新辅助化疗对卵巢癌患者术后静脉自控镇痛的影响

The effect of neoadjuvant chemotherapy on patient controlled intravenous analgesia postoperatively in ovarian cancer patients

目的 探讨新辅助化疗对卵巢癌患者术后静脉自控镇痛疗效的影响.方法 选择卵巢癌患者63例.按术前有无新辅助化疗分为：新辅助化疗组（N组）33例;直接手术组（D组）30例.患者术前行临床周围神经病变评分（TNSe评分）、术后行镇痛效果及不良反应的评估.结果 两组患者术前一般状况、Karnofsky评分等差异均无统计学意义（P〉0.05）.N组患者术后2、4、8 h的VAS评分、Bolus需求次数及有效次数、镇痛疗程所需镇痛药物总量均显著低于D组（P〈0.05）;恶心、呕吐评分明显高于D组（P〈0.05）.两组患者术后2、4、8、12 h布氏舒适度评分、头晕评分、瘙痒评分及Ramsay镇静评分比较差异无统计学意义（P〉0.05）.镇痛总药量与TNSc评分呈负直线相关（r=-0.881,P=0.048）;恶心评分与TNSc评分呈正直线相关（r=0.920,P=0.027）.结论 新辅助化疗后患者存在不同程度的周围神经病变;病变程度越重,术后PCIA药物需求量越少,恶心反应发生增多.

Objective To investigate the effect of neoadjuvant chemotherapy on patient controlled intravenous analgesia （ PICA） postoperatively in ovarian cancer patients. Methods Sixty three patients with ovarian cancer （ASA I -Ⅲ grade） were selected. They were divided into 2 groups according to with or without neoadjuvant chemotherapy： neoadjuvant chemotherapy group （N） 33 cases, direct operation group （D） 30 cases. Both of them were completed with tumor cell reduction-extinction operation under total intravenous general anesthesia. Patients＇ chemotherapy-induced peripheral neuropathy（CIPN） was assessed by the total neuropathy score exclusively clinically-based （TNSc） preoperatively, the assessment of analgesic effect and side-effect was performed postoperatively. Results No statistically significant difference between the two groups （P 〉 0. 05） on ages, body mass index, ASA grades and Kamofsky scores. Patients in group N were significantly lower than that of group D（ P 〈 0. 05） on the VAS scores at 2、4、8 h postoperatively, the pressure times and effective times of Bolus and the total consumption amount of analgesic drug in the whole process of analgesia treatment. But the scores on nausea and vomiting of group N were significantly highter than that of group D（ P 〈 0. 05）. There were no significant differences on Bruggrmann comfort scale at 2, 4, 8, 12 h postoperatively, dizziness scores, pruritus scores and Ramsay Sedation scores between this two groups （P 〉0.05）. There was negative linear correlation between the total consumption amount of analgesic drug in the whole process of analgesia treatment and TNSc scores （r = -0. 881, P = 0. 048） , and there was positive linear correlation between nausea scores and TNSc scores （r = 0. 920, P = 0. 027）. Conclusion Patients with neoadjuvant chemotherapy have peripheral neuropathy at different degree before operation. The more serious of peripheral neuropathy, the less demand of PCIA analgesic drug postoperatively and with more side effects occur, such as nausea.