连续膈肌脚后间隙阻滞治疗顽固性上腹部癌痛疗效观察  

Continuous block in crura of diaphragm space for intractable upper abdominal cancer pain

作　　者：付霜[1] 曲丕盛[2] 方军[1] 袁晓红[1] 

机构地区：[1]浙江省肿瘤医院麻醉科,杭州310022 [2]浙江省中西医结合医院麻醉疼痛科

出　　处：《中国康复医学杂志》2015年第3期260-264,共5页Chinese Journal of Rehabilitation Medicine

摘　　要：目的:观察连续膈肌脚后间隙神经阻滞对顽固性上腹部癌性疼痛的疗效。方法:71例中晚期上腹部癌痛患者,随机分单次腹腔神经丛阻滞(NCPB)组(N组)、连续膈肌脚后间隙神经阻滞组(C组)和单独镇痛药物组(D组)。观察治疗前、后1周、1、2、4、6个月视觉模拟评分(VAS),吗啡用量和生存质量(QOL)及相关并发症情况。结果:3组治疗前后VAS评分均显著降低(P<0.01),1周至4个月,N组、C组低于D组(P<0.05),第6个月时,N组、D组差异不显著(P>0.05)。治疗后1—6个月疗效优良率D组低于N组、C组(P<0.05)。N组、C组治疗后吗啡用量低于D组,QOL均明显提高(P<0.01)。结论:神经阻滞联合镇痛药物优于单独药物治疗。连续膈肌脚后神经阻滞远期疗效及QOL改善优于单次NCPB治疗,可安全应用于临床治疗。Objective： To assess effects of continuous block in crura of diaphragm space by alcohol for intractable upper abdominal cancer pain. Method： Seventy-one patients who suffered intractable upper abdominal cancer pain （morphine consumption 1〉 90mg/day, VAS ≥5）, were randomly divided into neurolytic celiac plexus block （NCPB） group （group N, n= 27）, Continuous block in crura of diaphragm space group （group C, n=24） and drug group （group D, n=20）. Before puncture, a T12—L1 interspace CT scan was performed to determined the optimal approach, for the N group injected once for blocking by alcohol 25--30ml after puncture, the C group continuous injected alcohol 20--25ml once daily for 3 days via the catheter 3--5cm inserted in crura of diaphragm space by a needle punctured. D group titrated dosage for providing treatment of moderate. （observation, follow-up and recorded before, after 1 week of treatment, and 2, 4, 6 months of VAS, QOL curative effects of the three groups were compared with morphine usage and related complications）. Result： VAS before and after the treatment, in the three groups were significantly decreased （P〈 0.01）. After the treatment of 1 week to 4 months, N and C groups were lower than those in D group （P〈 0.05）, but the difference between group D and group N was not significant in 6th months （P 〉 0.05）. The excellent and good rate were higher in the 1st week after treatment not significant difference （P〉0.05）, but in the period of 1st to 6th months, the rates of group C and N were significantly higher （P〈 0.05）. To sixth months, the rates were 57.1% in N group, C group of 66.7% and more stable. The morphine consumption were significantly low-er than that of D group after nerve block in the treatment of two groups （P 〈 0.05）. Before and after treat-ment in group D, QOL had no significant difference, but in group N and C were significantly improved （P 〈0.01）. There were no serious complications in all patients. Conclusion�

关 键 词：膈肌脚后间隙 腹腔神经丛阻滞 癌性疼痛 

分 类 号：R730.5[医药卫生—肿瘤]