彩色多普勒超声引导下阿霉素肋间神经毁损性阻滞的最小有效容量  

THE STUDY OF ADRIAMYCIN MINIMUM EFFECTIVE VOLUME IN DOPPLER ULTRASOU-ND-GUIDED INTERCOSTAL NERVE DAMAGE

作　　者：郑晓春[1] 吴松松[2] 黄风怡[1] 郭艳华[1] 徐文言[1] 陈晓辉[1] 

机构地区：[1]福建省立医院麻醉科,福州350001 [2]福建省立医院超声诊断科,福州350001

出　　处：《中国疼痛医学杂志》2012年第5期283-286,共4页Chinese Journal of Pain Medicine

基　　金：福建省卫生厅青年研究基金资助(项目编号:2009-1-4,2010-4-6)

摘　　要：目的:彩超引导精确定位行肋间神经毁损,探索阿霉素感觉神经毁损的最小有效容量。方法:21例带状疱疹后遗神经痛(postherpetic neuralgia,PHN)患者在彩色超声引导下穿刺肋间神经,以肋间动脉旁2 mm为目标,分别注射0.25%阿霉素0.2 ml^0.4 ml,注射后72 h内能使视觉模拟评分(visualanalogue scale,VAS)低于3为有效。应用Dixon上下法探索最小有效治疗容量,并用Probit test计算50%和95%有效容量(effective volume,EV50、EV95)。结果:彩超下可观察到目标肋间的重要结构,肋间动脉回声清晰,但肋间神经均未能探及。肋骨面到壁层胸膜的距离0.6±0.2 cm。穿刺针道均全程监测,注药后可见药液包绕肋间动脉,无误入胸腔等并发症。全部病例中注射容量为0.2 ml的有5例(有效0例);0.3 ml的有10例(有效5例,持续镇痛时间19±7天);容量0.4 ml的5例(有效4例,镇痛时间35±16天)(P<0.05);EV50、EV95分别为0.3 ml和0.36 ml。结论:彩色超声引导直视下肋间神经毁损术的安全性得到保证。阿霉素95%有效注射容量为0.36 ml。Objective： To explore the adriamycin minimum effective volume in Doppler ultra sound-guided intercostal nerve damage. Methods： 21 postherpetic neuralgia （PHN） patients received ultrasound-guided puncture intercostal nerves. The target areas were around intercostal arteries about 2 ram, and then 0.25% adriamycin was injected. The visual analogue scale （VAS） score was measured at 72 h after injection. The effective certification of pain control was that VAS score less than 3. The Dixon up and down method was used to explore the minimum effective volume and Probit test was used to calculate 50% and 95% effective capacity （EV50, EV95）. Results： Some important intercostal structure can be observed during Doppler ultrasound guiding, intercostal arteries were clear and intercostal nerve was failed to explore. The distances from rib surface to the parietal pleura were 0.6±0.2 cm. The needle pass ways were monitored, and the drug surrounding the intercostal artery after injection can be seen, without any straying into the chest complications. In all patients, injection volume was 0.2 ml in 5 cases （0 cases was effective）; 0.3 ml in 10 cases （5 cases were effective）; 0.4 ml in another 5 cases （4 cases were effective）. EV50 and EV95 were 0.3 ml and 0.36 ml respectively. Conclusion： The safety of ultrasoundguided intercostal nerve damage was guaranteed. The study show that adriamycin 0.36 ml （EV95） could produce analgesia effectively.

关 键 词：多普勒 肋间神经 阿霉素 

分 类 号：R445.1[医药卫生—影像医学与核医学]