利多卡因-表阿霉素-超液化碘油混合乳剂在肝癌TACE相关疼痛管理中的应用  

The application of lidocaine-epirubicin-lipiodol emulsion in the management of TACE-related pain in HCC patients

作　　者：王天成 马聪[1] 肖煜东[1] 张子曙[1] WANG Tiancheng;MA Cong;XIAO Yudong;ZHANG Zishu(Department of Radiology,Second Xiangya Hospital of Central South University,Changsha,Hunan Province 410011,China)

机构地区：[1]中南大学湘雅二医院放射科,长沙410011

出　　处：《介入放射学杂志》2020年第4期366-371,共6页Journal of Interventional Radiology

摘　　要：目的探讨利多卡因-表阿霉素-超液化碘油乳剂在缓解TACE术中及术后患者疼痛的有效性及安全性。方法采用前瞻性随机对照的研究方法,共纳入55例患者。运用最小化法动态随机将患者分为A组(n=28)与B组(n=27)。A组在栓塞前通过导管一次性注入利多卡因100 mg,再注入表阿霉素-超液化碘油乳剂,B组在栓塞术中注入利多卡因-表阿霉素-超液化碘油乳剂。两组利多卡因用量均为100 mg。观察并记录患者术中及术后72 h内的疼痛评分(使用视觉疼痛评分量表),比较两组患者的一般情况,术后不良反应及其他止痛药物使用量。计量资料用均数±标准差或中位数(四分位间距)表示,计数资料用百分比表示;两组患者之间计量资料比较使用独立样本t检验或Mann-Whitney U检验,计数资料比较用χ2检验或者Fisher精确检验;以P<0.05为差异有统计学意义。结果两组患者的一般情况、碘油使用总量、TACE手术时长、表阿霉素用量及术后不良反应均无统计学差异(P>0.05)。B组在术中及术后4 h、8 h、24 h的疼痛评分均明显小于A组(P<0.01),而在术前,术后48 h、72 h两组间的疼痛评分差异无统计学意义(P>0.05)。B组患者TACE术后曲马多使用量小于A组患者(P<0.05),两组患者术后哌替啶使用量差异无统计学意义(P>0.05)。结论利多卡因-表阿霉素-超液化碘油乳剂具有延长利多卡因止痛时长的作用,可以在TACE术中和术后有效减轻患者疼痛程度,达到长时间的止痛效果,从而提高患者住院期间生活质量。Objective To invastigate the effectiveness and safety of lidocaine-epirubicin-lipiodol emulsion in relieving intraoperative and postoperative pain related to transcatheter arterial chemoembolization(TACE) in patients with hepatocellular carcinoma(HCC). Methods A total of 55 HCC patients were enrolled in this prospective randomized controlled trial. Using minimization method, the patients were dynamically and randomly divided into group A(n=28) and group B(n=27). For patients in group A, one-off injection of lidocaine 100 mg through catheter was given before TACE, which was followed by injection of epirubicin-lipiodol emulsion. For patients in group B, injection of lidocaine-epirubicinlipiodol emulsion was adopted during TACE. The dosage of lidocaine was 100 mg in both groups. Pain scores during and within 72 hours after TACE(using visual pain rating scale) were recorded. The general situation of patients, postoperative adverse reactions and dosage of other analgesic drugs were compared between the two groups. The measurement data was represented by(mean±standard deviation) or by median(interquartile range), and the enumeration data was expressed as a percentage. The comparison of measurement data between the two groups of patients was conducted by independent sample t test or Mann-Whitney U test, and χ2 test or Fisher accurate test were used to compare the enumeration data. The difference of P<0.05 was defined as statistically significant. Results No statistically significant differences in general condition, the total amount of used lipiodol, the time spent for TACE, the dose of epirubicin and the incidence of postoperative adverse reactions existed between the two groups(P>0.05). The intraoperative pain score as well as 4-hour, 8-hour and 24-hour postoperative pain scores in group B were remarkably lower than those in group A(P<0.01), while no statistically significant differences in preoperative pain score as well as in 48-hour and 72-hour postoperative pain scores existed between the two groups(P>0.05). The

关 键 词：肝癌 经动脉化疗栓塞术 利多卡因 疼痛管理 

分 类 号：R735.7[医药卫生—肿瘤]