 号：R735.7[医药卫生—肿瘤]