上腹部癌性痛患者三种腹腔神经丛毁损术效果的比较  

Comparison of efficacy of three kinds of neurolytic celiac plexus block in patients with upper abdominal cancer pain

作　　者：曲丕盛[1] 付霜[2] 张铁山[1] 陶凡[1] 郑汉光[1] 

机构地区：[1]杭州市红十字会医院麻醉科,310003 [2]浙江省肿瘤医院麻醉科

出　　处：《中华麻醉学杂志》2015年第1期60-63,共4页Chinese Journal of Anesthesiology

基　　金：浙江省卫生厅课题（200581406）

摘　　要：目的 比较上腹部癌性痛患者三种腹腔神经丛毁损术的效果.方法 选择上腹部癌症患者67例,性别不限,体重52～ 69 kg,采用随机数字表法将其分为3组：单侧膈肌脚后间隙毁损组（S组,n=23）、双侧膈肌脚后间隙毁损组（D组,n=22）和膈肌脚后间隙连续毁损组（C组,n=22）.S组、D组分别在CT引导下经皮单针、双针穿刺成功后注入无水乙醇总计25 ～ 30 ml行腹腔神经丛毁损,C组穿刺至膈肌脚后间隙后置管,经导管注入无水乙醇25～30 ml行腹腔神经丛毁损,每天1次,连续3d.治疗前、治疗后1周、1个月、2个月、4个月、6个月时记录吗啡日用量和VAS评分,采用VAS加权计算法评定疗效,记录治疗后腹泻、低血压、排尿困难、神经损伤等不良反应的发生情况.结果 与S组或D组比较,C组治疗后4～6个月吗啡日用量降低,治疗后4～6个月治疗有效率升高,C组和D组腹泻发生率较S组高,C组低血压发生率低于其他2组（P＜0.05）.结论 对于腹部癌性痛患者,膈肌脚后间隙连续腹腔神经丛毁损术的毁损效果较完善,且不良反应较少,效果优于单侧膈肌脚后间隙毁损术和双侧膈肌脚后间隙毁损术.Objective To compare the efficacy of three kinds of neurolytic celiac plexus block （NCPB） in the patients with upper abdominal cancer pain.Methods Sixty-seven patients of both sexes,with upper abdominal cancer,aged 45-64 yr,weighing 52-69 kg,were randomly divided into 3 groups using a random number table：single-needle NCPB using crura of diaphragm space approach group （group S,n =23）,double-needle NCPB via an anterior and posterior crura of diaphragm space approach group （group D,n =22）,and continuous NCPB via crura of diaphragm space approach group （group C,n =22）.In S and D groups,NCPB was performed with single injection of anhydrous alcohol 25-30 ml after CT-guided successful single and double punctures,respectively.In group C,a catheter was inserted into the crura of diaphragm space and then anhydrous alcohol 25-30 ml was injected via the catheter once a day for 3 consecutive days to perform NCPB.Before treatment,at 1 week after treatment,1,2,4 and 6 months after treatment,the daily consumption of morphine and VAS score were recorded.The therapeutic efficacy was evaluated using VAS weighted value calculation.The development of adverse effects such as diarrhea,hypotension,dysuria and damage to nerves was recorded.Results Compared with S or D groups,the daily consumption of morphine was significantly decreased at 4-6 months after treatment,the rate of effective treatment was increased at 4-6 months after treatment,and the incidence of hypotension was decreased in group C.The incidence of diarrhea was significantly higher in D and C groups than in group S.Conclusion For the patients with upper abdominal cancer pain,continuous NCPB via crura ofdiaphragm space approach provides perfect efficacy with fewer adverse reactions,and the efficacy is better than that of single-needle NCPB using crura of diaphragm space approach or double-needle NCPB via an anterior and posterior crura of diaphragm space approach.

关 键 词：腹腔丛 神经传导阻滞 

分 类 号：R730.5[医药卫生—肿瘤]