CT引导下无水乙醇腹腔神经丛阻滞术治疗顽固性上腹部癌痛的量效关系  

Dose-response relationship of anhydrous ethanol for celiac plexus block performed under CT guidance in treating intractable upper abdominal cancer pain

作　　者：陈炜 费勇 姚明 黄冰 邓甲甲 Chen Wei;Fei Yong;Yao Ming;Huang Bing;Deng Jiajia(Department of Anesthesiology and Pain Medicine,the First Hospital of Jiaxing,Jiaxing 314001,China)

机构地区：[1]嘉兴市第一医院麻醉与疼痛医学中心,314001

出　　处：《中华麻醉学杂志》2020年第3期320-322,共3页Chinese Journal of Anesthesiology

基　　金：国家自然科学基金(81341035);浙江省省市共建重点学科建设计划(201901)。

摘　　要：目的确定CT引导下无水乙醇腹腔神经丛阻滞术治疗顽固性上腹部癌痛的量效关系。方法选择在CT引导下行无水乙醇腹腔神经丛阻滞术治疗顽固性上腹部癌痛的患者100例,年龄39~89岁,性别不限,体重37~64 kg,VAS评分≥7分,采用随机数字表法分为5组(n=20):不同剂量无水乙醇+碘海醇混合液组(R1-5组)。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。两侧分别注入含造影剂(30%碘海醇注射液0.4 ml)的1%盐酸利多卡因2 ml,CT示药液已会师包绕腹主动脉后20 min时,两侧分别注入无水乙醇8 ml(R1组)、10 ml(R2组)、12 ml(R3组)、14 ml(R4组)、16 ml(R5组)和碘海醇(碘海醇与无水乙醇1∶5)的混合液。阻滞有效定义为无水乙醇腹腔神经丛阻滞后10 min时,上腹部疼痛VAS评分≤3分,且收缩压较术前降低20%以上。采用Probit法计算无水乙醇腹腔神经丛阻滞术治疗顽固性上腹部癌痛的半数有效剂量(ED50)、95%有效剂量(ED95)及95%可信区间(CI)。结果无水乙醇腹腔神经丛阻滞术治疗顽固性上腹部癌痛的ED50及其95%CI为11.937(10.959~12.939)ml,ED95及其95%CI为19.665(17.448~24.212)ml。结论CT引导下无水乙醇腹腔神经丛阻滞术治疗顽固性上腹部癌痛的ED50和ED95分别为11.937和19.665 ml。Objective To determine the dose-response relationship of anhydrous ethanol for celiac plexus block performed under CT guidance in treating intractable upper abdominal cancer pain.Methods One hundred patients of both sexes with intractable upper abdominal cancer pain,aged 39-89 yr,weighing 37-64 kg,of visual analog scale score≥7,scheduled for elective celiac plexus block performed under CT guidance,were divided into 5 groups(n=20 each)by a random number table method:mixture of different doses of anhydrous ethanol plus iohaeol groups(R1-R5 groups).T12-L1 interspace was located first.The needle was inserted at the level of T12-L1 interspace.The points of needle entry were determined by CT.On the left side,a needle was inserted,and the tip slid off the vertebral body anterolaterally until it reached the left slide of aorta and left crus of diaphragm.On the right side,a needle was inserted and advanced until the anterior side of the vertebral body between the right crura of diaphragm.One percent lidocaine hydrochloride 2 ml containing contrast agent(30%iodohydramol injection 0.4 ml)was injected through the left and right needle.At 20 min after CT showed that the liquid injected had been met and wrapped around the abdominal aorta,the mixture of anhydrous ethanol 8 ml(R1 group),10 ml(R2 group),12 ml(R3 group),14 ml(R4 group),16 ml(R5 group)and iodinitol(iodinitol∶anhydrous ethanol=1∶5)was injected through the left and right needle.Effective block was defined as the visual analog scale score of superior abdominal pain≤3 and decrease in systolic pressure by more than 20%compared with the preoperative level at 10 min after the abdominal plexus block with anhydrous ethanol.The ED50,ED95 and 95%confidence interval of celiac plexus block in treating intractable upper abdominal cancer pain were calculated by Probit analysis.Results The ED50 and ED95(95%confidence interval)of celiac plexus block in treating refractory upper abdominal cancer pain were 11.937(10.959-12.939)ml and 19.665(17.448-24.212)ml,respectively.Concl

关 键 词：无水乙醇 剂量效应关系 药物 疼痛 顽固性 腹腔丛 神经传导阻滞 

分 类 号：R730.5[医药卫生—肿瘤]