影响TACE术治疗HCC患者恶心呕吐的非化疗因素分析

doi:10.3969/j.issn.1672-5069.2017.04.020

摘要/Abstract

摘要： 目的研究影响肝细胞癌（HCC）患者肝动脉化疗栓塞术（TACE）术后发生恶心呕吐的非化疗因素。方法随机选取我院2014~2016年诊治的360例确诊为HCC患者,记录所有HCC患者的性别、年龄、体质指数（BMI）、肝区疼痛、肿瘤质地、大小、是否发生转移、手术次数、是否发热、发热持续时间、腹部有无肿胀、注射碘化油的量等,并采用Logistic回归分析逐一分析以上所有因素与HCC患者TACE术后发生恶心呕吐的关系。根据恶心程度语言描述分级和主诉疼痛程度分级法进行评价。结果在360例HCC患者中,发生2级恶心58例（16.11%）,1级恶心83例（23.06%）,0级恶心219例（60.83%）;在大部分HCC患者中,其年龄越大,发生恶心呕吐的程度越轻（r=-0.303,P<0.05）;疼痛和腹胀程度越严重,发生恶心呕吐的程度越重（r=0.299,r=0.497,P<0.05）;疼痛时间越长,恶心呕吐程度越重（r=-0.203,P<0.05）;Logistic回归分析结果显示,高龄是HCC患者TACE术后恶心呕吐的保护因素,而长时间的腹痛和腹胀是TACE术后恶心呕吐的危险因素;根据结构方程模型的分析结果显示,恶心呕吐与腹部疼痛和腹胀程度呈现出直接的正向效应（β=0.39,β=0.69,P<0.01）,年龄与腹胀也呈现出正向效应（β=0.02,P<0.01）,而年龄与腹疼程度呈现出负向效应（β=-0.02,P<0.01）。结论引起HCC患者TACE术后恶心呕吐的发生是与多种不同因素共同作用引起的,其中与年龄、腹痛和腹胀程度关系最为密切,其中高龄是HCC患者TACE术后恶心呕吐发生的保护因素,而长时间的腹痛和腹胀是TACE术后恶心呕吐发生的危险因素。

关键词: 肝细胞癌, 肝动脉化疗栓塞术, 恶心呕吐, 影响因素

Abstract: Objective To study the non-chemotherapeutic factors influencing postoperative nausea and vomiting in patients with hepatocellular carcinoma（HCC） after transcatheter arterial chemoembolization （TACE）. Methods 360 patients with HCC were recruited in our hospital between 2014 and 2016,and we collected the patient’s gender,age,body mass index,right upper quadrant pain,tumor size,the metastasis,fever,abdominal distention,dose of iodized oil,and the Logistic regression analysis was used to analyze the influencing factors of postoperative nausea and vomiting in patients with HCC after TACE. Results According to degree of nausea language description,the grade 2 nausea was found in 58 cases （16.11%）,grade 1 nausea in 83 cases （23.06%）,and grade 0 nausea in 219 cases（60.83%） out of the 360 patients with HCC;the age was negatively correlated（r=-0.303,P<0.05）,while the right upper quadrant pain and abdominal distention were positively correlated to the degree of nausea and vomiting （r=0.299,r=0.497,P<0.05）;the longer the pain lasted, the more severe the nausea and vomiting（r=-0.203,P<0.05）;Logistic analysis showed that the elderly was a protected factor for the occurrence of nausea and vomiting in patients with HCC after TACE, while long time abdominal pain and distention were the independent factors for it; the results of the structural equation model showed that the abdominal pain and distention stimulated nausea and vomiting （β=0.39,β=0.69,P<0.01）,age promoted abdominal distention （β=0.02,P<0.01）,while age down-regulated abdominal pain （β=-0.02,P<0.01）. Conclusion There are a variety of factors including age,abdominal pain and abdominal distention involved in the occurrence of nausea and vomiting in patients with HCC after TACE, and the old age is a protective factor of postoperative nausea and vomiting,while the long time abdominal pain and abdominal distention are the risk factors for it.

Key words: Hepatocellular carcinoma, Transcatheter arterial chemoembolization, Nausea and vomiting, Influencing factors

郭帅. 影响TACE术治疗HCC患者恶心呕吐的非化疗因素分析[J]. 实用肝脏病杂志, 2017, 20(4): 460-463.

Guo Shuai.. Non-chemotherapeutic factors influencing postoperative nausea and vomiting in patients with hepatocellular carcinoma after TACE[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(4): 460-463.

参考文献

[1] 李燕飞. HCC肝动脉化疗栓塞术合并高血压病病人的护理.全科护理,2014,12（5）:450-451.
[2 田贞. 肝动脉化疗栓塞术的介入治疗及护理体会.河北医学,2014,521（12）:2116-2117.
[3] 万娟,罗艳丽,肖凤鸣,等. 肝动脉化疗栓塞术配合放射性碘植入治疗HCC预后相关影响因素研究.陕西医学杂志,2015,24（11）:1473-1475.
[4] 张玉山,高国生. 经皮肝动脉化疗栓塞术联合索拉非尼治疗HCC的疗效及不良反应研究. 中国生化药物杂志,2014,73（7）:99-101.
[5] 缪洪飞,马硕一,曾庆乐,等. 肝动脉化疗栓塞术联合肿瘤边缘适形治疗HCC患者的临床疗效.实用医学杂志,2016,32（9）:1488-1491.
[6] Wang W,Xu L,Liu P,et al. Blocking WNT secretion reduces growth of hepatocellular carcinoma cell lines mostly independent of β-catenin signaling. Neop Lasia,2016,18（12）:711-723.
[7] Henkels KM,Muppani NR,Gomez-cambronero J. Pld-specific small-molecule inhibitors decrease tumor-associated macrophages and neutrophils infiltration in breast tumors and lung and liver metastases. Plos One,2016,11（11）:553.
[8] Kugler DG,Flomerfelt FA,Costa DL,et al. Systemic toxoplasma infection triggers a long-term defect in the generation and function of naive T lymphocytes. J Exp Med,2016,125（125）:521.
[9] 陈倩,温春阳,王爱平,等. 老年HCC患者射频消融术与肝动脉化疗栓塞术治疗前后肝血清学指标变化.中国老年学杂志,2014,26（21）:5985-5987.
[10] 冯超,赵剑波,陈勇,等. 原发性HCC切除术后预防性经肝动脉介入治疗：肝动脉化疗栓塞术和化疗灌注术比较.介入放射学杂志,2014,23（8）:679-682.
[11] 李建军,郑加生,崔雄伟,等. C形臂碘油CT在HCC肝动脉化疗栓塞术中的应用价值. 中华介入放射学电子杂志,2013,58（2）:109-112.
[12] 高银,周波,王建华,等. 盐酸二氢埃托啡用于HCC肝动脉化疗栓塞术中镇痛疗效评价.介入放射学杂志,2013,22（11）:904-907.
[13] 尤慧明,赵念博,陈祖华. AFP-L3阳性HCC患者肝动脉化疗栓塞术后碘油沉积与AFP-L3%下降相关性分析.中国乡村医药,2014,16（10）:69-70.
[14] 成陕林,王超峰. 经肝动脉化疗栓塞后联合索拉非尼治疗HCC患者临床观察.实用肝脏病杂志,2016,19（5）:612-613.
[15] Metser U,Halankar J,Langer D,et al. Effect of chemotherapy on the impact of FDG-PET/CT in selection of patients for surgical resection of colorectal liver metastases:single center analysis of pet-cam randomized trial. Ann Nucl Med,2016,25（126）:6-7.
[16] Sciancalepore D,Musci S,Fracella MR,et al. Extramedullary plasmacytoma mimicking pancreatic cancer:an unusual presentation. Case Rep Oncol Med,2016,2016（26）:691.
[17] Traish A. Testosterone therapy in men with testosterone deficiency:are we beyond the point of no return. Investig Clin Urol,2016,57（6）:384-400.
[18] 侯韦莲,张晓东. 肝动脉化疗栓塞术治疗原发性HCC后的临床疗效调查. 实用肝脏病杂志,2006,9（1）:48-49.
[19] Sohn JH,Duran R,Zhao Y,et al. Validation of the Hong Kong liver cancer staging system in determining prognosis of the north american patients following intra-arterial therapy. Clin Gastroenterol Hepatol,2016,27（72）:377-378.
[20] Chiou SH,Lee KT. Proteomic analysis and translational perspective of hepatocellular carcinoma:identification of diagnostic protein biomarkers by anoncoproteogenomics approach. Kaohsiung J Med Sci,2016,32（11）:535-544.

[1]	曹策, 郁义星, 王贝贝, 赵卫峰. 增强磁共振成像联合血清甲胎蛋白和脱-γ-羧基凝血酶原诊断肝细胞癌临床价值探讨[J]. 实用肝脏病杂志, 2019, 22(6): 896-899.
[2]	朱俊, 丁莹, 王世清, 张野, 刘野, 刘泽刚. 围手术期应用乌司他丁治疗对肝细胞癌患者肝切除术后外周血Th22细胞百分比和血浆白细胞介素-22的影响*[J]. 实用肝脏病杂志, 2019, 22(5): 720-723.
[3]	王刚, 赵洪波, 朱亚玲, 蒋保三, 张越美, 刁勇. 基于数据库分析肝细胞癌细胞XPO5基因水平变化及其临床意义*[J]. 实用肝脏病杂志, 2019, 22(5): 724-727.
[4]	彭思璐, 刘冰, 孙宏, 林剑, 潘志颖, 邓存良. HBV相关慢加急性肝衰竭患者预后及其影响因素分析^*[J]. 实用肝脏病杂志, 2019, 22(4): 545-548.
[5]	戴青云, 王润东, 荚卫东. 术前预后营养指数评估肝细胞癌患者肝切除术后早期肿瘤复发价值探讨^*[J]. 实用肝脏病杂志, 2019, 22(4): 561-564.
[6]	杨富存, 尚怀学, 盖永浩. 钆塞酸二钠增强磁共振扫描诊断肝脏局灶性病变研究^*[J]. 实用肝脏病杂志, 2019, 22(4): 577-580.
[7]	杜敏, 周敏, 纪宗淑, 刘海燕, 汤睿, 周亮, 高智. 脓毒症并发肝损伤患者临床特征及其危险因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 369-372.
[8]	彭新健, 肖玉辉, 许斯鼎, 石荣跃, 王耀政, 王瑜琳. 放射性肝损伤患者肝脏磁共振扩散加权成像表现特征分析[J]. 实用肝脏病杂志, 2019, 22(3): 373-376.
[9]	德吉, 白玛, 白央, 米玛仓决. 慢性乙型肝炎和肝硬化患者肝脏硬度检测值的变化及其影响因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 401-404.
[10]	乔志忠. 超声造影定量分析鉴别肝脏局灶性结节性增生与原发性肝癌初步探讨[J]. 实用肝脏病杂志, 2019, 22(3): 421-424.
[11]	朱光曦（综述）, 文良志, 陈东风（审校）. 非酒精性脂肪性肝病相关肝细胞癌发病机制研究进展[J]. 实用肝脏病杂志, 2019, 22(3): 453-456.
[12]	高朋彬,赵晓彦,秦浩,吴凤影,钟海振,王琳,贾慧娜,李树娟. 戊型肝炎肝衰竭死亡原因分析^*[J]. 实用肝脏病杂志, 2019, 22(2): 220-223.
[13]	王虎明,樊东升,徐杰,刘险峰,周宁,丽敏,包娜娜. 肝细胞癌患者癌组织miRNA-30c水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2019, 22(2): 248-251.
[14]	幸奠奎,程婧. ¹⁸F-FDG PET/CT检查指标预测肝细胞癌微血管侵犯临床价值研究^*[J]. 实用肝脏病杂志, 2019, 22(2): 252-254.
[15]	李克田,沈明格,王凤荣,胡春荣,曹玉杰,芦鹏. 血糖水平对原发性肝癌患者¹⁸F-FDG摄取和PET/CT检查图像质量的影响研究^*[J]. 实用肝脏病杂志, 2019, 22(2): 256-259.