Nonspherical Polyvinyl Alcohol Particles versus Tris-Acryl Microspheres: Randomized Controlled Trial Comparing Pain after Uterine Artery Embolization for Symptomatic Fibroids
Nonspherical Polyvinyl Alcohol Particles versus Tris-Acryl Microspheres: Randomized Controlled Trial Comparing Pain after Uterine Artery Embolization for Symptomatic Fibroids
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DOI：
10.1148/radiol.2020201895
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发表时间：
2021-02-01
期刊：
影响因子：
19.7
通讯作者：
Kim, Man-Deuk
中科院分区：
文献类型：
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作者：
Han, Kichang;Kim, So Yeon;Kim, Man-Deuk
背景资料：关于非球形聚乙烯醇（PVA）颗粒和三丙烯酰明胶微球（TAGM）在子宫动脉栓塞（UAE）中的比较数据有限。目的：比较PVA与TAGM治疗症状性子宫肌瘤后的疼痛。材料和方法：在这项随机临床试验中，参与者被分配接受非球形PVA（355-550 μ m）或TAGM（500-700 μ m）给药。两组患者均在术后24 h内给予芬太尼静脉自控镇痛及抢救性镇痛药。测量中性粒细胞与淋巴细胞比率以评估炎症反应。UAE后第1天行MRI增强扫描，评价子宫肌瘤坏死和正常子宫肌层缺血情况。在UAE术前和术后3个月评估症状严重程度评分和健康相关生活质量评分。随着时间的推移测量的变量进行了分析，通过使用广义估计方程method.Results：共54名参与者（平均年龄44岁，6 - 4 [标准差]）进行了评估（每组27名参与者）。虽然疼痛评分和芬太尼剂量在最初的24小时内没有差异，但PVA组使用急救镇痛药的比例较高（33% vs 11%; P = 0.049）。栓塞后，症状严重程度评分和健康相关生活质量评分在组间无差异（症状严重程度评分：PVA为16 [四分位数范围，6-22]，TAGM为19 [四分位数范围，9-34]，P = 0.45;健康相关生活质量评分：PVA组为93 [四分位距，80-97]，TAGM组为89 [四分位距，84-96]，P = 0.41）。PVA组从术前到术后24小时的嗜中性粒细胞/淋巴细胞比值变化更大（PVA组为3.9 [四分位数间距，2.7-6.8]，TAGM组为2.5 [四分位数间距，1.5-4.6]; P = 0.02）。两组间肌瘤完全显性坏死率无差异，但PVA组中正常子宫肌层的短暂性全子宫缺血更常见（44% vs 15%; P = 0.04）。结论：当用于子宫动脉栓塞时，聚乙烯醇颗粒和三丙烯酰明胶微球导致相似的疼痛评分和芬太尼剂量。聚乙烯醇导致更大的炎症反应，更高的补救镇痛剂使用率，更频繁的短暂性全子宫缺血。(C)RSNA，2020年
Background: Data are limited regarding comparison between nonspherical polyvinyl alcohol (PVA) particles and tris-acryl gelatin microspheres (TAGM) in uterine artery embolization (UAE).Purpose: To compare pain after UAE with PVA versus TAGM for treatment of symptomatic fibroids.Materials and Methods: In this randomized clinical trial, participants were assigned to be administered nonspherical PVA (355-550 mu m) or TAGM (500-700 mu m). Both groups were administered fentanyl-based intravenous patient-controlled analgesia during the first 24 hours after UAE and rescue analgesics. Neutrophil-to-lymphocyte ratio was measured to assess inflammatory response. Contrast-enhanced MRI 1 day after UAE was used to evaluate dominant fibroid necrosis and ischemia of normal myometrium. Symptom severity score and health-related quality-of-life score were assessed before and 3 months after UAE. Variables measured over time were analyzed by using the generalized estimating equation method.Results: A total of 54 participants (mean age, 44 years 6 4 [standard deviation]) were evaluated (27 participants in each group). Although pain scores and fentanyl dose were not different during the first 24 hours, use of rescue analgesics was higher in the PVA group (33% vs 11%; P =.049). After embolization, symptom severity score and health-related quality-of-life score were not different between groups (symptom severity score: 16 [interquartile range, 6-22] for PVA vs 19 [interquartile range, 9-34] for TAGM, P =.45; health-related quality-of-life score: 93 [interquartile range, 80-97] for PVA vs 89 [interquartile range, 84-96] for TAGM, P =.41). Changes in neutrophil-to-lymphocyte ratio from before to 24 hours after UAE were greater in the PVA group (3.9 [interquartile range, 2.7-6.8] for PVA and 2.5 [interquartile range, 1.5-4.6] for TAGM; P =.02). Rates of complete dominant fibroid necrosis were not different between groups, but transient global uterine ischemia of normal myometrium was more frequent in the PVA group (44% vs 15%; P =.04).Conclusion: When used in uterine artery embolization, polyvinyl alcohol particles and tris-acryl gelatin microspheres resulted in similar pain scores and fentanyl dose. Polyvinyl alcohol resulted in a greater inflammatory response, higher rates of rescue analgesic use, and more frequent transient global uterine ischemia. (C) RSNA, 2020