| 张一肖,陶凡,赵杰,曲丕盛,万海方,章小林.连续腹腔神经丛阻滞对癌性腹痛患者的血流动力学变化的影响[J].浙江中西医结合杂志,2020,30(11): |
| 连续腹腔神经丛阻滞对癌性腹痛患者的血流动力学变化的影响 |
| The hemodynamic effects of continuous abdominal plexus on in patients with cancer abdominal pain |
| 投稿时间：2018-12-22 修订日期：2020-10-10 |
| DOI： |
| 中文关键词: 连续腹腔丛神经阻滞 腹腔神经丛 膈肌脚后间隙 上腹部癌性疼痛 |
| 英文关键词:Continuous abdominal plexus block Peritoneal plexus Posterior foot space of diaphragm Cancerous pain of upper abdomen |
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| 中文摘要: |
| 摘 要 目的 比较单次与连续腹腔神经丛阻滞对癌性腹痛患者血流动力学影响。方法 选择53例上腹部癌症伴重度疼痛的患者，随机分成两组：单次腹腔神经丛阻滞（S组，N=26）；连续腹腔神经丛阻滞（D组，N=27）。两组分别在CT引导下经皮穿刺成功，S组为经穿刺针一次性注入无水酒精30ml，D组为经膈肌脚后间隙预留置导管并分次注入无水酒精20-25ml后，分别予24h、48h重复经导管进行上述阻滞。记录两组病人神经阻滞术前、中、后的血流动力学变化及VAS评分；记录两组并发症和毒副作用。 结果 两组的一般资料比较差异无统计学意义（P>0.05)；血流动力学变化，S组在神经阻滞术后10min、30min发生低血压及窦缓的比例高于D组，差异有统计学意义（P<0.05)。VAS评分比较，两组V0-V2 差异无统计学意义（P>0.05）；D组V3-V4的VAS评分低于S组，差异有统计学意义（P<0.05)；两组不良反应发生率差异无统计学意义（P>0.05)。结论 经膈肌脚后间隙预放置导管并连续多次腹腔神经丛阻滞术对患者的血流动力学更平稳，发生低血压和窦缓的比例低，且远期镇痛效果更理想，适合用于晚期癌症患者的疼痛治疗。 |
| 英文摘要: |
| ABSTRACT Objective A comparison of the hemodynamics effects of single and continuous abdominal plexus in patients with cancer abdominal pain. Methods Fifty-three patients who suffered intractable upper abdominal cancer pain,were randomly divided into neurolytic celiac plexus block (NCPB) group (group S, n=26), Continuous block in crura of diaphragm space group (group D, n=27). Before puncture, a T12—L1 interspace CT scan was performed to determined the optimal approach, for the S group injected once for blocking by alcohol 30ml after puncture, the D 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. We observed the changes of hemodynamics and VAS scores before, during and after nerve block and the complications and side effects were recorded. Results There was no significant difference in general data between the two groups (P > 0.05). The incidence of hypotension and sinus bradycardia in group S was higher than that in group D at 10 and 30 mi after nerve block (P < 0.05) in hemodynamic changes. There was no significant difference in V0-V2 between the two groups (P > 0.05) by VAS score; the VAS score of V3-V4 in group D was lower than that in group S (P < 0.05); there was no significant difference in the incidence of adverse reactions between the two groups (P > 0.05). Conclusion Pre-placement of catheters through the posterior diaphragm foot space and continuous multiple celiac plexus block are more stable for hemodynamics, lower incidence of hypotension and sinus bradycardia, and better long-term analgesic effect. It is suitable for pain treatment in patients with advanced cancer. |
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