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-1β and TNF-α were 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-1β and TNF-α after treatment were significantly lower than those before treatment (P＜0.001); (3) There was a positive correlation between plasma IL-1β, TNF-α levels 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-1β and TNF-α of patients are significantly positively correlated with VAS, which can be used as key indicators for pain severity and auxiliary evaluation of pain changes.
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