超前镇痛模式在肝动脉化疗栓塞术围手术期的应用

doi:10.3877/cma.j.issn.2095-5782.2026.01.008

目的

探讨超前镇痛模式对肝癌患者行肝动脉化疗栓塞术（transarterial chemoembolization，TACE）围手术期的镇痛效果。

方法

将2023年5月至9月，南京市江宁医院放射介入科收治的36例TACE治疗患者给予常规疼痛管理及心理干预，为对照组；2023年10月至2024年3月，47例TACE治疗患者在对照组的基础上加用超前镇痛，为观察组。对比分析2组患者术中及术后6、24 h的疼痛数字评定量表（numeric rating scale，NRS）评分、术后追加镇痛药情况及围手术期舒适度评分（bruggrmann comfort scale，BCS）。

结果

观察组术中及术后6、24 h的NRS评分均低于对照组，差异有统计学意义（P<0.05）；观察组术后24 h内追加镇痛药物比例为29.8%，明显低于对照组（77.8%），差异有统计学意义（P<0.05）；术中、术后6 h观察组的BCS高于对照组，差异有统计学意义（P<0.05）；术后24 h，2组患者的舒适度差异无统计学意义（P>0.05）。

结论

超前镇痛模式可有效降低TACE治疗患者围手术期疼痛程度，减少术后镇痛药物使用，提高患者围手术期早期舒适度，值得临床推广。

关键词: 肝癌, 超前镇痛, 肝动脉化疗栓塞术

Objective

To investigate the analgesic efficacy of preemptive analgesia in the perioperative period of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) patients.

Methods

36 cases of patients undergoing TACE from May 2023 to September 2023 admitted to the Department of Interventional Radiology at Jiangning Hospital were allocated into control group and received routine pain management and psychological intervention. From October 2023 to March 2024, 47 cases of patients undergoing TACE were managed with preemptive analgesia on the basis of the control group as the observation group. The Numeric Rating Scale (NRS) scores during surgery, at 6 h and 24 h after intervention, postoperative additional analgesic requirements, and perioperative comfort levels (Bruggrmann Comfort Scale, BCS) were compared between the two groups.

Results

In the observation group the NRS score were lower than those of control group during surgery, at 6 h and 24 h after intervention (P<0.05). The proportion of patients requiring additional analgesics within 24 h postoperatively was 29.8% in the observation group, significantly lower than that of the control group (77.8%). The BCS scores of the observation group were higher than those of the control group during surgery and at 6 h postoperatively (P<0.05), while no significant difference was observed at 24 h postoperatively (P>0.05).

Conclusion

Preemptive analgesia effectively reduces pain intensity in patients undergoing TACE, decreases postoperative analgesic consumption, and enhances comfort during the early perioperative period. Therefore, preemptive analgesia is worthy of clinical promotion and application.

Key words: Hepatocellular carcinoma, Preemptive analgesia, Transarterial chemoembolization

表1 2组患者基本资料比较

基本资料	观察组（n=47）	对照组（n=36）	t/χ²值	P值
年龄(岁， $x ¯$ ±s)	63.98±7.18	65.28±8.88	0.708	0.481
性别[例(%)]			0.042	0.838
男性	37(78.72)	29(80.56)
女性	10(21.28)	7(19.44)
BMI(kg/m²， $x ¯$ ±s)	22.54±2.51	22.11±1.89	0.845	0.400
TACE史[例(%)]			1.084	0.298
有	12(25.53)	13(36.11)
无	35(74.47)	23(63.89)
肿瘤数量[例(%)]			0.257	0.612
<3	35(74.47)	25(69.44)
≥3	12(25.53)	11(30.46)

表1 2组患者基本资料比较

基本资料	观察组（n=47）	对照组（n=36）	t/χ²值	P值
年龄(岁， $x ¯$ ±s)	63.98±7.18	65.28±8.88	0.708	0.481
性别[例(%)]			0.042	0.838
男性	37(78.72)	29(80.56)
女性	10(21.28)	7(19.44)
BMI(kg/m²， $x ¯$ ±s)	22.54±2.51	22.11±1.89	0.845	0.400
TACE史[例(%)]			1.084	0.298
有	12(25.53)	13(36.11)
无	35(74.47)	23(63.89)
肿瘤数量[例(%)]			0.257	0.612
<3	35(74.47)	25(69.44)
≥3	12(25.53)	11(30.46)

表2 2组患者NRS评分及24 h内镇痛药物干预情况比较

指标		观察组（n=47）	对照组（n=36）	t/χ²值	P值
NRS评分（ $x ¯$ ±s）	术中	1.38±1.65	3.22±2.50	3.739	<0.001
	术后6 h	1.55±1.98	3.44±2.63	3.601	0.001
	术后24 h	0.79±1.18	2.00±2.12	3.081	0.003
术后24 h内镇痛药物干预[例(%)]		14（29.78）	28（77.77）	18.783	<0.001

表2 2组患者NRS评分及24 h内镇痛药物干预情况比较

指标		观察组（n=47）	对照组（n=36）	t/χ²值	P值
NRS评分（ $x ¯$ ±s）	术中	1.38±1.65	3.22±2.50	3.739	<0.001
	术后6 h	1.55±1.98	3.44±2.63	3.601	0.001
	术后24 h	0.79±1.18	2.00±2.12	3.081	0.003
术后24 h内镇痛药物干预[例(%)]		14（29.78）	28（77.77）	18.783	<0.001

表3 2组患者BCS评分及术后恶心、呕吐发生率比较

组别		观察组（n=47）	对照组（n=36）	t/χ²值	P值
BCS评分（分， $x ¯$ ±s）	术中	2.39±1.549	1.34±0.94	3.612	0.001
	术后6 h	2.44±1.52	1.43±1.06	3.434	0.001
	术后24 h	1.56±1.11	1.19±0.65	1.757	0.085
术后24 h内恶心、呕吐发生情况[例(%)]		14（29.79）	16(44.44)	1.898	0.168

表3 2组患者BCS评分及术后恶心、呕吐发生率比较

组别		观察组（n=47）	对照组（n=36）	t/χ²值	P值
BCS评分（分， $x ¯$ ±s）	术中	2.39±1.549	1.34±0.94	3.612	0.001
	术后6 h	2.44±1.52	1.43±1.06	3.434	0.001
	术后24 h	1.56±1.11	1.19±0.65	1.757	0.085
术后24 h内恶心、呕吐发生情况[例(%)]		14（29.79）	16(44.44)	1.898	0.168

[1]	中国医师协会介入医师分会临床诊疗指南专委会. 中国肝细胞癌经动脉化疗栓塞(TACE)治疗临床实践指南(2023年版)[J]. 中华医学杂志, 2023, 103(34): 2674-2694.
[2]	Lu J, Zhao M, Arai Y, et al. Clinical practice of transarterial chemoembolization for hepatocellular carcinoma: consensus statement from an international expert panel of international society of multidisciplinary interventional oncology (ismio)[J]. Hepatobiliary Surg Nutr, 2021, 10(5): 661-671.
[3]	罗君, 邵国良, 郑家平, 等. 原发性肝癌肝动脉化疗栓塞术后腹痛的发生规律及影响因素[J]. 介入放射学杂志, 2017, 26(7): 613-617.
[4]	中国医师协会介入医师分会. 中国肝细胞癌经动脉化疗栓塞治疗临床实践指南[J]. 中华介入放射学电子杂志, 2019, 7(3): 178-184.
[5]	陈瑜, 黄道琼, 李海燕, 等. 肝癌栓塞术后疼痛患者择时给药时间点的改进及效果[J]. 中华护理杂志, 2019, 54(3): 393-395.
[6]	Byrne K, Smith C. Preemptive analgesia: an unobtainable goal?[J]. J Cardiothorac Vasc Anesth, 2019, 33(2): 460-461.
[7]	Zhang Z, Zhang J, Zhang P, et al. Clinical efficacy of dexmedetomidine preemptive analgesia in breast tumor resection[J]. Am J Transl Res, 2024, 16(12): 7343-7353.
[8]	Sun Z, Liu C, Huang L, et al. The efficacy of preemptive multimodal analgesia in elderly patients undergoing laparoscopic colorectal surgery: a randomized controlled trial[J]. Sci Rep, 2024, 14(1): 25438.
[9]	Cao L, Yang T, Hou Y, et al. Efficacy and safety of different preemptive analgesia measures in pain management after laparoscopic cholecystectomy: a systematic review and network meta-analysis of randomized controlled trials[J]. Pain Ther, 2024, 13(6): 1471-1497.
[10]	Vilai P, Dhanachanvisith N, Kongmalai P. Efficacy of preemptive analgesia on tourniquet and postoperative pain relief in open carpal tunnel release: a prospective randomized control trial[J]. J Hand Surg Am, 2023, 48(8): 828. e1-828. e7.
[11]	Zhu X. Efficacy of preemptive analgesia versus postoperative analgesia of celecoxib on postoperative pain, patients' global assessment and hip function recovery in femoroacetabular impingement patients underwent hip arthroscopy surgery[J]. Inflammopharmacology, 2020, 28(1): 131-137.
[12]	Zhou J, Sun H, Wang Z, et al. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 edition)[J]. Liver Cancer, 2020, 9(6): 682-720.
[13]	中国医师协会介入医师分会介入围手术专委会, 中国医师协会介入医师分会介入临床诊疗指南专委会. 肝脏恶性肿瘤介入治疗围术期疼痛管理专家共识(2022)[J]. 介入放射学杂志, 2022, 31(10): 943-948.
[14]	张晶晶, 庞文燕, 王云, 等. 基于集束化策略的护理干预在肝癌介入治疗患者中的应用及其对疼痛及PSQI评分的影响[J]. 现代医学, 2023, 51(7): 991-996.
[15]	Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update[J]. J Hepatol, 2022, 76(3): 681-693.
[16]	You K, Wang J, Xu J, et al. Development and validation of a predictive scoring system for post-transarterial chemoembolization pain management in liver cancer patients[J]. J Gastrointest Oncol, 2024, 15(1): 425-434.
[17]	Lyu N, Kong Y, Li X, et al. Effect and safety of prophylactic parecoxib for pain control of transarterial chemoembolization in liver cancer: a single-center, parallel-group, randomized trial[J]. J Am Coll Radiol, 2022, 19(1 Pt A): 61-70.
[18]	黄傅荔, 王芳, 范本芳, 等. 多学科疼痛管理干预在DEB-TACE术后对患者的疼痛影响分析[J]. 南通大学学报(医学版), 2022, 42: 71-73.
[19]	彭冲, 卢芳燕, 孙军辉. 基于快速康复外科的多模式镇痛在肝动脉化疗栓塞术中的应用[J]. 中华介入放射学电子杂志, 2021, 9(2): 215-219.
[20]	Guo JG, Zhao LP, Rao YF, et al. Novel multimodal analgesia regimen improves post-tace pain in patients with hepatocellular carcinoma[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(6): 510-516.
[21]	Ge Z, Li M, Chen Y, et al. The efficacy and safety of parecoxib multimodal preemptive analgesia in artificial joint replacement: a systematic review and meta-analysis of randomized controlled trials[J]. Pain Ther, 2023, 12(4): 1065-1078.
[22]	Ye R R, Jiang S, Xu X, et al. Dezocine as a potent analgesic: overview of its pharmacological characterization[J]. Acta Pharmacol Sin, 2022, 43(7): 1646-1657.
[23]	Zhang Q, Li X, Wang Y, et al. Dezocine as preemptive analgesia alleviates ultrapulse CO₂ fractional laser treatment induced pain in patients with acne scars[J]. J Cosmet Dermatol, 2024, 23(10): 3241-3247.
[24]	侯益轩, 李俊梅, 李亚琼, 等. 肝癌TACE术后发生腹痛的影响因素meta分析[J]. 介入放射学杂志, 2022, 31(4): 351-356.
[25]	Yang Y, Chen S, Yan Z, et al. Construction and validation of prediction model of severe abdominal pain post-transarterial chemoembolization in patients with hbv-associated primary liver cancer[J]. Comput Math Methods Med, 2022, 2022: 5203166.
[26]	刘兴雯, 胡燊, 郭霞, 等. 超前镇痛联合同质化管理对原发性肝癌患者TACE治疗后疼痛的影响研究[J]. 当代护士(上旬刊), 2022, 29(9): 42-46.
[27]	何璐, 黄朝意, 曾洋帆, 等. 肝癌患者介入术后早期恶心呕吐现状及影响因素分析[J]. 护理学杂志, 2022, 37(23): 50-52, 62.
[28]	梁轶, 严忠婷, 桑玉还, 等. 肝癌患者肝动脉化疗栓塞术后恶心和呕吐的危险因素及评估工具研究进展[J]. 介入放射学杂志, 2024, 33(5): 565-570.
[29]	Sakamoto T, Saito Y, Kobayashi M, et al. Effect of palonosetron and dexamethasone administration on the prevention of gastrointestinal symptoms in hepatic arterial chemoembolization with epirubicin[J]. Support Care Cancer, 2020, 28(7): 3251-3257.

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[10]	李勃, 叶威良, 张静雯, 上文文. 叶酸-聚乙二醇-阿霉素连接物对肝癌裸鼠皮下移植瘤生长及心脏毒性影响的研究[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(02): 101-107.
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Effects of preemptive analgesia in perioperative management of transarterial chemoembolization

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