肝动脉化疗栓塞联合射频消融序贯治疗中小肝癌的观察与护理

Observation and nursing of the sequential treatment of medium and small liver cancer with hepatic arterial chemoembolization combined with radiofrequency ablation

目的探讨原发性中小肝癌行肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)序贯治疗的观察与护理。方法对我院102例不愿手术或不能外科手术以及术后复发的中小肝癌患者,行肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)序贯治疗,序贯治疗前做好心理护理和一般护理,治疗后重视疼痛管理,加强发热、出血、胃肠道反应、肝功能异常等并发症的观察与护理,并同时做好出院指导。采用随机数字表法将102例分成实验组53例和对照组49例,对照组术前不使用芬太尼,术后疼痛评分≥4分再遵医嘱给予止痛药;实验组术前6 h常规予芬太尼透皮贴4.2 mg贴前胸壁,术后常规医嘱给予氨酚羟考酮长期口服。结果两组术后平均疼痛VAS评分比较,实验组低于对照组(P<0.05);实验组患者满意度高于对照组(P<0.05);102例患者治疗后病灶控制良好,无严重并发症发生。结论对肝动脉化疗栓塞联合射频消融序贯治疗后患者应实施相应的护理措施,可提高疗效,以降低患者不舒适感,减少并发症发生,达到快速康复。

Objective To investigate the nursing of sequential treatment of primary moderate and small liver cancer with hepatic arterial chemoembolization（TACE） combined with CT-guided radiofrequency ablation （RFA）. Methods A total of 102 patients with moderate to small liver cancer who were reluctant to take surgery or were unable to take surgery, as well as had postoperative recurrence were given sequential treatment of TACE combined with RFA. Psycho- logical care and general care were given before the sequential treatment. After the treatment, attention was paid to pain management, and the observation and nursing of fever, bleeding, gastrointestinal reactions, abnormal liver function and other complications were strengthened. The discharge guidance was performed at the same time. The 102 patients were divided into the experimental group（53 cases） and the control group（49 cases） by the random number table method. The control group was not given fentanyl before surgery. The patients were given pillkillers as prescribed by the doctor when the postoperative pain score was greater than or equal to 4; the experimental group was given the fentanyl transdermal paste 4.2 mg which was pasted on the chest wall 6 hours before the surgery, and was given long-term oral administra- tion of oxycodone-acetaminophen after the surgery as prescribed by the doctor. Results The mean pain VAS score was lower in the experimental group than in the control group after surgery（P〈O.05）. The patients＂ satisfaction was higher in the experimental group than the control group（P〈0.05）. The lesions were well-controlled in 102 patients after the treatment, without serious complications. Conclusion The patients undergoing sequential treatment of TACE combined with RFA should be given appropriate nursing measures, so as to improve the curative effect, reduce the discomfort and complications, and then achieve rapid recovery.