Chang Kai-Ting, Liu Chun-Jen, Tsai Hsiu-Ting, Hsu Tse-Pin, Chen Po-Ting, Hu Sophia H
Department of Nursing, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei City, 10002, Taiwan.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, National, Taiwan University Hospital, No.7, Chung Shan S. Rd., Taipei City, 10002, Taiwan.
Int J Nurs Stud. 2020 Sep;109:103641. doi: 10.1016/j.ijnurstu.2020.103641. Epub 2020 May 16.
People with hepatocellular carcinoma who undergo transcatheter arterial chemoembolization usually experience back pain due to lie supine for at least 4 hours to avoid bleeding and hematoma. Body positioning is an effective and safe method for decreasing back pain in people with transfemoral cardiac catheterization; however, its effects and safety among patients with high bleeding tendency are unknown.
To investigate whether body positioning could decrease back pain without increasing the chance of bleeding after transcatheter arterial chemoembolization.
A single-blind randomized controlled trial (ClinicalTrials.gov No.: NCT03784469).
A total of 78 people with liver cancer who had undergone chemoembolization through the femoral artery were enrolled. Each person was randomly assigned to either the control or intervention group (each consisted of 39 participants). The control group received the usual care, remaining flat and lying in a supine position, whereas the intervention group had their positions changed in the second and fourth hour after chemoembolization. Participants' pain level was rated by using numerical rating scale -11 (score from 0 to 10), bleeding was measured by using volume of blood (cc.) in gauze and hematoma size in diameter (cm), and satisfaction was self-rated from 1 to 5. Repeated-measure analysis of variance (ANOVA) was used to compare the difference in pain levels over time within each group and independent t test to compare the mean difference of pain between groups at 5 endpoints, both methods with Bonferroni adjustment. Independent t test, chi-squared test, and Fisher's exact test compared postembolization discomfort, puncture sites bleeding, satisfaction between groups.
Significant changes of pain levels over time in both intervention [F(2.93, 111.20)=7.64, p<.001] and control groups [F(2.66, 101.17)=20.55, p<.001]. The intervention group had a significantly lower mean pain score in the second hour (t = -2.838, p = .006) and fourth hour (t = -4.739, p < .001) when patients turning to the side than did the control group lying supine. Furthermore, patients in the intervention group had significantly higher satisfaction than did those in the control group (t = -2.422, p = .018). No hematoma and significant difference of post-procedural bleeding between groups.
Changing patients' body positions in bed after transcatheter arterial chemoembolization is a safe and effective method of decreasing back pain, and increasing patients' satisfaction, without increasing the complications of bleeding and hematoma. Clinicians should change the positions of people with hepatocellular carcinoma 2 hours after they receive transcatheter arterial chemoembolization.
接受经导管动脉化疗栓塞术的肝细胞癌患者通常因需仰卧至少4小时以避免出血和血肿而经历背痛。体位调整是一种在经股动脉心脏导管插入术患者中减轻背痛的有效且安全的方法；然而，其在高出血倾向患者中的效果和安全性尚不清楚。
研究体位调整在经导管动脉化疗栓塞术后能否减轻背痛而不增加出血风险。
一项单盲随机对照试验（ClinicalTrials.gov编号：NCT03784469）。
共纳入78例经股动脉接受化疗栓塞术的肝癌患者。将每个人随机分配到对照组或干预组（每组39名参与者）。对照组接受常规护理，保持平卧位仰卧，而干预组在化疗栓塞术后第二小时和第四小时改变体位。使用数字评分量表-11（0至10分）对参与者的疼痛程度进行评分，通过纱布上的出血量（cc.）和血肿直径（cm）测量出血情况，满意度采用1至5分自评。采用重复测量方差分析（ANOVA）比较每组内不同时间点的疼痛程度差异，采用独立t检验比较两组在5个时间点的疼痛平均差异，两种方法均进行Bonferroni校正。采用独立t检验、卡方检验和Fisher精确检验比较栓塞后不适、穿刺部位出血、两组间的满意度。
干预组[F(2.93, 111.20)=7.64, p<.001]和对照组[F(2.66, 101.17)=20.55, p<.001]的疼痛程度随时间均有显著变化。干预组患者在翻身侧卧后的第二小时（t = -2.838, p = .006）和第四小时（t = -4.739, p < .001）的平均疼痛评分显著低于仰卧的对照组。此外，干预组患者的满意度显著高于对照组（t = -2.422, p = .018）。两组间无血肿形成，术后出血无显著差异。
经导管动脉化疗栓塞术后在床上改变患者体位是一种安全有效的减轻背痛、提高患者满意度的方法，且不增加出血和血肿并发症。临床医生应在肝细胞癌患者接受经导管动脉化疗栓塞术后2小时改变其体位。
