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临床价值

发布时间：2018-11-18 16:01

【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(P0.05)。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。
[Abstract]:Objective to investigate the value of lidocaine local anesthesia combined with remifentanil vein enhancement in radiofrequency ablation of liver tumors. Methods A retrospective analysis was made on 1 252 patients undergoing radiofrequency ablation of liver tumors in our department. All patients were treated with American RITA cluster multipole radiofrequency needle. The intravenous infusion of remifentanil was performed by intravenous infusion of remifentanil at a dose of 2mg/kg body mass before percutaneous puncture. The initial dose of remifentanil was 0.05 渭 g / (kg min),. 24 hours before radiofrequency ablation (T0), at the beginning of operation (T1), at the beginning of 30min (T2) and at the end of operation (T3), the mean arterial blood pressure, (MAP), heart rate, (HR), oxygen saturation (SPO2) were recorded. Visual analogue score (VAS) was used to evaluate the analgesic effect. Results radiofrequency ablation was performed successfully in 1 250 patients (1 250 / 1 252 卤99. 84%). The average operation time was (59. 02 卤14. 63) min, remifentanil was (242.22 卤22. 73) 渭 g. The average VAS pain score was (2.42 卤1.13). Compared with the time point of T0, the SPO2 of T1 and T2T 3 did not change significantly, but the MAP,HR increased significantly (P 0.05). The VAS pain score of patients with 5cm was higher than that with 5cm (P0.05). The VAS pain score of the patients with lesions located at the top of the diaphragm and subcapsular was higher than that of the patients with the lesions located in other parts (P < 0. 05). Serious anaesthesis-related complications were found in 2 patients, all of which were related to the respiratory inhibition of remifentanil. All patients recovered completely after corresponding treatment. Conclusion Lidocaine local anesthesia combined with remifentanil vein enhancement can effectively relieve the pain in patients undergoing radiofrequency ablation of liver tumors. Tumor size and tumor location are the main factors affecting analgesic effect.
【作者单位】：北京大学第一医院介入血管外科;
【分类号】：R614;R735.7

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