高强度聚焦超声消融术治疗良性甲状腺结节疼痛评估及其影响因素
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摘要
目的评估高强度聚焦超声消融(HIFU)术治疗良性甲状腺结节时疼痛的严重程度及影响因素。方法应用HIFU术治疗109例良性甲状腺结节患者。治疗前患者均接受静脉推注哌替啶和地西泮。治疗后,要求患者按照视觉模拟评分法对治疗过程中(T1)治疗后2 h(T2)及次日早晨(T3)的疼痛感受进行评估。利用二分类Logistic回归模型评估治疗过程中疼痛的相关影响因素,包括患者一般情况、结节大小、体质量指数(BMI)和治疗参数。结果在T1时患者疼痛评分中位数为65.0(0.00～100.00)。二分类Logistic回归多变量分析结果显示,T1>65.0时,只有较高的BMI指数(OR=1.250,95%CI 1.091～1.433,P=0.001),较大的结节体积(OR=0.889,95%CI 0.819～0.966,P=0.006)和较长的治疗时间(OR=0.885,95%CI 0.833～0.939,P<0.001)是影响患者疼痛的独立影响因素。结论 HIFU术治疗良性甲状腺结节过程中,患者的BMI指数、结节大小和治疗时间是患者疼痛的独立影响因素。
Objective To assess the severity and influencing factors of pain in high-intensity focused ultrasound ablation(HIFU) for benign thyroid nodules.Methods Totally 109 patients with benign thyroid nodule were treated with HIFU ablation.Before treatment,all patients received a bolus of intravenous pethidine and diazepam.After treatment,patients were asked to assess their pain perception on a visual analogue scale(0-100)(0=no pain;100=worse possible pain) during treatment,2 h after treatment and the following morning.Binary Logistic regression was used to evaluate associated factors for pain including patients' general condition,nodule size,body mass index(BMI)and treatment parameters.Results At T1,median pain score was 65.0(0.00～100.00).In multivariate analysis,only lower BMI(OR=1.250,95% CI 1.091～1.433,P=0.001),larger nodule volume(OR=0.889,95% CI0.819～0.966,P=0.006) and longer treatment time(OR=0.906,95% CI 0.864～0.950,P<0.001) were independent factors for pain score at T1> 65.0.Conclusion Our study found that in the treatment of benign thyroid nodules with HIFU ablation,the patients' BMI,nodule size and treatment time were an independent variables affecting the pain.
Objective To assess the severity and influencing factors of pain in high-intensity focused ultrasound ablation(HIFU) for benign thyroid nodules.Methods Totally 109 patients with benign thyroid nodule were treated with HIFU ablation.Before treatment,all patients received a bolus of intravenous pethidine and diazepam.After treatment,patients were asked to assess their pain perception on a visual analogue scale(0-100)(0=no pain;100=worse possible pain) during treatment,2 h after treatment and the following morning.Binary Logistic regression was used to evaluate associated factors for pain including patients' general condition,nodule size,body mass index(BMI)and treatment parameters.Results At T1,median pain score was 65.0(0.00～100.00).In multivariate analysis,only lower BMI(OR=1.250,95% CI 1.091～1.433,P=0.001),larger nodule volume(OR=0.889,95% CI0.819～0.966,P=0.006) and longer treatment time(OR=0.906,95% CI 0.864～0.950,P<0.001) were independent factors for pain score at T1> 65.0.Conclusion Our study found that in the treatment of benign thyroid nodules with HIFU ablation,the patients' BMI,nodule size and treatment time were an independent variables affecting the pain.
引文
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[7]Kovatcheva R D,Vlahov J D,Stoinov J I,et al.Benign Solid Thyroid Nodules:US-guided High-Intensity Focused Ultrasound AblationInitial Clinical Outcomes[J].Radiology,2015,276(2):597-605.
[8]Esnault O,Franc B,Menegaux F,et al.High-intensity focused ultrasound ablation of thyroid nodules:first human feasibility study[J].Thyroid,2011,21(9):965-973.
[9]Vaessen H,Knuttel F M,van Breugel J,et al.Moderate-to-deep sedation technique,using propofol and ketamine,allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound(MR-HIFU)treatment for uterine fibroids:a pilot study[J].J Ther Ultrasound,2017,5:8.
[10]李晨,殷晶晶,王加林.甲状腺结节微创治疗现状[J].山东医药,2016(26):111-113.
[11]段滨红,江红,杜馥曼,等.高强度聚焦超声技术治疗甲状腺结节的临床观察[J].标记免疫分析与临床,2015,22(1):1-3.
[12]Lang B H,Woo Y C,Wong C.High-Intensity Focused Ultrasound for Treatment of Symptomatic Benign Thyroid Nodules:A Prospective Study[J].Radiology,2017,284(3):897-906.
[13]Lang B,Wong C,Ma E.Single-session high intensity focussed ablation(HIFU)versus open cervical hemithyroidectomy for benign thyroid nodule:analysis on early efficacy,safety and voice quality[J].Int JHyperthermia,2017,33(8):868-874.
[14]Bini F,Trimboli P,Marinozzi F,et al.Treatment of benign thyroid nodules by high intensity focused ultrasound(HIFU)at different acoustic powers:a study on in-silico phantom[J].Endocrine,2018,59(3):506-509.
[15]Mc Kendall M J,Haier R J.Pain sensitivity and obesity[J].Psychiatry Res,1983,8(2):119-125.
[16]Zahorska-Markiewicz B,Zych P,Kucio C.Pain sensitivity in obesity[J].Acta Physiol Pol,1988,39(3):183-187.
[2]Durante C,Costante G,Lucisano G,et al.The natural history of benign thyroid nodules[J].JAMA,2015,313(9):926-935.
[3]Korkusuz Y,Groner D,Raczynski N,et al.Thermal ablation of thyroid nodules:are radiofrequency ablation,microwave ablation and high intensity focused ultrasound equally safe and effective methods[J].Eur Radiol,2017.
[4]Sung J Y,Baek J H,Kim K S,et al.Single-session treatment of benign cystic thyroid nodules with ethanol versus radiofrequency ablation:a prospective randomized study[J].Radiology,2013,269(1):293-300.
[5]Wong K P,Lang B H.Use of radiofrequency ablation in benign thyroid nodules:a literature review and updates[J].Int J Endocrinol,2013:428363.
[6]Korkusuz H,Sennert M,Fehre N,et al.Local thyroid tissue ablation by high-intensity focused ultrasound:effects on thyroid function and first human feasibility study with hot and cold thyroid nodules[J].Int JHyperthermia,2014,30(7):480-485.
[7]Kovatcheva R D,Vlahov J D,Stoinov J I,et al.Benign Solid Thyroid Nodules:US-guided High-Intensity Focused Ultrasound AblationInitial Clinical Outcomes[J].Radiology,2015,276(2):597-605.
[8]Esnault O,Franc B,Menegaux F,et al.High-intensity focused ultrasound ablation of thyroid nodules:first human feasibility study[J].Thyroid,2011,21(9):965-973.
[9]Vaessen H,Knuttel F M,van Breugel J,et al.Moderate-to-deep sedation technique,using propofol and ketamine,allowing synchronised breathing for magnetic resonance high-intensity focused ultrasound(MR-HIFU)treatment for uterine fibroids:a pilot study[J].J Ther Ultrasound,2017,5:8.
[10]李晨,殷晶晶,王加林.甲状腺结节微创治疗现状[J].山东医药,2016(26):111-113.
[11]段滨红,江红,杜馥曼,等.高强度聚焦超声技术治疗甲状腺结节的临床观察[J].标记免疫分析与临床,2015,22(1):1-3.
[12]Lang B H,Woo Y C,Wong C.High-Intensity Focused Ultrasound for Treatment of Symptomatic Benign Thyroid Nodules:A Prospective Study[J].Radiology,2017,284(3):897-906.
[13]Lang B,Wong C,Ma E.Single-session high intensity focussed ablation(HIFU)versus open cervical hemithyroidectomy for benign thyroid nodule:analysis on early efficacy,safety and voice quality[J].Int JHyperthermia,2017,33(8):868-874.
[14]Bini F,Trimboli P,Marinozzi F,et al.Treatment of benign thyroid nodules by high intensity focused ultrasound(HIFU)at different acoustic powers:a study on in-silico phantom[J].Endocrine,2018,59(3):506-509.
[15]Mc Kendall M J,Haier R J.Pain sensitivity and obesity[J].Psychiatry Res,1983,8(2):119-125.
[16]Zahorska-Markiewicz B,Zych P,Kucio C.Pain sensitivity in obesity[J].Acta Physiol Pol,1988,39(3):183-187.