盐酸氢吗啡酮与地佐辛在经肝动脉化疗栓塞术镇痛中的作用

Analgesia effect of hydromorphone hydrochloride and dezocine in receiving transhepatic arterial chemoembolization: a comparative study

目的探讨盐酸氢吗啡酮与地佐辛在经肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)中的镇痛效果及其不良反应。方法纳入2021年1月至10月在华中科技大学同济医学院附属同济医院接受TACE的患者270例,将患者分为3组,每组90例。H1组:术前15 min静脉注射1 mg盐酸氢吗啡酮;H2组:术前15 min静脉注射2 mg盐酸氢吗啡酮,注射时间为2~3 min;D组:术前30 min肌内注射5 mg地佐辛。在手术开始时、药物注入后5 min和0.5、1、2、4、8、12 h对患者进行视觉模拟评分(visual analogue scale,VAS)。比较3组患者的VAS评分以及镇痛药物不良反应的发生情况。结果3组患者不良反应比较,H1和H2组患者发生头晕、恶心、呕吐等不良反应的比例均小于D组(P<0.05);H2组有2例患者发生了呼吸抑制,另两组均未出现。3组患者应用镇痛药物各时间点VAS评分比较,H1和H2组术后0.5 h、1 h的VAS评分低于D组(P<0.05)。各组不同化疗药物比较,H1和H2组术后0.5 h、1 h的VAS评分低于D组(P<0.05)。各组不同栓塞药物比较,使用载药微球颗粒的H1、H2和D组患者的VAS评分差异无统计学意义(P>0.05),使用超液化碘油及明胶海绵颗粒的H1和H2组患者术后0.5 h、1 h的VAS评分低于D组(P<0.05)。各组不同CNLC分期分组比较,CNLCⅠ期H1、H2和D组患者的VAS评分差异无统计学意义(P>0.05),CNLCⅡ期及Ⅲ期H1组和H2组患者术后0.5 h、1 h的VAS评分低于D组(P<0.05)。结论盐酸氢吗啡酮能够在有效镇痛的基础上减少阿片类药物引起的不良反应。

Objective To compare the analgesic efficacy and adverse reactions of hydromorphone hydrochloride with those of dezocine in patients receiving transcatheter arterial chemoembolization(TACE).Methods A total of 270 patients, who underwent TACEat the Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology of China between January 2021 and October 2021,were enrolled in this study. The patients were randomly and equally divided into three groups with 90 patients in each group;group H1(intravenous injection of 1 mg hydromorphone at 15min before surgery);group H2(intravenous injection of 2 mg hydromorphone at 15 min before surgery,with the injection time of 2-3 min);and group D(intramuscular injection of 5mg dezocine 30 min before surgery). Visual analysis scale(VAS) scores were recorded at the beginning of operation, as well as at 5 min, 0.5 h, 1 h, 2 h, 4 h, 8 h and 12 h after injection of analgesics. The VAS scores and the adverse reactions of analgesics were compared between each other among the three groups. Results The incidences of adverse reactions such as dizziness, nausea and vomiting in group H1 and group H2 were lower than those in group D(P<0.05). Two patients in group H2 developed respiratory depression, which was not observed in the other two groups. The VAS scores at 5min and 1h after injection of analgesics in group H1 and group H2 were lower than those in group D(P<0.05). In patients using drug-loaded microspheres, no statistically significant difference in VAS score existed between each other among the three groups(P>0.05). In patients using ultra-liquefied iodine oil and gelatin sponge particles, the VAS scores at 5 min and 1h after injection of analgesics in group H1 and group H2 were lower than those in group D(P<0.05). In patients with CNLC stage I, the VAS scores of group H1 and group H2 were notstatistically significant different from that of group D(P>0.05). In patients with CNLC stage Ⅱ and CNLC stage Ⅲ, the VAS scores at 5 min and 1h after injection of analgesics in group H1 and group H2 were remarkably lower than those in group D(P<0.05). Conclusion On the basis of exerting an effective analgesia, hydromorphone hydrochloride can reduce the occurrence of adverse reaction events.(J Intervent Radiol, 2022, 31: 970-974)