肝脏 ›› 2022, Vol. 27 ›› Issue (6): 640-643.

• 肝癌 • 上一篇    下一篇

肝癌射频消融患者术后中重度疼痛的危险因素分析

刘民强, 查晓亮, 黄湘荣, 吴强, 何仁亮   

  1. 518112 广东 深圳市第三人民医院麻醉科(刘民强、查晓亮、吴强、何仁亮),肝病三科(黄湘荣)
  • 收稿日期:2021-08-02 出版日期:2022-06-30 发布日期:2022-08-04
  • 通讯作者: 何仁亮,Email:szherenliang@163.com
  • 基金资助:
    广东省自然科学基金(2020A1515010977)

Risk factors of moderate and severe pain in patients with hepatocellular carcinoma after radiofrequency ablation

LIU Min-qiang1, ZHA Xiao-liang1, HUANG Xiang-rong1, WU Qiang, HE Ren-liang   

  1. Department of Anesthesiology, The Third People’s Hospital of Shenzhen, Guangdong 518112, China
  • Received:2021-08-02 Online:2022-06-30 Published:2022-08-04
  • Contact: HE Ren-liang,Email:szherenliang@163.com

摘要: 目的 筛选肝癌(hepatocellular carcinoma,HCC)患者行经皮肝穿刺射频消融(radiofrequency ablation,RFA)术后中重度疼痛的危险因素。方法 择期行全麻下CT引导经皮肝穿刺RFA的HCC患者102例,根据术后24 h内视觉模拟评分(visual analogue scale,VAS)情况分为中重度疼痛组(VAS ≥ 3分)和非中重度疼痛组(VAS < 3分)。收集患者性别、年龄、ASA分级、肝硬化及肝脏手术情况、术前疼痛情况、肿瘤病灶大小、肿瘤位置、与肝包膜的距离、肿瘤数量、消融病灶数量、消融时间及手术时间,采用多因素logistic回归分析筛选术后中重度疼痛的独立危险因素。结果 56例患者术后24 h内发生了中重度疼痛。与非中重度疼痛组比较,中重度疼痛组术前合并疼痛、病灶> 1.5 cm及消融时间>12 min比例较高,组间比较差异有统计学意义(P< 0.05);多因素logistic回归分析结果显示:病灶> 1.5 cm及消融时间>12 min是患者术后中重度疼痛的独立危险因素(P< 0.05)。结论 HCC患者肿瘤病灶> 1.5 cm或RFA消融时间>12 min时术后易发生中重度疼痛,术后应注意及时给予镇痛治疗。

关键词: 肝癌, 射频消融, 疼痛, 危险因素

Abstract: Objective To investigate risk factors of moderate and severe pain in patients with hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA).Methods One hundred and two patients with HCC who underwent computed tomography (CT)-guided percutaneous RFA under general anesthesia were enrolled. According to the visual analog scale (VAS) within 24 hours after operation, patients were divided into moderate and severe pain group (VAS ≥ 3 points) and non moderate/severe pain group (VAS < 3 points). Clinical data of the patients including gender, age, American Society of Anesthesiologists (ASA[A1]) classification, history of cirrhosis and liver surgery, preoperative pain, tumor size, tumor location, distance between tumor and liver capsule, tumor number, ablation number, ablation time and operation time were collected. Multivariate logistic regression analysis was performed to screen the risk factors for moderate and severe pain after operation.Results Fifty-six patients (54.9%) had moderate or severe pain within 24 hours after operation. Compared with the non moderate/severe pain group, the proportion of preoperative pain, tumor size > 1.5cm and ablation time > 12min in the moderate and severe pain group were higher (P<0.05). Multivariate logistic regression analysis showed that tumor focus > 1.5 cm and ablation time > 12 min were independent risk factors of moderate and severe pain in HCC patients after RFA (P<0.05).Conclusion Tumor size > 1.5 cm or RFA time > 12 min are positively related to the occurrence of moderate and severe pain in HCC patients after operation. Prompt analgesic treatment after RFA should be paid more attention to.

Key words: Hepatocellular carcinoma, Radiofrequency ablation, Pain, Risk factors