摘要
目的探讨利多卡因局部麻醉联合瑞芬太尼静脉强化在肝肿瘤射频消融中的应用价值。方法回顾性分析在我科接受肝脏肿瘤射频消融治疗的患者1 252例。全部消融患者均采用美国RITA集束多极射频针。经皮穿刺前采用利多卡因局部浸润麻醉,剂量为2mg/kg体质量,射频过程中给予瑞芬太尼起始剂量为0.05μg/(kg·min),经静脉泵入。记录患者射频消融术前24h(T0)、手术开始时(T1)、手术开始后30min(T2)及手术结束时(T3)各时间点的平均动脉血压(MAP)、心率(HR)、血氧饱和度(SPO2);采用视觉模拟评分法(VAS)进行镇痛疗效评定。结果 1 250例(1 250/1 252,99.84%)患者均顺利完成射频消融手术,平均手术时间为(59.02±14.63)min,瑞芬太尼平均用量为(242.22±22.73)μg,VAS疼痛评分平均为(2.42±1.13)分。与T0时间点比较,T1、T2、T3各时间点SPO2无明显改变,而MAP、HR均显著升高,差异有统计学意义(P均<0.05)。肿瘤最大径>5cm的患者VAS疼痛评分高于肿瘤最大径≤5cm的患者(P<0.05)。病灶位于膈顶部及被膜下患者的VAS疼痛评分高于病灶位于其他部位的患者(P均<0.05)。2例患者出现较严重的麻醉相关并发症,均与瑞芬太尼的呼吸抑制作用有关,经相应治疗后均完全康复。结论利多卡因局部麻醉联合瑞芬太尼静脉强化可有效缓解患者在肝肿瘤射频消融术中的疼痛感,肿瘤大小和肿瘤部位是影响镇痛效果的主要影响因素。
Objective To explore the clinical value of lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors.Methods Totally 1 252 patients with hepatic tumors treated by radiofrequency ablation were analyzed.RITA cluster multipole radio needles were used in all cases.Local anesthesia with lidocaine was used before percutaneous puncture,and the dosage was 2 mg/kg of body mass.The initial dose of remifentanil was injected with pump at 0.05μg/（kg·min）during operation.Mean arterial pressure（MAP）,heart rate（HR）and saturation of peripheral oxygen（SPO2）were recorded 24 hbefore radiofrequency ablation（T0）,at the beginning of operation（T1）,30 min after operation（T2）and at the end of surgery（T3）.Visual analogue scale（VAS）was used to assess the analgesic effect during the whole ablation procedure.Results Radiofrequency ablation were successfully performed in 1 250 patients（1 250/1 252,99.84%）.The average time was（59.02±14.63）min.The average dosage of remifentanil was（242.22±22.73）μg.The average VAS score was（2.42±1.13）points.Compared with the preoperative T0 time point,SPO2 did not change significantly at each time of T1,T2 nor T3,but MAP and HR were significantly higher than those before operation（both P〈0.05）.VAS scores were significantly higher in patients with tumors size 〉5 cm than those in patients with tumors size≤5 cm（P〈0.05）.VAS scores were significantly higher in patients with lesions under hepatic capsule and in diaphragm dome than in patients with lesions in other parts（both P〈0.05）.Severe anesthesia related complications occured in 2 patients,related to the respiratory inhibitory effect of remifentanil,and the patients were completely recovered after corresponding treatment.Conclusion Lidocaine combined with remifentanil intravenous anesthesia for radiofrequency ablation of liver tumors can effectively relieve the pain in patients.Tumor size and tumor location are the main impact factors on analgesic effect.
出处
《中国介入影像与治疗学》
CSCD
北大核心
2017年第11期651-654,共4页
Chinese Journal of Interventional Imaging and Therapy
关键词
射频消融
麻醉
瑞芬太尼
Radiofrequency ablation
Anesthesia
Remifentanil
