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ENGLISH ABSTRACT
影像引导下肿瘤热消融治疗镇痛专家共识
中国临床肿瘤学会肿瘤消融治疗专家委员会
中国抗癌协会肿瘤消融治疗专业委员会
中国医师协会介入医师分会肿瘤消融专业委员会
中国医师协会肿瘤消融治疗技术专家组
作者及单位信息
·
DOI： 10.3760/cma.j.cn112138-20220313-00174
Expert consensus on analgesia for image-guided thermal ablation of tumors
The Ablation Expert Committee of the Chinese Society of Clinical Oncology
the Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association
the Tumor Ablation Committee of the Chinese College of Interventionalists
the Expert Group on Tumor Ablation Therapy of the Chinese Medical Doctors
Ye Xin
Fan Weijun
Authors Info & Affiliations
The Ablation Expert Committee of the Chinese Society of Clinical Oncology
the Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association
the Tumor Ablation Committee of the Chinese College of Interventionalists
the Expert Group on Tumor Ablation Therapy of the Chinese Medical Doctors
Ye Xin
Department of Oncology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China
Fan Weijun
Department of Minimally Invasive Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
·
DOI： 10.3760/cma.j.cn112138-20220313-00174
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摘要

影像引导下热消融（image-guided thermal ablation，IGTA）技术已经广泛应用于肿瘤的治疗，每年治疗例数迅速增加。由中国临床肿瘤学会肿瘤消融治疗专家委员会、中国抗癌协会肿瘤消融治疗专业委员会、中国医师协会介入医师分会肿瘤消融专业委员会、中国医师协会肿瘤消融治疗技术专家组组织国内有关专家，讨论制定了本共识，以便能更好地为IGTA治疗肿瘤围手术期镇痛提供参考。其主要内容包括：（1）药品和设备的准备；（2）多模式镇痛、局部麻醉、区域神经阻滞或椎管内麻醉联合镇痛镇静方案、全身麻醉；（3）常见不良反应及其处理。

导管消融术;肿瘤;镇痛
ABSTRACT

Image-guided thermal ablation (IGTA) has been applied in the treatment of tumors, and the number of patients treated is increasing rapidly every year. The Ablation Expert Committee of the Chinese Society of Clinical Oncology, the Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association,the Tumor Ablation Committee of the Chinese College of Interventionalists, and the Expert Group on Tumor Ablation Therapy of the Chinese Medical Doctors provided the platform for multidisciplinary experts to formulate the “Expert consensus on analgesia for image-guided tumor thermal ablation (2022 Edition)”. The main contents of the“Expert consensus”include: (1) preparation of medicines and equipment; (2) Multimodal analgesia, local anesthesia, regional nerve block or spinal anesthesia combined with analgesic sedation, general anesthesia; (3) common adverse reactions and management of perioperative anesthesia.

Catheter ablation;Neoplasms;Analgesia
Ye Xin,Department of Oncology, the First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Jinan 250014, China, Email: mocdef.3ab610202naiatnixey
Fan Weijun,Department of Minimally Invasive Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China, Email: mocdef.6ab214691nujiewnaf
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引用本文

中国临床肿瘤学会肿瘤消融治疗专家委员会,中国抗癌协会肿瘤消融治疗专业委员会,中国医师协会介入医师分会肿瘤消融专业委员会,等. 影像引导下肿瘤热消融治疗镇痛专家共识[J]. 中华内科杂志,2022,61(09)：1008-1015.

DOI:10.3760/cma.j.cn112138-20220313-00174

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疼痛是一种与实际或潜在组织损伤相关，或类似的令人不愉快的感觉和情感体验 ［ 1 , 2 ］ 。痛觉感受器广泛分布在皮肤各层、小血管和毛细血管旁结缔组织、胸膜和腹膜的脏层壁层、黏膜下层等处，任何伤害性刺激（物理或化学），均可导致局部组织损伤，释放内源性致痛因子导致疼痛。影像引导下热消融（image-guided thermal ablation，IGTA）作为一种精准微创治疗技术已经广泛应用于各种肿瘤的治疗，其主要包括射频消融（radiofrequency ablation，RFA）、微波消融（microwave ablation，MWA）、冷冻消融（cryoablation）、激光消融（laser ablation，LA）和高强度聚焦超声消融（high intensity focused ultrasound，HIFU） ［ 3 , 4 , 5 , 6 , 7 ］ 。IGTA治疗肿瘤时消融针要依次穿刺经过皮肤、皮下组织、肌肉、实质脏器的包膜以及消融时局部温度变化刺激，都会产生痛觉。患者的疼痛不仅会导致热消融手术无法进行，严重影响治疗效果，而且也会导致患者焦虑和心理恐惧。因此，IGTA手术时的麻醉镇痛是能否顺利完成消融手术的重要基础条件 ［ 8 , 9 , 10 ］ 。IGTA镇痛遵循患者自愿和临床安全的原则，必要时在麻醉医师协助和指导下，通过实施有效的镇痛技术，达到最大程度减轻患者疼痛的目的。由中国抗癌协会肿瘤消融治疗专业委员会、中国临床肿瘤学会肿瘤消融治疗专家委员会、中国医师协会介入医师分会肿瘤消融专业委员会组织国内有关专家，讨论制定了“影像引导下肿瘤热消融治疗镇痛专家共识（2022年版）”，以便能更好地为IGTA治疗肿瘤围手术期镇痛提供参考。
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备注信息
A
叶欣，山东第一医科大学第一附属医院肿瘤中心（山东省千佛山医院）山东省肺癌研究所，济南 250014，Email： mocdef.3ab610202naiatnixey
B
范卫君，中山大学肿瘤防治中心微创介入科，广州510060，Email： mocdef.6ab214691nujiewnaf
C

中国临床肿瘤学会肿瘤消融治疗专家委员会, 中国抗癌协会肿瘤消融治疗专业委员会, 中国医师协会介入医师分会肿瘤消融专业委员会, 等. 影像引导下肿瘤热消融治疗镇痛专家共识[J]. 中华内科杂志, 2022, 61(9): 1008-1015. DOI: 10.3760/cma.j.cn112138-20220313-00174.

D
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