双针会师法腹腔丛阻滞对顽固性上腹部癌痛患者的镇痛作用  

The analgesic effect of bilateral neurolytic celiac plexus block on intractable upper abdominal cancer pain

作　　者：黄冰[1] 沈纪林[2] 郑汉光[3] 周煦燕[1] 侯健[1] 陆雅萍[1] 孙建良[1] 

机构地区：[1]嘉兴医学院附属第一医院麻醉科,浙江省嘉兴市314000 [2]嘉兴医学院附属第一医院放射科,浙江省嘉兴市314000 [3]杭州市红十字会医院麻醉科

出　　处：《中华麻醉学杂志》2006年第11期1032-1035,共4页Chinese Journal of Anesthesiology

基　　金：浙江省卫生厅人才基金资助项目(2000QN13);嘉兴市科技局计划项目(2006AZ2006)

摘　　要：晚期癌痛患者17例,男9例,女8例,年龄46-85岁,体重38-63kg,VASⅢ或Ⅳ级。CT引导下经T12-L1椎间隙左、右穿刺,针尖分别抵达膈脚外腹主动脉旁及膈脚内。分别注入含造影剂(30％碘海醇注射液1 m1)的1％利多卡因8 ml,CT示所注药液有会师趋势或已会师包绕腹主动脉后,左、右分别注入无水酒精20、15 ml,再次CT观察酒精扩散情况,以视觉模拟评分(VAS)及改良生活质量(QOL)评分评价镇痛效果。会师包绕腹主动脉的11例患者中8例(73％)镇痛效果满意至去世;另6例酒精在腹主动脉周围被转移的淋巴结分割呈斑点、斑片状,其中3例(50％)完全无痛。与腹腔丛阻滞(NCPB)前相比,NCPB后各时点的VAS评分下降,QOL评分升高(P<0．01)。双针会师法腹腔丛阻滞可使所注无水酒精在腹腔丛恰当分布,对顽固性上腹部癌痛患者有较好的镇痛效果。Bilateral neurolytic celiac plexus block was performed under CT control in 17 patients with intractable upper abdominal cancer pain. The patients were placed in prone position with a pillow under abdomen. T12-L1 interspace was located first. The needles were inserted at the level of T12-L1 interspace lateral to the midline. The points of needle entry were determined by CT. On the left side a 12 gauge 10 cm blunted needle which was slightly bent at distal 2 cm was inserted. The needle tip slid off the vertebral body anterolaterally until it reached the left side of aorta and left crus of diaphragm. On the right side a 7 gauge 12 cm needle was inserted through a 12 gauge guide needle and advanced through intervertebral disc until the anterior side of the vertebral body between the right crura of diaphragm. A mixture of alcohol and contrast medium 20 ml and 25 ml was injected through the left and right needle respectively. The spread of the neurolytic agent （alcohol） was checked by CT. The analgesia was evaluated by VAS and quality of life （QOL） score. As shown by CT scan the neurolytic agent spread in a vertical direction for （89 ± 36） mm on the left side and （76 ± 29）mm on the right. The neurolytic agent injected through the two needles met before the aorta in 11 patients, of whom 8 patients experienced complete pain relief （73%）. Complete analgesia was achieved in only 3 of the other 6 patients （50%）. VAS score was reduced from 7.91 ± 1.21 （before block） to 2.24 ± 0.41 （1 month after block） （P 〈 0.01）. The QOL score increased from 42 ± 5 to 51 ± 6 （ P 〈 0.01）. Bilateral neurolytic celiac plexus block can provide better analgesia in patients with intractable upper abdominal cancer pain.

关 键 词：自主神经传导阻滞 腹腔丛 疼痛 顽固性 肿瘤 

分 类 号：R735[医药卫生—肿瘤]