双次腹腔神经丛毁损性阻滞治疗中上腹顽固性癌性内脏痛疗效观察

Assessment of consecutive neurolytic celiac plexus block technique outcomes in the management of refractory visceral cancer pain

目的探讨双次腹腔神经丛毁损性阻滞治疗中上腹顽固性癌性内脏痛的疗效及安全性。方法对2005年1月—2011年12月在疼痛科住院保守治疗失败并接受CT引导下双次腹腔神经丛毁损性阻滞治疗的顽固性癌痛患者24例进行分析,评价患者疼痛缓解情况、不良反应以及并发症。结果双次腹腔神经丛毁损性阻滞能明显缓解患者的疼痛,VAS评分由术前的(8.3±1.3)分下降到术后的(1.4±1.1)分,吗啡用量由术前的(120±80)mg/d下降到术后的0,与术前比较差异均有统计学意义(P<0.01,P<0.05);疼痛缓解持续到术后6个月或直至患者死亡。其中发生轻微腹泻8例(33.3%),低血压9例(37.5%),一过性下肢无力1例(4.2%),但无手术相关死亡发生。结论 CT引导下双次腹腔神经丛毁损性阻滞可有效缓解中上腹顽固性癌性内脏痛患者的疼痛,显著减少阿片类药物用量,从而减少镇痛药的不良影响,且中远期疗效佳、安全性高。

Objective To explore the efficacy and safety of two-time celiac plexus block for the treatment of abdominal damage of intractable visceral pain caused by cancer.Methods For inpatients from January 2005 to December 2011 who were failed of conservative treatment of pain and underwent CT-guided celiac plexus blockade two-time block for the treatment of intractable cancer pain,24 cases were analyzed to evaluate the pain relief,adverse reactions and complications.Results Two-time celiac plexus blockade can relieve patients of pain,VAS score from preoperative（8.3±1.3）points down to postoperative（1.4±1.1）points,morphine from preoperative（120±80）mg/d down to postoperative 0,compared with preoperative differences were statistically significant（P0.01 or P0.05）;pain relief last 6 months or until death.Mild diarrhea which occurred in 8 cases（33.3%）,hypotension in 8 cases（37.5%）,transient lower extremity weakness in 1 case（4.2%）,but no procedure-related deaths occurred.Conclusion CT-guided celiac plexus blockade double times of arrest can effectively alleviate the intractable abdominal visceral pain in patients with cancer pain,significantly reduced opioid consumption,thus reducing the adverse effects of analgesics,and the long-term clinical outcome and safe.