帕瑞昔布用于肝细胞癌肝动脉化疗栓塞止痛的效果和安全性研究

Study on the efficacy and safety of paricoxib for pain relief after hepatic artery chemoembolization in hepatocellular carcinoma

目的探讨帕瑞昔布用于接受肝动脉化疗栓塞术(TACE)治疗的肝细胞癌患者控制疼痛的有效性和安全性。方法选取2020年1月至2023年1月西安交通大学附属西安市中心医院收治的接受TACE治疗的肝细胞癌患者213例。完全随机分为塞来昔布组、帕瑞昔布组、羟考酮组,各71例。患者在TACE术后即刻(T 0)接受塞来昔布、帕瑞昔布或羟考酮治疗,TACE术后48 h内每12小时(术后12、24、36 h,分别记为T 12、T 24、T 36)给药1次。评估并比较3组各时点的疼痛评分。分析患者最高疼痛评分时点发生疼痛的独立危险因素。观察不良反应发生情况。结果3组患者最高疼痛评分均出现在T 12时点。T 12时,帕瑞昔布组最高疼痛评分低于塞来昔布组和羟考酮组[(2.75±0.23)分比(4.40±0.23)、(4.17±0.26)分],T 24时帕瑞昔布组疼痛评分低于塞来昔布组(均P<0.05)。Logistic回归分析结果显示,肝实质栓塞术、胆囊腔内栓塞术和预防性止痛使用非帕瑞昔布是患者T 12时发生疼痛的独立危险因素(均P<0.05)。塞来昔布组发生呕吐2例(2.8%)、便秘1例(1.4%),帕瑞昔布组发生疼痛1例(1.4%)、呕吐3例(4.2%)、便秘3例(4.2%),羟考酮组发生疼痛2例(2.8%)、呕吐6例(8.4%)、便秘5例(7.0%)。结论在接受TACE治疗的肝细胞癌患者中,帕瑞昔布止痛效果优于羟考酮和塞来昔布,且不良反应较少。

Objective To explore the effectiveness and safety of paricoxib for pain control in patients with hepatocellular carcinoma undergoing hepatic artery chemoembolization(TACE)treatment.Methods Totally 213 hepatocellular carcinoma patients who received TACE treatment from Xi′an Central Hospital Affiliated to Xi′an Jiaotong University from January 2020 to January 2023 were selected.They were completely randomized into celecoxib group,paricoxib group,and oxycodone group,with 71 cases in each group.The patients received treatment with celecoxib,paricoxib,or oxycodone immediately after TACE(T 0),and took it once every 12 h(12,24 and 36 h after TACE noted as T 12,T 24 and T 36)within 48 h after TACE.The pain scores of the three groups were evaluated and compared at each time point.The independent risk factors for pain in patients at time point of highest pain score were analyzed.The occurrence of adverse reactions was observed.Results The highest pain score of all three groups of patients appeared at T 12.At T 12,the highest pain score in the paricoxib group was lower than those in the celecoxib group and oxycodone group[(2.75±0.23)vs(4.40±0.23),(4.17±0.26)],and at T 24,the pain score in the paricoxib group was lower than that in the celecoxib group(all P<0.05).The results of Logistic regression analysis showed that liver parenchymal embolization,gallbladder endovascular embolization,and prophylactic pain relief using non paricoxib were independent risk factors for pain in patients with T 12(all P<0.05).There were 2 cases of vomiting(2.8%),and 1 case of constipation(1.4%)in the celecoxib group,1 case of pain(1.4%),3 cases of vomiting(4.2%),and 3 cases of constipation(4.2%)in the paricoxib group,and 2 cases of pain(2.8%),6 cases of vomiting(8.4%),and 5 cases of constipation(7.0%)in the oxycodone group.Conclusion Among hepatocellular carcinoma patients receiving TACE treatment,paroxycoxib has a better analgesic effect than oxycodone and celecoxib,and has fewer adverse reactions.