超声引导下腹腔神经丛毁损治疗癌性上腹痛的效果  

Effect of ultrasound-guided celiac plexus lesion in the treatment of cancerous upper abdominal pain

作　　者：张宇 双丽 布仁吉雅 苗淑芳 布和 张凯琴 亲德门 潘小平 ZHANG Yu;SHUANG Li;Burenjiya;MIAO Shufang;BU He;ZHANG Kaiqin;Qindemen;PAN Xiaoping(Postgraduate School of Baotou Medical College,Baotou 014040,China;Tumor Interventional Vascular Surgery Department of Inner Mongolia International Mongolian Medical Hospital;Laboratory Department of Inner Mongolia International Mongolian Medical Hospital;Mongolian Cancer Department of Inner Mongolia International Mongolian Medical Hospital)

机构地区：[1]包头医学院研究生院,内蒙古包头014040 [2]内蒙古国际蒙医医院肿瘤介入血管外科 [3]内蒙古国际蒙医医院检验科 [4]内蒙古国际蒙医医院蒙医肿瘤科

出　　处：《包头医学院学报》2023年第12期76-81,共6页Journal of Baotou Medical College

摘　　要：目的:观察超声引导下腹腔神经丛毁损(CPN)治疗前、后镇痛的效果、及血浆白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)整体含量及与疼痛度的相关关系。方法:对49例经三阶梯药物镇痛后仍未缓解的顽固上腹痛病患,在超声引导下行CPN,观察不良反应,统计CPN治疗前和治疗后1 d、3 d、1周、1个月病患疼痛度,通过视觉模拟量表(VAS)评分评估疼痛度,并采集治疗前及治疗后72 h空腹静脉血,用ELISA法测定IL-1β及TNF-α含量。结果:(1)治疗后49例病患VAS评分显著低于治疗前(P<0.001);(2)治疗后病患血浆IL-1β、TNF-α含量均显著低于治疗前(P<0.001);(3)治疗前及治疗后72 h,病患血浆IL-1β、TNF-α含量与VAS评分之间呈正相关(r=0.750、r=0.748,P<0.001);(4)治疗期间未出现严重并发症。仅有5例出现穿刺部位疼痛,24 h后缓解;13例出现腹泻;10例发生恶心、呕吐;8例出现术后低血压。结论:超声引导下CPN便利、安全、有效,近期镇痛效果好,可成为介入治疗上腹部癌痛的手段。患者血浆IL-1β、TNF-α含量与VAS呈显著正相关,可用作疼痛严重度及辅助评估疼痛改变的关键指标。Objective:To observe the analgesic effect of ultrasound-guided celiac plexus lesion(CPN)before and after treatment and the overall content of plasma interleukin-1β(IL-1β)and tumor necrosis factor-α(TNF-α)and their correlation with pain degree.Methods:Forty-nine patients with intractable upper abdominal pain who had not been relieved after three-step drug analgesia were treated with ultrasound-guided CPN.The adverse reactions were observed.The pain degree of patients before and 1 day,3 days,1 week and 1 month after CPN treatment was counted.The pain degree was evaluated by Visual Analogue Scale(VAS)score.Fasting venous blood was collected before and 72 hours after treatment,and the contents of IL-1βand TNF-αwere determined by ELISA.Results:(1)The VAS score of 49 patients after treatment was significantly lower than that before treatment(P<0.001);(2)The levels of plasma IL-1βand TNF-αafter treatment were significantly lower than those before treatment(P<0.001);(3)There was a positive correlation between plasma IL-1β,TNF-αlevels and VAS scores before treatment and 72 hours after treatment(r=0.750,r=0.748,P<0.001);(4)No serious complications occurred during the treatment,only 5 patients had pain at the puncture site,which was relieved 24 hours later;13 patients had diarrhea;10 patients had nausea and vomiting;8 patients had hypotension after treatment.Conclusion:Ultrasound-guided CPN is convenient,safe and effective,and has good short-term analgesic effect.Meanwhile,it can be used as a means of interventional therapy for upper abdominal cancer pain.The levels of plasma IL-1βand TNF-αof patients are significantly positively correlated with VAS,which can be used as key indicators for pain severity and auxiliary evaluation of pain changes.

关 键 词：超声 腹腔神经丛 恶性肿瘤 疼痛 细胞因子 

分 类 号：R730.5[医药卫生—肿瘤]