短时正念身体扫描控制肝癌患者局麻下射频消融术中高血压和疼痛的临床观察  

Clinical observation of efficacy of brief mindfulness-based body scan in control of intraoperative hypertension and pain in patients undergoing radiofrequency ablation for liver cancer under local anesthesia

作　　者：彭静[1,2] 肖亮[3] 屈英俊[3] 李兰 刘鑫[3] 谢艳会[1,3] PENG Jing;XIAO Liang;QU Yingjun;LI Lan;LIU Xin;XIE Yanhui(Teaching and Research Section of Clinical Nursing,Central South University,Changsha 410008,China;Xiangya School of Nursing,Central South University,Changsha 410013,China;Department of Liver Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院临床护理教研室,湖南长沙410008 [2]中南大学湘雅护理学院,湖南长沙410013 [3]中南大学湘雅医院肝脏外科,湖南长沙410008

出　　处：《中国普通外科杂志》2023年第2期254-260,共7页China Journal of General Surgery

基　　金：湖南省长沙市自然科学基金资助项目(kq2014286)。

摘　　要：背景与目的:肝癌患者在接受局麻下射频消融(RAF)治疗过程中,不可避免地会产生焦虑和紧张情绪,使得患者对疼痛更加敏感,进而导致血压升高和耐受能力下降,甚至迫使治疗中止。因此,维持生命体征稳定和减轻疼痛是肝癌患者局麻下RAF成功实施的保证,临床通常使用降压及止痛药物缓解上述症状,但药物有其固有的副作用且加重了患者的经济负担。正念减压(MBSR)治疗已被证实在多种不良情绪和慢性疼痛控制方面具有积极作用,然而其在肝癌治疗领域的价值却鲜见报道。因此,本研究探讨短时正念身体扫描(BMBS)在肝癌患者局麻下RAF治疗术中控制高血压和疼痛的疗效,为其临床推广应用提供数据支持。方法:回顾性分析2018年1月—2019年6月在中南大学湘雅医院肝脏外科接受局麻下RAF治疗的67例肝癌患者资料。其中,32例在RAF治疗全程仅接受BMBS,不用降压药(BMBS组),另35例采用舌下含服氨氯地平片控制血压在正常范围左右(对照组)。所有患者在RAF前后测量血压4次(BMBS或口服降压药前10 min、即将给予BMBS或口服降压药前、RAF开始时、RAF结束时)。比较两组的基线特征,以及RAF过程中血压变化、止痛药使用次数和疼痛评分等疗效评价指标。结果:两组患者的基线情况无明显差异(均P>0.05)。组内比较显示,BMBS组与对照组患者收缩压和舒张压经各自处理后均明显降低(均P<0.05)。组间比较发现,BMBS组各时间点收缩压和舒张压差异均无统计学意义(均P>0.05)。BMBS组患者的止痛药需求量和疼痛评分明显低于对照组(P=0.044、P=0.003)。结论:BMBS作为一种简单的MBSR方法,对肝癌患者行局麻下RAF治疗术中的高血压及疼痛有较好的控制效果,具有良好的临床应用前景。唯因其实施有赖于医护人员接受心理干预方面的专业训练,将来有必要在这一方面加强培训,以使得更多患者从中获益。Background and Aims:During the radiofrequency ablation(RAF)treatment under local anesthesia for liver cancer,anxiety and stress are inevitable reactions in patients,which will make the patients more sensitive to pain,and thereby lead to increased blood pressure and decreased tolerance,even forced discontinuation of treatment.Therefore,maintaining the stability of vital signs and relieving pain are the guarantees of the successful implementation of RAF under local anesthesia for patients with liver cancer.Conventionally,antihypertensive and analgesic medications are often used to relieve the above symptoms in clinical practice.Still,these drugs possess inherent side effects and increase the patients’economic burden.Mindfulness-based stress reduction(MBSR)therapy has been proven to positively impact the control of various adverse emotions and chronic pain.However,its value in the treatment of liver cancer is rarely reported.Therefore,this study was conducted to investigate the efficacy of a brief mindfulness-based body scan(BMBS)in controlling intraoperative hypertension and pain in patients receiving RAF under local anesthesia for liver cancer and provide data support for its clinical application.Methods:The data of 67 patients who underwent RAF for liver cancer from January 2018 to June 2019 in the Department of Liver Surgery,Xiangya Hospital,Central South University,were retrospectively analyzed.Of the patients,32 cases received BMBS only without administering antihypertensive drugs throughout RAF(BMBS group),and the other 35 cases received sublingual administration of amlodipine sublingual amlodipine tablets to control the blood pressure and keep it around the normal level(control group).All patients underwent blood pressure measurement 4 times before and after RAF(10 min before the initiation of BMBS or oral administration of antihypertensive drugs,immediately before the initiation of BMBS or oral administration of antihypertensive medications,at the initiation of RAF,and the completion of RAF).The baseline

关 键 词：肝肿瘤 射频消融术 正念 高血压 疼痛 

分 类 号：R735.7[医药卫生—肿瘤]