局部晚期宫颈癌不同速率子宫动脉灌注紫杉醇术中疼痛的观察及处理

Observation and Management of the Intraoperative Pain Occurred in Different Speed of Uterine Artery Infusion of Paclitaxel for Locally Advanced Cervical Cancer

目的：观察比较不同速率子宫动脉灌注紫杉醇治疗局部晚期宫颈癌术中疼痛情况并探讨其处理方法。方法：前瞻性分析202例经子宫动脉灌注紫杉醇联合奈达铂治疗局部晚期宫颈癌的临床资料。其中Ⅱb期160例,Ⅲa期30例,Ⅲb期12例。其中鳞癌172例,腺癌23例,腺鳞癌7例。中位年龄47（20~80）岁。经子宫动脉先灌注奈达铂（80~100mg/m2）,再灌注紫杉醇（135~175mg/m2,生理盐水稀释总量为120ml）。 A组102例和B组100例经智能输液泵以2.5ml/min和5ml/min的速率泵入紫杉醇。介入术中记录患者疼痛情况和生命体征变化情况。采用实体瘤疗效评价标准评价近期疗效。结果：共169例患者发生疼痛反应,发生率为83.66%（169/202）,其中A组疼痛发生率为68.63%（70/102）,B组疼痛发生率为99.00%（99/100）,两组患者发生疼痛反应的差异有统计学意义（χ2=98.62,P＆lt;0.001）。两组患者局部肿瘤缓解率差异无统计学意义（χ2=0.327,P＆gt;0.05）。结论：子宫动脉灌注紫杉醇治疗局部晚期宫颈癌时,以2.5ml/min的泵速泵入紫杉醇,可以减轻患者术中疼痛反应,并不影响疗效,值得临床推广。

[ Abstract] Objective： To observe the status of pain occurred in uterine artery infusion of paclitaxel for locally advanced cervical cancer patients and to study the corresponding dealing methods. Methods： A total of 202 patients with locally advanced cervical cancer were treated with uterine artery infusion of paclitaxel and nedaplatin. Among them, 160 cases were in stage IIb,30 stage Ⅲa and 12 stage Ⅲb. There were 172 patients with squamous cell carcinoma,23 adeno-carcinoma,7 adenosquamous carcinoma. Transcatheter uterine artery infusion of nedaplatin（80~100mg/m2 ） was applied firstly , followed by different rates of infusion of paclitaxel （135~175mg/m2 ）：2. 5ml/min in Group A（102 cases） and 5ml/min in Group B（100 cases）. Pain and changes in vital signs of patients were recorded intraoperatively. Short-time ef-ficacy was evaluated by RECIST. Results： Pain occurred in 169（83. 66%） patients. The incidence was 68. 63%（70/102） in Group A and 99. 00% （99/100） in Group B with significant difference between these two groups （χ2=98.62, P＆lt;0.001）. No obvious difference was found in local tumor remission rate between these two groups （χ2=0.327, P＆gt;0.05）. Conclusion：Interventional uterine artery infusion of paclitaxel at the pump speed of 2. 5ml/min is recommended for the locally advanced cervical cancer patients which can alleviate intraoperative pain without any influence to the efficacy.