氢吗啡酮对肝癌患者肝动脉化疗栓塞术后的镇痛效果

The analgesic effect of hydromorphone on severe post-TACE painin patients with hepatocellular carcinoma

目的 探讨氢吗啡酮对肝癌患者肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后重度疼痛的镇痛疗效。方法 回顾分析TACE术后出现重度疼痛的肝癌患者67例,根据其接受的镇痛药物分为吗啡组36例与氢吗啡酮组31例。观察两组在给药后不同时间点视觉模拟评分法(VAS)的下降程度。比较采用独立样本t检验。结果TACE术后,中国肝癌分期方案(CNLC)Ⅲa-Ⅲb期相比Ⅰb-Ⅱb期更容易出现重度疼痛(P=0.004)。给药15 min、30 min及6 h后,接受C-TACE或D-TACE治疗患者氢吗啡酮组的VAS评分下降程度均优于吗啡组,同样,CNLCⅠb-Ⅱb期或Ⅲa-Ⅲb期患者的VAS评分下降程度氢吗啡酮组均优于吗啡组(均P<0.05)。给药1 h后,接受TACE治疗患者的VAS评分下降程度氢吗啡酮组总体优于吗啡组(P=0.032);但接受C-TACE或D-TACE治疗患者的VAS评分下降程度两组差异均无统计学意义(均P>0.05);给药1 h后,CNLC分期Ⅰb-Ⅱb期患者的VAS评分下降程度氢吗啡酮组与吗啡组差异无统计学意义(P=0.114),CNLC分期Ⅲa-Ⅲb期患者的VAS评分下降程度氢吗啡酮组优于吗啡组(P=0.007)。结论 氢吗啡酮可以有效减轻C-TACE及D-TACE术后不同肝癌分期患者的重度疼痛,为TACE术后镇痛提供一个良好的选择。

Objective To explore the analgesic effect of hydromorphone on severe pain in patients with hepatocellular carcinoma(HCC) after receiving transcatheter arterial chemoembolization(TACE). Methods A total of 67 patients with HCC, who developed severe pain after receiving TACE, were enrolled in this study.According to the analgesic drugs being used, the patients were divided into morphine group(n=36) and hydromorphone group(n=31). The reduction degrees of visual analogue scale(VAS) score determined at different time points after administration of analgesic drugs were recorded. By using independent sample t-test, the reduction degrees of VAS score after administration of analgesic drugs were compared between the two groups.Results After TACE, the patients with CNLC stage Ⅲa-Ⅲb HCC were more likely to have severe pain than the patients with stage Ⅰb-Ⅱb HCC(P=0.004). At 15 minutes, 30 minutes, and 6 hours after the administration of analgesic drugs, the decrease degrees of VAS score in hydromorphone group were better than those in morphine group. Similarly, the decrease degrees of VAS score in the patients with CNLC stage Ⅰb-Ⅱb HCC orⅢa-Ⅲb HCC in hydromorphone group were better than those in morphine group(all P<0.05). One hour after administration of analgesic drugs, the decrease degree of VAS score of patients receiving TACE in hydromorphone group were better than that in morphine group(P=0.032), but the differences in the decrease degree of VAS score in patients receiving conventional TACE(C-TACE) and in patients receiving drug-eluting microspheres TACE(D-TACE)between the two groups were not statistically significant(all P>0.05). One hour after administration of analgesic drugs, the differencein the decrease degree of VAS score in the patients with CNLC stage Ⅰb-Ⅱb HCC between the two groups was statistically significant(P=0.114), while the decrease degree of VAS score in the patients with CNLC stage Ⅲa-Ⅲb HCC in hydromorphone group was better than that in morphine group(P=0.007). Conclusion Hydromorphone can effectively relieve severe pain in HCC patients with different CNLC stages after receiving C-TACE or D-TACE, providing a good choice for analgesia after TACE.(J Intervent Radiol, 2022, 31: 988-991)