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中华普通外科学文献(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 442 -446. doi: 10.3877/cma.j.issn.1674-0793.2021.06.009

论著

帕瑞昔布超前镇痛在肝射频消融中的应用:倾向匹配分析
陈健聪1, 赖佳明1, 王炯亮2, 周仲国2,()   
  1. 1. 510080 广州,中山大学附属第一医院胆胰外科
    2. 510060 广州,中山大学肿瘤防治中心肝脏外科
  • 收稿日期:2021-02-09 出版日期:2021-12-01
  • 通信作者: 周仲国
  • 基金资助:
    广东省基础与应用基础研究基金项目(2020A1515110485); 中山大学肿瘤防治中心临床医学科学家基金资助项目(16zxqk04)

Application of parecoxib preanalgesia in liver radiofrequency ablation: A propensity score matching analysis

Jiancong Chen1, Jiaming Lai1, Jiongliang Wang2, Zhongguo Zhou2,()   

  1. 1. Department of Pancreato-Biliary Surgery, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
    2. Department of Hepatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
  • Received:2021-02-09 Published:2021-12-01
  • Corresponding author: Zhongguo Zhou
引用本文:

陈健聪, 赖佳明, 王炯亮, 周仲国. 帕瑞昔布超前镇痛在肝射频消融中的应用:倾向匹配分析[J/OL]. 中华普通外科学文献(电子版), 2021, 15(06): 442-446.

Jiancong Chen, Jiaming Lai, Jiongliang Wang, Zhongguo Zhou. Application of parecoxib preanalgesia in liver radiofrequency ablation: A propensity score matching analysis[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 442-446.

目的

探讨选择性环氧合酶2抑制剂帕瑞昔布在肝脏射频消融术(RFA)中的超前镇痛作用。

方法

回顾性分析2015年4月至2016年1月中山大学肿瘤防治中心共188例(其中原发癌122例,转移灶66例)行RFA治疗患者的临床资料,分为帕瑞昔布组和对照组。帕瑞昔布组在术前30 min和术后每12小时均给药40 mg帕瑞昔布,且连续给药2 d,对照组则未做给药处理,倾向性评分匹配评估围手术期应用帕瑞昔布能否对患者在疼痛、呕吐、发热、炎症反应、术后住院时间等方面产生获益。

结果

经过倾向性评分匹配分析在两组中匹配44对患者,帕瑞昔布组术后当天和术后第1天的VAS疼痛评分较对照组显著降低(P<0.001、0.001),同时丙氨酸氨基转移酶和C反应蛋白水平也较对照组低,分别为[(177.0±88.0)mmol/L vs (327.7±387.1)mmol/L,P=0.043;(20.0±29.0)mg/L vs (49.7±44.1)mg/L,P<0.001]。

结论

帕瑞昔布可显著减轻RFA患者术后疼痛和炎性反应,加速患者术后康复。

Objective

To investigate the preanalgesic effect of selective cyclooxygenase-2 inhibitor parecoxib after liver radiofrequency ablation (RFA).

Methods

The clinical data of 188 cases of liver cancer (including 122 primary cancers and 66 metastases) receiving radiofrequency ablation in Sun Yat-sen University Cancer Center from April 2015 to January 2016 were retrospectively analyzed, and they were divided into the parecoxib group and control group. Parecoxib group was given 40 mg parecoxib 30 min before surgery and every 12 hours after surgery for 2 consecutive days, while the control group was not given the medication, to evaluate whether perioperative application of parecoxib would benefit patients in terms of pain, vomiting, fever, inflammatory response, postoperative hospital stay and other aspects.

Results

We matched 44 pairs of patients in the two study groups by propensity-score matching analysis. And further data analysis showed a significant reduction in VAS scores on the day after surgery and the first day after surgery in the parecoxib group (P<0.001, 0.001, respectively). The serum levels of alanine aminotransferase and C-reactive protein were also lower than those in the control group [(177.0±88.0) mmol/L vs (327.7±387.1) mmol/L, P=0.043; (20.0±29.0) mg/L vs (49.7±44.1) mg/L, P<0.001], respectively.

Conclusion

Parecoxib can significantly reduce postoperative pain and inflammation in patients with RFA, thus accelerating postoperative recovery.

图1 研究流程图
表1 两组肝细胞癌患者基线特征的比较
表3 倾向评分匹配后肝细胞癌患者RFA术后并发症、肝功能和住院时间的比较
图2 帕瑞昔布组与对照组术后VAS疼痛评分(A)及术后发热(B)的情况比较
表2 倾向评分匹配前后肝细胞癌患者的协变量
[1]
Qian X, Yan X, Zhai X, et al. Hepatocellular carcinoma surveillance and treatment: A way to reduce cancer-related mortality in cirrhotic patients[J]. J Clin Transl Hepatol, 2019, 7(1): 1-2.
[2]
Costentin C. Hepatocellular carcinoma surveillance[J]. Presse Med, 2017, 46(4): 381-385.
[3]
Singal AG, Lim JK, Kanwal F. AGA clinical practice update on interaction between oral direct-acting antivirals for chronic hepatitis C infection and hepatocellular carcinoma: expert review[J]. Gastroenterology, 2019, 156(8): 2149-2157.
[4]
Lee DH, Lee JM, Kang TW, et al. Clinical outcomes of radiofrequency ablation for early hypovascular HCC: A multicenter retrospective study[J]. Radiology, 2018, 286(1): 338-349.
[5]
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.
[6]
Zhu Y, Zhou C, Yang Y, et al. Efficacy of parecoxib sodium on postoperative shivering: Meta-analysis of clinical trials[J]. J Int Med Res, 2018, 46(1): 3-10.
[7]
Cheng L, Long HT, Sun BH, et al. The efficacy of a multimodal analgesia protocol in preventing heterotopic ossification after acetabular fractures surgery[J]. Int J Clin Pharm, 2017, 39(4): 826-830.
[8]
Chen H, Luo A. Safety and efficacy study of the cyclooxygenase-2 inhibitor parecoxib sodium applied for postoperative analgesia after endo-nasal operation[J]. Pain Pract, 2016, 16(4): 467-472.
[9]
Siribumrungwong K, Cheewakidakarn J, Tangtrakulwanich B, et al. Comparing parecoxib and ketorolac as preemptive analgesia in patients undergoing posterior lumbar spinal fusion: A prospective randomized double-blinded placebo-controlled trial[J]. BMC Musculoskelet Disord, 2015, 16: 59.
[10]
Zhu Y, Wang S, Wu H, et al. Effect of perioperative parecoxib on postoperative pain and local inflammation factors PGE2 and IL-6 for total knee arthroplasty: A randomized, double-blind, placebo-controlled study[J]. Eur J Orthop Surg Traumatol, 2014, 24(3): 395-401.
[11]
Wainwright TW, Immins T, Middleton RG. Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery[J]. Best Pract Res Clin Anaesthesiol, 2016, 30(1): 91-102.
[12]
中华医学会外科学分会外科手术学学组,中国医疗保健国际交流促进会加速康复外科学分会肝脏外科学组. 肝切除术后加速康复中国专家共识(2017版)[J/CD]. 中华肝脏外科手术学电子杂志, 2017, 6(4): 254-260.
[13]
Liu LN, Xu HX, Lu MD, et al. Percutaneous ultrasound-guided thermal ablation for liver tumor with artificial pleural effusion or ascites[J]. Chin J Cancer, 2010, 29(9): 830-835.
[14]
Shi M, Guo RP, Lin XJ, et al. Partial hepatectomy with wide versus narrow resection margin for solitary hepatocellular carcinoma: A prospective randomized trial[J]. Ann Surg, 2007, 245(1): 36-43.
[15]
Hinshaw JL, Laeseke PF, Winter TC. Radiofrequency ablation of peripheral liver tumors: intraperitoneal 5% dextrose in water decreases postprocedural pain[J]. AJR Am J Roentgenol, 2006, 186(5 Suppl): S306-S310.
[16]
Ongiem A, Siriussawakul A, Aungsumat Wangdee BNS W, et al. Assessment of pain severity after radiofrequency ablation in patients with hepatocellular carcinoma[J]. J Med Assoc Thai, 2016, 99(5): 572-577.
[17]
Ljungqvist O. ERAS--enhanced recovery after surgery: moving evidence-based perioperative care to practice[J]. JPEN J Parenter Enteral Nutr, 2014, 38(5): 559-566.
[18]
Azevedo I, Ugalde Figueroa P. Commentary: can preemptive analgesia decrease opioid use after foregut laparoscopic surgery?[J]. J Thorac Cardiovasc Surg, 2020, 159(2): 747-748.
[19]
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain--United States, 2016[J]. JAMA, 2016, 315(15): 1624-1645.
[20]
Lanas A. Advances in gastrointestinal bleeding[J]. Gastroenterol Hepatol, 2016, 39(Suppl 1): 53-61.
[21]
Korotkova M, Lundberg IE. The skeletal muscle arachidonic acid cascade in health and inflammatory disease[J]. Nat Rev Rheumatol, 2014, 10(5): 295-303.
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