利多卡因-表阿霉素-碘油混合乳剂缓解TACE治疗乏血供肝癌疼痛效果研究

Efficacy of Lidocaine-Epirubicin-Lipiodol Emulsion for TACE Related-Pain in Patients with Hypovascular HCC

目的 探究利多卡因-表阿霉素-碘油混合乳剂对经导管动脉化疗栓塞(TACE)治疗乏血供肝癌患者的疼痛缓解效果。方法 回顾性分析本院共计119例行TACE治疗的肝癌患者资料,按肿瘤血供程度将其分为富血供组(n=51)、乏血供组(n=36)和乏血供+利多卡因组(n=32)。三组均将药物混合成乳剂进行治疗。采用视觉模拟评分量表(VAS)评估患者术中及术后4、8、24 h和2、4天的疼痛感。比较三组患者VAS评分、不同时间点的疼痛程度、术中与术后疼痛的相关性、术后镇痛药用量和其他治疗相关不良反应。结果 术后8 h内富血供组VAS评分显著低于乏血供组(P<0.05),术后3天内VAS评分在乏血供+利多卡因组显著低于其他两组(P<0.05),术后第4天三组间无统计学差异(P=0.332)。术后24 h内三组患者的轻、中、重度疼痛具有显著性差异(P<0.05),术后48 h差异无统计学意义(P=0.271)。术中与术后2天内的疼痛感有线性相关性。术后镇痛药用量在第三组显著低于其他两组(P<0.001)。三组间的其他不良反应无统计学差异(P>0.05)。结论 乏血供肝癌患者TACE治疗后疼痛感较富血供者严重,利多卡因-表阿霉素-碘油混合乳剂治疗安全,并且能显著减轻乏血供肝癌患者术中及术后疼痛感。

Objective To investigate the efficacy of transcatheter arterial chemoembolization(TACE)by lidocaine-epi-rubicin-lipiodol emulsion for relieving the pain of patients with hypovascular hepatocellular carcinoma.Methods A total of 119 patients who received TACE in our center were enrolled in this retrospective study.They were divided into three groups of hypervascular(n=51),hypovascular(n=36),and hypovascular+lidocaine(n=32).The lidocaine-epirubicin-lipiodol emulsion was mixed by"water in oil"method.The pain scores were recorded according to visual analogue scale(VAS)during and within 4 days after TACE.The VAS score,pain degree,correlation of VAS score between the indicated times,dosage of analgesic,and other side effects were evaluated.Results The VAS score was significantly lower in the hypervascular group than the hypovascular group within 8 hours(P<0.05),while it was significantly lower in the hypovas-cular+lidocaine group compared with other two groups within 3 days after TACE(P<0.05).However,the difference of VAS score was not significant between the three groups 4 days later(P=0.332).The differences of pain degree were sig-nificant between the three groups within 24 hours after TACE(P<0.05),while it was not significant 2 days later(P=0.271).The VAS scores between intraoperation and within 2 days after operation were linear dependent(P<0.001).The dosage of analgesic in the hypovascular+lidocaine group was significantly lower than other two groups(P<0.001).The side effects were not significantly different between the three groups(P>0.05).Conclusion It was more painful for pa-tients with hypovascular than hypervascular HCC after TACE.Lidocaine-epirubicin-lipiodol emulsion can effectively reduce the pain degree of patients with hypovascular HCC.