摘要
目的:观察腹腔神经丛毁损性治疗前后镇痛效果、患者生存质量及血浆胃动素、β-内啡肽的变化。方法:选取2009年2月至2010年9月间中国医科大学附属盛京医院收治的62例顽固性上腹部癌性疼痛患者,其中男37例,女25例,平均年龄57.6岁。应用多种强阿片类镇痛药效果不佳或不良反应严重,疼痛评分大于5,生存质量低下,无严重凝血功能障碍,无腹腔内感染、脓毒血症及肠梗阻。在CT引导下行腹腔神经丛毁损性阻滞治疗。观察镇痛疗效、生存质量、不良反应及并发症,在治疗前及治疗后第1、3、7天检测血浆胃动素及β-内啡肽水平。结果:治疗后患者疼痛明显缓解,疼痛评分降低,治疗前l1点数字疼痛评分(NRS)为7.6±1.2,治疗后第7天为1.1±0.3,疼痛缓解50%(中度)以上的患者占96.8%。治疗后不良反应轻微,均在3天内缓解,无严重并发症发生,生存质量评分在治疗后明显改善,QOL各指标评分均明显降低。血浆胃动素水平在治疗后l天开始明显升高,治疗后3天达高峰,治疗后7天略有回落,但仍明显高于治疗前水平;β-EP水平在治疗后1天未见明显变化,但在治疗后3天明显升高,治疗后7天高达(336.9±29.4)pg/mL。结论:腹腔神经丛毁损阻滞治疗可以明显缓解上腹部癌痛,提高胃动素及β-内啡肽水平,改善胃肠动力,提高患者的生存质量,疗效确切,安全易行。
Objective： To evaluate the effects ofneurolytic celiac plexus block （ NCPB ） on pain relief, quality of life, and blood concentration of motilin and β-endorphin before and after treatment in patients with upper abdominal visceral cancer pain. Methods： Sixty-two patients with intractable upper abdominal visceral cancer pain were enrolled in the study （ 37 males and 25 females ）. All cases, including those with pain managed by opioids and those who rejected opioid usage because of severe adverse effects, still suffered persistent moderate-to-severe pain （ NRS ≥ 5 ） and had poorer health-related quality of life. Patients with coagulation disorders, intra-abdominal infection, pyemia or intestinal obstruction were not included in this study. NCPB was performed under CT guidance. Numeric rating scales （ NRS ）, pain relief and complications were recorded. Patients completed generic HS （ SF-36 ） and cancer-specific HRQL （ QOL-CS ） questionnaires before and after treatment to evaluate their quality of life. Blood concentration of motilin and 13-endorphin was observed before treatment and 1, 3, and 7 days after NCPB. Results： Pain relief was observed in all patients after NCPB. Numeric rating scale （ NRS ） at day 7 after treatment was 1.1±0.3 on average, lower than that before treatment （ 7.6±1.2 ）. Pain relief≥ 50 % was achieved in 96.8 %. Some patients who experienced mild adverse effects including low blood pressure, diarrhea, nausea and vomiting needed to stop treatment. No severe complications were observed in this study. Higher scores were exhibited on all SF-36 and QOL-CS before NCPB and lower scores were seen after the NCPB. Blood concentrations of motilin and β-endorphin changed signifi- cantly after NCPB. Motilin level was increased on the first day after NCPB, peaked on day 3 and then slightly decreased on day 7.13-endorphin level was increased on day 3 and reached 336.9±29.4 pg/mL on day 7 after NCPB. Conclusion： NCPB under CT guidance is an effective and safe technique for controlling intractable upper abdominal cancer pain. This treatment increases blood concentration levels of motilin and β-endorphin and improves the quality of life of patients with cancer pain.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2011年第5期272-274,283,共4页
Chinese Journal of Clinical Oncology
