氢吗啡酮超前镇痛对肝癌热消融手术患者的有效性与安全性分析  

Effectiveness and Safety Analysis of Preemptive Analgesia with Hydromorphone in Patients with Liver Cancer Undergoing Thermal Ablation

作　　者：朱扬 杨福刚 刘迪 翟妍 周军[1] 卢伟 ZHU Yang;YANG Fugang;LIU Di(Interventional Diagnositc and Therapeutic Center of Zhongnan Hospital,Wuhan Univiversity,Wuhan,Hubei Province 430071,P.R.China)

机构地区：[1]武汉大学中南医院介入诊疗中心,430071

出　　处：《临床放射学杂志》2025年第2期362-366,共5页Journal of Clinical Radiology

基　　金：湖北省卫生健康委员项目(编号:WJ2023M066);国家自然科学基金项目(编号:30670612)。

摘　　要：目的探究氢吗啡酮超前镇痛对肝癌热消融手术患者的镇痛效果及不良反应。方法选取行热消融治疗的40例肝癌患者,将患者分为两组,术前15 min使用镇痛药物,研究组缓慢推注氢吗啡酮1 mg,对照组缓慢推注吗啡10 mg,记录患者热消融穿刺前、消融开始即刻、消融开始后5 min、手术结束时及术后2、12、24、48 h疼痛视觉模拟评分(VAS)。同时记录补救镇痛次数、术后恢复质量量表(QoR-40)评估、患者镇痛满意度和不良反应发生情况。结果两组间消融前疼痛VAS差异无统计学意义(P>0.05)。在消融即刻、消融开始后5 min、手术结束时及术后2、12、24、48 h,研究组VAS均低于对照组,差异有统计学意义(t值分别为7.437、10.824、8.168、9.478、7.152、8.987、7.175,均P<0.05),研究组在术后48 h内累计补救镇痛次数低于对照组,患者对镇痛药物的镇痛效果满意度优于对照组(t值分别为3.176、5.168,均P<0.05),两组之间出院前情绪状态、心理支持、身体舒适度、疼痛、自理能力及总分差异无统计学意义(t值分别为0.856、0.547、1.347、2.154、0.078、0.876,P>0.05),两组患者药物相关不良反应比较,差异无统计学意义(χ^(2)值为5.155,P>0.05)。两组患者均未出现与疼痛药物使用相关的并发症。结论氢吗啡酮超前镇痛用于肝癌患者的热消融术具有良好的镇痛效果,且安全性好。Objective To investigate the analgesic effect and side effects of hydromorphone preemptive analgesia in patients with liver cancer undergoing thermal ablation.Methods Forty patients with liver cancer who underwent thermal ablation were enrolled and divided into 2 groups.The patients were given analgesic drugs 15 min before ablation procedures.Twenty patients were given intravenous hydromorphone 1mg(study group,n=20)and the other twenty was given intravenous morphine 10m g(control group,n=20)VAS scores were recorded before thermal ablation,immediately after ablation,5 minutes after ablation,at the end of surgery,and 2,12,24,and 48 hours after surgery.At the same time,the number of remedial analgesia,the evaluation of postoperative Quality of Recovery Scale(QoR-40),patient satisfaction and the occurrence of adverse reactions were recorded.Results There was no significant difference in pre-ablation pain VAS scores between the two groups(P>0.05).Immediately after ablation and aT_(2),12,24 and 48 hours after surgery,VAS score of the study group was lower than that of the control group,the difference was statistically significant(t=7.437、10.824、8.168、9.478、7.152、8.987、7.175,all P<0.05).The cumulative number of remedial analgesia in the study group was lower than that of the control group within 48 hours after procedures,and the satisfaction of patients with analgesic effects of analgesics was better than that of the control group(t=3.176、5.168,P<0.05).There was no statistical significance in post-procedures emotional state,psychological support,physical comfort,pain,self-care ability and total score between the two groups(t=0.856、0.547、1.347、2.154、0.078、0.876,P>0.05),and there was no statistical significance in drug-related adverse reactions between the two groups(χ^(2)=5.155,P>0.05).There were no complications related to pain medication use in either group.Conclusion Prolonged analgesia with hydromorphone has good analgesic effect and safety in thermal ablation of patients with liver cancer.

关 键 词：氢吗啡酮 超前镇痛 肝癌 热消融 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]