Comparison of effectiveness of epidural analgesia and monitored anesthesia care for high-intensity focused ultrasound treatment of adenomyosis
Comparison of effectiveness of epidural analgesia and monitored anesthesia care for high-intensity focused ultrasound treatment of adenomyosis
复制标题
硬膜外镇痛与监护麻醉护理高强度聚焦超声治疗子宫腺肌症的效果比较
DOI：
--
复制
发表时间：
2018
影响因子：
3.1
通讯作者：
J. Moon
中科院分区：
文献类型：
--
作者：
Chang;Jae Young Lee;Soohan Ro;Seungeun Choi;J. Moon
摘要背景：高强度聚焦超声（HIFU）是一种非侵入性的热破坏性手术，目标是内部器官，具有可能导致疼痛的集中超声能量。目的比较硬膜外镇痛（EA）和监测麻醉护理（MAC）在高强度聚焦超声（HIFU）治疗子宫腺肌病中的效果。材料与方法：68例患者纳入本病例对照研究。37例患者接受MAC; 31例患者接受透视引导硬膜外镇痛。主要结局是患者报告重度或极重度术中疼痛的频率。次要结局是镇痛剂剂量、消融率和其他临床因素的差异。结果如下：EA组报告的重度或极重度术中疼痛的发生率显著低于MAC组（41.9% vs. 75.7%; p = 0.006）。治疗期间，EA组瑞芬太尼的消耗量显著较低（173 ± 189 µg vs. 426 ± 380 µg; p = .001），恢复室芬太尼的使用量也是如此（52 ± 38 µg vs. 75 ± 44 µg; p = .030）。多变量分析显示EA是增加非灌注体积比的最大贡献因素（B = 0.41; 95%置信区间= 0.29 - 0.53; p <0.001）。电针组HIFU治疗后热损伤的发生率显著较低（22.6% vs. 54.1%; p = 0.008）。结论：在HIFU治疗子宫腺肌病期间，EA改善了疼痛控制质量和消融率，而没有增加治疗相关并发症的风险。EA还减少了HIFU治疗期间和治疗后阿片类镇痛药的消耗。
Abstract Background: High-intensity focused ultrasound (HIFU) is a noninvasive thermodestructive procedure targeting internal organs with concentrated sonification energy that may cause pain. We aimed to compare the effectiveness of epidural analgesia (EA) and monitored anesthesia care (MAC) in HIFU treatment of uterine adenomyosis. Materials and Methods: Sixty-eight patients were included in this case-control study. Thirty-seven patients underwent MAC; 31 patients underwent fluoroscope-guided epidural analgesia. The primary outcome was a frequency of patients reporting severe or very severe intraoperative pain. Secondary outcomes were differences in dosages of analgesics, ablation ratio, and other clinical factors. Results: The EA group reported a significantly lower frequency of severe or very severe intraoperative pain than did the MAC group (41.9% vs. 75.7%; p = .006). Consumption of remifentanil during treatment was significantly lower in the EA group (173 ± 189 µg vs. 426 ± 380 µg; p = .001), as was the use of fentanyl in the recovery room (52 ± 38 µg vs. 75 ± 44 µg; p = .030). Multivariable analysis revealed EA to be the largest contributing factor to increased nonperfused volume ratio (B = 0.41; 95% confidence interval = 0.29 to 0.53; p < .001). The frequency of thermal injury after HIFU was significantly lower in the EA group (22.6% vs. 54.1%; p = .008). Conclusions: EA during HIFU treatment of uterine adenomyosis improved quality of pain control and ablation ratio over MAC without increasing risk of treatment-related complications. EA also reduced consumption of opioid analgesics during and after HIFU treatment.
影响因子：
19.7
作者：
CLINE, HE;HYNYNEN, K;JOLESZ, FA
通讯作者：
JOLESZ, FA