氟比洛芬酯复合地佐辛在肝包膜下肿瘤微波消融术中的应用
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摘要
目的探讨氟比洛芬酯(凯纷)复合地佐辛对经皮肝癌微波消融(MWA)消融范围累及肝脏包膜的镇痛效果及安全性。方法选取2017年12月至2018年7月接受局麻下CT引导经皮穿刺肝癌MWA消融范围累及肝包膜的患者40例,随机分为A组(n=20)和B组(n=20),A组采用氟比洛芬酯(1 mg/kg)术中静脉麻醉镇痛复合地佐辛(0.1 mg/kg)术前肌注镇痛,B组单纯使用地佐辛(0.1 mg/kg)术前肌注。记录两组患者术中不同时间点平均动脉压、呼吸频率、心率以及氧饱和度;观察术中患者不良反应率;记录术后不同时间点疼痛视觉模拟评分(VAS),采用重复测量方差分析、t检验,χ~2检验等分析镇痛效果指标。结果两组患者性别、年龄、病灶大小及病灶距肝脏包膜的最近距离比较,差异均无统计学意义(P>0.05),两组患者术中不同时间点呼吸频率、平均动脉压、脉氧饱和度以及心率比较,差异均无统计学意义(P>0.05),术中两组诸生命体征变化趋势亦均无统计学意义(P>0.05),A、B两组并发症的发生率分别为15%、45%,差异有统计学意义(P<0.05),A、B两组患者手术开始后5 min、20 min、2 h疼痛VAS经重复测量的多因素方差分析比较,满足球形条件(P>0.05),并进行多变量方差分析显示A、B两组患者各时间点的疼痛评分(视觉模拟评分,VAS)的差异有统计学意义(F=31.735,P<0.05),对A、B两组每个对应时间点患者的疼痛VAS进行比较,发现两组患者手术开始后5 min,20 min疼痛VAS差异无统计学意义(F=0.208、0.483,P>0.05),手术开始后2 h A组患者疼痛VAS明显低于B组,有统计学意义(F=5.104,P<0.05)。结论氟比洛芬酯复合地佐辛可以安全有效地控制消融范围累及肝脏包膜的经皮肝癌MWA中的疼痛。
Objective To evaluate the analgesic effect and safety of flurblprofen axetil combined with dizocine in percutaneous microwave ablation(PMWA) of hepatic subcapsular tumors with the ablation extent involving liver capsule. Methods A total of 40 patients with hepatic subcapsular tumor, who received CTguided PMWA under local anesthesia during the period from December 2017 to July 2018 and the extent of ablation involved hepatic capsule, were enrolled in this study. The patients were randomly divided into group A(n=20) and group B(n=20). Patients in group A received intraoperative intravenous injection of flurbiprofen axetil(1 mg/kg) for anesthesia analgesia and preoperative intramuscular injection of dezocin(0.1 mg/kg) for analgesia. Patients in group B only received preoperative intramuscular injection of dezocin(0.1 mg/kg) for analgesia. The mean arterial pressure, respiratory rate, heart rate and oxygen saturation of patients in the two groups at different time periods during PMWA were recorded. The occurrence of adverse reactions during PMWA was documented and the visual analogue scale(VAS) score of pain at different time points after PMWA was recorded. The analgesic effect indexes were evaluated by repeated measurement of variance analysis, t-test, and χ~2 test. Results No statistically significant differences in gender, age, size of lesions and the shortest distance from the lesion to the liver capsule existed between the two groups(P>0.05). There were no significant differences in respiratory rate, mean arterial pressure, pulse oxygen saturation(pulse oximetry) and heart rate between the two groups at different time points during PMWA(P >0.05). No statistically significant changes in variation tendency of vital signs were observed in each group(P>0.05). The incidences of complications in group A and group B were 15% and 45% respectively, the difference between the two groups was statistically significant(P<0.05). The VAS scores determined at 5 min, 20 min and 2 h after the beginning of PMWA were compared between group A and group B by repeated measurement of variance analysis, which satisfied with the spherical condition(P >0.05). Multivariate analysis of variance revealed that there was a significant difference in VAS score between the two groups at different time points(F =31.735,P <0.05). Comparison between corresponding point-in-time VAS score of the two groups demonstrated that no statistically significant differences in VAS scores determined at 5 min and 20 min after the beginning of PMWA existed between the two groups(F=0.208 and F=0.483 respectively, P>0.05). The VAS score determined at 2 h after the beginning of PMWA in group A was remarkably lower than that in group B, the difference was statistically significant(F =5.104, P <0.05). Conclusion In treating hepatic subcapsular tumors with PMWA with the ablation extent involving liver capsule, flurblprofen axetil combined with dizocine can safely and effectively control intraoperative pain.(J Intervent Radiol, 2019, 28: 652-655)
Objective To evaluate the analgesic effect and safety of flurblprofen axetil combined with dizocine in percutaneous microwave ablation(PMWA) of hepatic subcapsular tumors with the ablation extent involving liver capsule. Methods A total of 40 patients with hepatic subcapsular tumor, who received CTguided PMWA under local anesthesia during the period from December 2017 to July 2018 and the extent of ablation involved hepatic capsule, were enrolled in this study. The patients were randomly divided into group A(n=20) and group B(n=20). Patients in group A received intraoperative intravenous injection of flurbiprofen axetil(1 mg/kg) for anesthesia analgesia and preoperative intramuscular injection of dezocin(0.1 mg/kg) for analgesia. Patients in group B only received preoperative intramuscular injection of dezocin(0.1 mg/kg) for analgesia. The mean arterial pressure, respiratory rate, heart rate and oxygen saturation of patients in the two groups at different time periods during PMWA were recorded. The occurrence of adverse reactions during PMWA was documented and the visual analogue scale(VAS) score of pain at different time points after PMWA was recorded. The analgesic effect indexes were evaluated by repeated measurement of variance analysis, t-test, and χ~2 test. Results No statistically significant differences in gender, age, size of lesions and the shortest distance from the lesion to the liver capsule existed between the two groups(P>0.05). There were no significant differences in respiratory rate, mean arterial pressure, pulse oxygen saturation(pulse oximetry) and heart rate between the two groups at different time points during PMWA(P >0.05). No statistically significant changes in variation tendency of vital signs were observed in each group(P>0.05). The incidences of complications in group A and group B were 15% and 45% respectively, the difference between the two groups was statistically significant(P<0.05). The VAS scores determined at 5 min, 20 min and 2 h after the beginning of PMWA were compared between group A and group B by repeated measurement of variance analysis, which satisfied with the spherical condition(P >0.05). Multivariate analysis of variance revealed that there was a significant difference in VAS score between the two groups at different time points(F =31.735,P <0.05). Comparison between corresponding point-in-time VAS score of the two groups demonstrated that no statistically significant differences in VAS scores determined at 5 min and 20 min after the beginning of PMWA existed between the two groups(F=0.208 and F=0.483 respectively, P>0.05). The VAS score determined at 2 h after the beginning of PMWA in group A was remarkably lower than that in group B, the difference was statistically significant(F =5.104, P <0.05). Conclusion In treating hepatic subcapsular tumors with PMWA with the ablation extent involving liver capsule, flurblprofen axetil combined with dizocine can safely and effectively control intraoperative pain.(J Intervent Radiol, 2019, 28: 652-655)
引文
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[4]吴文涛,贾振宇,陈奇峰,等.羟考酮对累及肝脏包膜经皮肝穿刺微波消融术肝癌患者的影响[J].临床麻醉学杂志,2017,33:656-659.
[5]吴文涛,贾振宇,陈奇峰,等.全麻下经皮肝癌微波消融术累及肝包膜对患者围手术期的影响[J].临床麻醉学杂志,2018,34:179-180.
[6]陈奇峰,贾振宇,杨正强,等.MR早期评估肝癌微波消融范围的临床研究[J],介入放射学杂志,2017,26:55-59.
[7]张雪花,张潆化,梁萍.超声引导下微波消融治疗肝癌246例并发症分析[J].解放军医学院学报,2015,36:883-885.
[8]谭凯,杜锡林,杨涛,等.手术切除、肝动脉化疗栓塞、微波固化联合门静脉化疗对肝细胞癌术后复发的疗效分析[J].中华肝胆外科杂志,2014,20:253-257.
[9]Komatsu R,You J,Mascha EJ,et al.Anesthetic induction with etomidate,rather than propofol,is associated with increased 30-day mortality and cardiovascular morbidity after noncardiac surgery[J].Anesth Analg,2013,117:1329-1337.
[10]彭露瑶,黄东.地佐辛与右美托咪定联合舒芬太尼对胶质瘤患者术后唤醒及镇痛的比较[J].中国生化药物杂志,2016,36:114-116.
[11]陈娟,丁维沛,赵志斌.地佐辛联合舒芬太尼在老年髋关节置换术后镇痛中的作用[J].中国老年学杂志,2015,35:2820-2822.
[12]樊宝才.我院骨科地佐辛注射液致不良反应80例分析[J].中国药房,2015,26:4521-4522.
[13]Akbari E.The role of cyclo-oxygenase inhibitors in attenua ting opioid:induced tolerance,hyperalgesia,and dependence[J].Med Hypotheses,2012,78:102-106.
[14]田明,杨伟伟,王楠.地佐辛复合氟比洛芬酯超前镇痛对高龄全髋关节置换术后镇痛效果观察[J].陕西医学杂志,2015,44:363-364.
[15]罗向阳.氟比洛芬酯和盐酸曲马多治疗妇科腹腔镜后疼痛的临床效果[J].临床医药实践,2014,23:238-240.
[2]吴江东,蒋宗滨.术后镇痛的趋势---多模式镇痛[J].实用疼痛学杂志,2013,9:63-67.
[3]Sommer M,de rijke JM,vankleef M,et al.The prevalence of postoperative pain in a sample of 1490 surgical inpatients[J].Eur J Anaesthesiol,2008,25:267-274.
[4]吴文涛,贾振宇,陈奇峰,等.羟考酮对累及肝脏包膜经皮肝穿刺微波消融术肝癌患者的影响[J].临床麻醉学杂志,2017,33:656-659.
[5]吴文涛,贾振宇,陈奇峰,等.全麻下经皮肝癌微波消融术累及肝包膜对患者围手术期的影响[J].临床麻醉学杂志,2018,34:179-180.
[6]陈奇峰,贾振宇,杨正强,等.MR早期评估肝癌微波消融范围的临床研究[J],介入放射学杂志,2017,26:55-59.
[7]张雪花,张潆化,梁萍.超声引导下微波消融治疗肝癌246例并发症分析[J].解放军医学院学报,2015,36:883-885.
[8]谭凯,杜锡林,杨涛,等.手术切除、肝动脉化疗栓塞、微波固化联合门静脉化疗对肝细胞癌术后复发的疗效分析[J].中华肝胆外科杂志,2014,20:253-257.
[9]Komatsu R,You J,Mascha EJ,et al.Anesthetic induction with etomidate,rather than propofol,is associated with increased 30-day mortality and cardiovascular morbidity after noncardiac surgery[J].Anesth Analg,2013,117:1329-1337.
[10]彭露瑶,黄东.地佐辛与右美托咪定联合舒芬太尼对胶质瘤患者术后唤醒及镇痛的比较[J].中国生化药物杂志,2016,36:114-116.
[11]陈娟,丁维沛,赵志斌.地佐辛联合舒芬太尼在老年髋关节置换术后镇痛中的作用[J].中国老年学杂志,2015,35:2820-2822.
[12]樊宝才.我院骨科地佐辛注射液致不良反应80例分析[J].中国药房,2015,26:4521-4522.
[13]Akbari E.The role of cyclo-oxygenase inhibitors in attenua ting opioid:induced tolerance,hyperalgesia,and dependence[J].Med Hypotheses,2012,78:102-106.
[14]田明,杨伟伟,王楠.地佐辛复合氟比洛芬酯超前镇痛对高龄全髋关节置换术后镇痛效果观察[J].陕西医学杂志,2015,44:363-364.
[15]罗向阳.氟比洛芬酯和盐酸曲马多治疗妇科腹腔镜后疼痛的临床效果[J].临床医药实践,2014,23:238-240.