经动脉内灌注利多卡因-碘油乳剂在恶性肿瘤栓塞化疗术中止痛疗效的评价

目的　评价经动脉内给予利多卡因 碘油乳剂行栓塞化疗术中控制疼痛和预防动脉痉挛的可行性和有效性 ,并探讨其最佳用量。方法　 1 2 0例恶性肿瘤患者均行栓塞化疗术 (TACE) ,随机分成3组 :行利多卡因 碘油乳剂栓塞者为A组 (n =4 0 ) ;TACE术前行利多卡因团注者为B组 (n =4 0 ) ,单纯TACE为C组者 (无利多卡因组 ,n =4 0 )。术后疼痛程度用一主观指标评价 (即视觉模拟等级 VAS 0 - 1 0)和一客观指标评价 (术后肌注镇痛剂的使用数量 ) ,术中动脉痉挛发生率通过DSA来评价。结果　 3组间疼痛发生率的差异有显著性 (P <0 .0 5 ) ,A ,B ,C组平均积分分别为 2 .78,3.87和 4 .4 6。术后疼痛积分提示A组较B组和C组显著降低 (P <0 .0 5 ) ,但B组和C组间差异无显著性 (P >0 .0 5 )。肌注镇痛剂控制难以忍受疼痛的药量上A组和B组患者均较C组有显著减少 (P <0 .0 5 ) ,A组和B组患者动脉痉挛发生率差异无显著性 ,但两者均较C组低 ,恶性肿瘤内碘油沉积在A组患者中最致密 ,尤其是在肝脏转移性肿瘤中碘油沉积更好。结论　经动脉灌注利多卡因 碘油乳剂行栓塞化疗术不但能减轻疼痛发生率 ,而且能阻止动脉痉挛的发生。它较术前给予哌替啶等强效镇痛剂和术中动脉灌注利多卡因更有效

Transarterial lidocaine-lipiodol emulsion administration for relief of pain during transarterial chemoembolization of malignant tumor

Objective To assess the feasibility and efficacy of transarterial lidocaine lipiodol emulsion administration for controlling abdominal pain and preventing the arterial spasm resulting from TACE, and to evaluate the optimal amount of lidocaine administration. Methods In a prospective trial of 120 consecutive patients with malignant tumor who underwent TACE were divided into three groups, those who received lidocaine lipiodol emulsion administration (group A, n =40), those who received lidocaine bolus intraarterial infusion immediately before TACE (group B, n =40) and those who received no lidocaine injection before TACE, (group C, n =40). The degree of post procedure pain was evaluated by a subjective method (using visual analogue scales from 0 to 10), and an objective method (amount of post procedure analgesics). Incidence and degree of arterial spasm were assessed by DSA. Results The correlative pain incidences between the three groups showed significant difference ( P <0.05). The mean pain score was 2.78 in group A, and 3.87, 4.46 in group B and C respectively. The mean pain score post procedure in group A was significantly lower than those of group B and C ( P <0.05), but no significant difference between B and C ( P >0.05). Mean dose of intramuscular analgesics for controlling intolerable pain in group A and B was significantly lower than that of group C ( P <0.05). There was no difference in the incidence of arterial spasm between group A and B but it was much lower in group C. Lipiodol deposit in malignant mass was densest in group A, especially in the metastatic nodules of the liver. Conclusions Transarterial administration of lidocaine lipiodol emulsion can not only reduce the incidence of pain during TACE, but also prevent the arterial spasm. It is much more effective than pre TACE administration of pethidine and intraarterial infusion of lidocaine. We recommond routinely for the administration of lidocaine lipiodol emulsion.