原发性肝癌患者接受TACE术时行右美托咪定联合吗啡麻醉临床应用价值分析

doi:10.3969/j.issn.1672-5069.2021.02.028

摘要/Abstract

摘要： 目的研究右美托咪定联合吗啡用于原发性肝癌(PLC)患者在接受经肝动脉化疗栓塞(TACE)治疗围术期的麻醉效果。方法 2018年7月～2020年7月我院接受TACE治疗的125例PLC患者,被分为A组(n=64),在围术期应用右美托咪定联合吗啡镇痛,和B组(n=61),采用吗啡镇痛。在栓塞即刻(T0)、术毕(T1)、术后12 h(T2)和术后24 h(T3)采用视觉模拟评分(VAS)和改良的警觉/镇静量表(OAA/S)评分评价镇痛效果,常规测量平均动脉血压(MAP)、收缩压(SBP)、舒张压(DBP)和心率(HR),了解血流动力学变化。结果在T0、T1、T2和T3时,A组VAS评分分别为(2.4±1.1)分、(2.0±0.9)分、(1.7±0.5)分和(1.2±0.3)分,显著低于B组【分别为(2.9±1.5)分、(2.5±1.3)分、(2.0±0.9)分和(1.6±0.5)分,P＜0.05】; 在T0、T1、T2和T3时,A组OAA/S评分分别为(4.6±0.3)分、(4.5±0.3)分、(4.7±0.2)分和(4.6±0.2)分,与B组比,无统计学差异【分别为4.5±0.3)分、(4.5±0.2)分、(4.6±0.4)分和(4.6±0.2)分,P＞0.05】; 在各时期,两组MAP、SBP、DBP和HR无显著性差异(P＞0.05);A组不良反应发生率为12.5%,显著低于B组的27.9%,差异有统计学意义(P＜0.05);近期考核,A组有效率和疾病控制率分别为67.2%和73.4%,与B组的68.9%和75.4%比,差异无统计学意义(P＞0.05)。结论应用右美托咪定联合吗啡自控镇痛能够更好地缓解PLC患者在接受TACE术治疗期间的疼痛,不良反应发生率低,值得尝试。

关键词: 原发性肝癌, 肝动脉化疗栓塞, 右美托咪定, 吗啡, 镇痛

Abstract: Objective The aim of this study was to investigate the analgesia of dexmedetomidine and morphine in patients with primary liver cancer (PLC) undergoing transcatheter hepatic arterial chemoembolization (TACE) .Methods A total of 125 patients with PLC were enrolled in our hospital between July 2018 and July 2020, and all underwent TACE. During the procedure, the patients with PLC were divided into group A (n=64) receiving dexmedetomidine and morphine for analgesia, and group B (n=61) receiving morphine for analgesia. The treatment was in an intravenous patient-controlled way. The visual analogue scale (VAS) and modified observers assessment of alertness/sedation scale (OAA/S) were applied for assessment of analgesia immediately after embolization (T0), completion of surgery (T1), 12 h (T2) after surgery, and 24 h (T3) after surgery. The mean arterial blood pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were monitored.Results At T0, T1, T2 and T3, the VAS scores in group A were (2.4±1.1), (2.0±0.9), (1.7±0.5) and (1.2±0.3), significantly lower than [(2.9±1.5), (2.5±1.3), (2.0±0.9) and (1.6±0.5), respectively, P < 0.05] in group B; at T0, T1, T2 and T3, the OAA/S scores in group A were (4.6±0.3), (4.5±0.3), (4.7±0.2) and (4.6±0.2), not significantly different compared to [ (4.5±0.3), (4.5±0.2), (4.6±0.4) and (4.6±0.2), respectively, P > 0.05] in group B; there were no significant differences as respect to MAP, SBP, DBP and HR in the two groups at any times (P > 0.05); the overall incidence of adverse reactions in group A was significantly lower than that in group B (12.5% vs. 27.9%, P < 0.05); the effective rate and disease control rate in group A after treatment were 67.2% and 73.4%, not statistically significantly different compared with 68.9% and 75.4%, respectively, in group B (P>0.05).Conclusion The application of dexmedetomidine and morphine combination for analgesia in an intravenous patient-controlled way in patients with PLC underwent TACE is effective and simple, which might relieve pain with less incidence of adverse reactions.

Key words: Hepatoma, Transhepatic arterial chemoembolization, Dexmedetomidine, Morphine, Analgesia

赵闯, 梁超, 董宝剑, 陈祖涛. 原发性肝癌患者接受TACE术时行右美托咪定联合吗啡麻醉临床应用价值分析[J]. 实用肝脏病杂志, 2021, 24(2): 260-263.

Zhao Chuang, Liang Chao, Dong Baojian, et al. Analgesia of dexmedetomidine and morphine in patients with primary liver cancer undergoing transcatheter hepatic arterial chemoembolization[J]. Journal of Practical Hepatology, 2021, 24(2): 260-263.

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