腹腔神经丛阻滞术对胰腺癌患者吗啡药物用量的影响

Influence of morphine consumption on pancreatic cancer under neurolytic celiac plexus block

目的:评价腹腔神经丛阻滞治疗后对胰腺癌患者吗啡用药量的影响。方法:回顾总结本院2007年6月至2013年5月期间98例晚期胰腺癌伴有上腹部疼痛的癌痛患者(吗啡日服用量≥90mg,VAS评分≥5),其中46例患者口服吗啡滴定,调整增加最终吗啡用量(对照组),52例接受CT引导行腹腔神经丛阻滞治疗干预(观察组),观察比较治疗前、治疗后1、2、4、6个月两组患者服用吗啡药物的日用量、疼痛评分(VAS)及副反应、并发症。结果:观察组患者经腹腔神经丛阻滞治疗1、2、4、6个月后,服用吗啡药物的日用量与疼痛评分(VAS)较治疗前均降低(P<0.01)且均有逐渐递增趋势,但术后各个时间段均低于对照组吗啡用量(P<0.01)。所有98例患者治疗后均未发生严重相关并发症,有1例腹腔神经丛阻滞治疗患者治疗后吗啡撤药期间出现戒断反应。结论:腹腔神经丛阻滞治疗可明显减轻晚期胰腺癌的癌性疼痛并降低患者的吗啡用量;腹腔神经丛阻滞治疗后需按照个体化用药原则来调整患者的吗啡使用量。

AIM： To assess the influence of morphine consumption on pancreatic cancer after neurolytic celiac block for cancer pain. METHODS： 98 patients were reviewed in 2007 June- 2013 May, who suffered from advanced pancreatic cancer pain, morphine consumption ≥ 90 mg/d, VAS ≥ 5. The 46 patients therapied with morphine oral titration in control group for adjusting the final dose of morphine, the 52 cases of observation group were carried on neuroytie celiae plexus bloek（NCPB） with dehydrated ethanol via CT-guided, observed and compared ）efore treatment, after 1, 2, 4, 6 months of two groups of patients taking morphine drug dosage, pain score （VAS） and side-effects, eomplieaions. RESULTS. The observation group were reated by NCPB in the period of 1, 2, 4, 6 nonths later, consumption of morphine andVAS were lower than before treatment （P 〈 0.01） and there was a gradually increasing trend in morphine drug dosage and VAS, but each time period were lower than those of in the control group（P〈 0.01） for morphine dosage. All of the 98 patients after treatment, there were no serious complications, 1 cases of NCPB for patients after treatment occurred abstinence reaction in morphine withdrawal. CONCLUSION： Neurolytic celiac plexus block can effectively reduce advanced pancreatic cancer pain and morphine consumption. Individual dosage of morphine intake is requisite in cancer pain.