电针频率是决定家兔电针镇痛效果是否能被纳洛酮阻断的重要因素

<正> 人们在临床实践中体验到,在同一穴位上运用不同的针刺手法可产生不同的治疗效果。这一现象愈来愈引起针灸原理研究工作者的兴趣。近二十年来针刺镇痛原理的研究日益深入,业已证明,电针刺激可使中枢神经系统释放阿片肽产生镇痛作用。但阿片颉颃剂纳洛酮阻断大鼠电针镇痛的程度和所需的剂量与电针频率密切相     

针刺镇痛频率特异性的进一步证明

我们以往的工作证明 ,不同频率的电针会引起中枢不同种类的神经肽释放 ,产生不同的生理作用和治疗效果 ,近年来又有一些新的资料进一步证明并扩展了这一假说。1 .2Ｈｚ电针引起中枢内吗啡肽 (ＥＭ)释放 ,1 0 0Ｈｚ无效ＥＭ是近年新发现的一种阿片肽 ,还不清楚何种频率的电针可促进其释放。①将ＥＭ抗体注入大鼠脊髓蛛网膜下腔可阻断 2Ｈｚ电针镇痛 ,而不影响 1 0 0Ｈｚ电针镇痛 (Ｈａｎ ,ｅｔａｌ.ＮｅｕｒｏｓｃＬｅｔｔ,1 999,2 74:75) ;②将ＥＭ抗体或μ受体拮抗剂ＣＴＯＰ注入小鼠脑室 ,阻断 2Ｈｚ电针镇痛而不影响 1 0 0Ｈｚ电针镇痛 (…     

不同参数电针对内源性阿片肽系统调节的量效关系（英文）

内源性阿片肽是针刺麻醉及镇痛效应的神经化学基础,电针的运用使准确控制刺激量成为可能。本文探讨了不同参数电针对内源性阿片肽系统调节的量效关系,从单因素和不同参数组合的角度,重点讨论电针频率、波形、强度对内源性阿片肽系统的干预作用。研究发现内源性阿片肽系统具有频率响应特异性,低频电针促进脑啡肽、β-内啡肽、内吗啡肽的释放;高频电针选择性激活强啡肽系统;中频电针介于二者之间,可促进脑啡肽、β-内啡肽、强啡肽同时释放。疏密波能引起脑啡肽、β-内啡肽、内吗啡肽与强啡肽同时释放,具有协同增效的作用,但临床实践需灵活选择,有时连续波疗效更佳。内源性阿片肽系统参与介导适宜强度的电针刺激,超强电针产生的针效是一种非阿片机制的应激反应。此外,不同电针参数组合有不同的效应,优化不同疾病的最佳电针参数组合对于指导临床应用以及促进电针疗法的发展具有切实意义。     

不同电针频率刺激对胃扩张疼痛大鼠下丘脑内P物质、β-内啡肽表达的影响

目的:通过比较不同电针频率刺激"足三里"对胃扩张疼痛大鼠的拟痛行为学评分和下丘脑内疼痛信息物质P物质(SP)、β-内啡肽(β-EP)的影响,阐明电针防治胃扩张疼痛可能的物质基础,探讨不同电针频率的效应差异。方法:50只大鼠完全随机分成空白组、假手术组、模型组、低频电针组和高频电针组,除空白组外采用胃内植入气囊并充气40mmHg压力造成胃扩张疼痛模型,低频(2Hz)和高频(100Hz)电针刺激"足三里"为施治因素,观察大鼠拟痛行为学评分,用免疫组化法检测下丘脑组织中SP、β-EP的表达。结果:低、高频电针均能明显降低胃扩张疼痛大鼠的拟疼痛行为学评分,与针前比较差异有统计学意义(P<0.01);且高频电针组优于低频电针组(P<0.01)。与空白组和假手术组比较,模型组下丘脑组织中SP、β-EP阳性细胞数明显增加(P<0.01),低、高频电针可使下丘脑组织中SP、β-EP阳性细胞数继续增加(P<0.01),且低频电针组的SP、β-EP阳性细胞数增加更明显(P<0.01)。结论:不同电针频率刺激"足三里"均可减轻胃扩张疼痛大鼠的应激反应,这可能是通过促进了下丘脑内疼痛信息物质SP、β-EP的合成与释放,从而发挥镇痛作用,且高频电针的镇痛效应优于低频针。     

炎性痛电针镇痛参数优选及对炎性因子的影响

目的:评价不同参数电针的抗炎镇痛效应。方法:30只SD雄性大鼠,随机分为空白对照组(N组)、模型组(M组)、2Hz电针组、120Hz电针组和2/120Hz电针组。采用弗氏完全佐剂(CFA)建立炎性痛模型。不同参数电针干预大鼠患侧足三里和昆仑穴,分别于造模前,造模后24h,治疗第1、3、5、7、9、10天检测大鼠右后足机械缩足阈值(PWTs)。采用酶联免疫吸附试验(ELISA)检测大鼠右后足跖白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)的含量。结果:在电针干预后第7～10天,2/120Hz组大鼠PWTs高于2Hz组(P0.01～0.05);干预后第7、9天,2/120Hz组大鼠PWTs高于120Hz组(P0.01)。2/120Hz组大鼠足跖炎症因子IL-1β含量低于M组(P0.05);120Hz组和2/120Hz组大鼠足跖炎症因子TNF-α含量显著低于M组(P0.05)和2Hz组(P0.05,P0.01)。结论:不同参数电针均具有抗炎镇痛作用,但不同参数组合电针镇痛效果有所不同,电针干预炎性疼痛时,以2(50μs)/120Hz(200μs)疏密波电刺激为宜。     

催产素与加压素在针刺镇痛中的作用（之四）两种阿片肽抗血清与催产素和加压素电针镇痛的关系

为探讨OT和AVP增强电针镇痛与脑内阿片肽镇痛系统之间的关系，本工作观察了大鼠侧脑室注射抗β-内啡肽血清(AEPS)和抗强啡肽血清(ADYNS)对OT和AVP增强电针镇痛效应的影响。本实验中电针的穴位是双侧“足三里”，电针频率为18Hz。以钾离子透入—甩尾反应为痛指标。     

大鼠蛛网膜下腔注射dbcAMP或dbcGMP分别对抗或加强电针镇痛

<正> 近年来不少工作证明中枢神经系统中的环磷酸腺苷(cAMP)和环磷酸鸟苷(cGMP)在针刺镇痛中起着重要作用。例如大鼠侧脑室注射cAMP可明显拮抗电针镇痛和吗啡镇痛,射注cGMP可加强电针镇痛和吗啡镇痛。如果将微量的cGMP或其衍生物二丁酰cGMP(dbcGMP)注入大鼠缰核内,不但加强电针镇痛,并可延缓电针耐受的发展。但两种环核苷酸在脊髓中对针刺镇痛起何种作用,目前尚未见报道。本工作将二丁酰cAMP(dbcAMP)或二丁酰cGMP注入大鼠脊髓蛛网膜下腔内,观察其对电针镇痛的影响。     

经皮穴位电刺激对甲状腺手术患者术中血流动力学的影响

<正>经皮穴位电刺激(TAES)通过对穴位施以一定频率电刺激,引起内源性阿片肽及中枢神经系统多种介质释放,起到镇静、镇痛、降低应激反应的作用。本研究旨在观察于合谷、内关穴行TAES对甲状腺手术患者术中血流动力学的影响。1资料与方法     

不同参数组合电针对炎性痛模型大鼠镇痛效果及炎症因子的影响

目的:评价不同参数组合电针的抗炎镇痛效应,筛选出电针治疗炎性痛的最佳参数组合。方法:30只SD雄性大鼠,随机分为空白组(N组)、模型组(M组)、2 Hz组、100 Hz组和2/100 Hz组,每组6只。于SD大鼠右后足跖内注射完全弗氏佐剂(CFA)建立大鼠炎性痛模型。用电针干预大鼠患侧"足三里"和"昆仑"穴,于造模前,造模后24 h,治疗第1、3、5、7、10天检测大鼠右后足机械缩足阈值(PWTs)。采用酶联免疫吸附试验检测大鼠右后足跖炎症因子白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)的含量。结果:造模后24 h,除N组外,其余各组大鼠PWTs均显著下降(P0.01),提示造模成功。与M组比较,电针刺激干预后,电针组各时间点PWTs明显上升(P0.01)。在干预后第1、3、5天三个时间点检测PWTs后发现,电针组之间无统计学差异(P0.05);在电针干预后第7天,2/100 Hz组大鼠PWTs高于2 Hz组和100 Hz组(P0.01);干预后第9天,2/100 Hz组和100 Hz组大鼠PWTs高于2 Hz组(P0.05,P0.01);干预后第10天,2/100 Hz组大鼠PWTs高于2 Hz组(P0.01)。与N组比较,M组大鼠足跖炎症因子IL-1β、TNF-α含量显著升高(P0.01)。与M组比较,2 Hz组、100 Hz组和2/100 Hz组大鼠足跖炎症因子IL-1β含量显著降低(P0.05,P0.01);100 Hz组和2/100 Hz组大鼠足跖炎症因子TNF-α含量显著降低(P0.01)。与2 Hz组比较,100 Hz组和2/100 Hz组大鼠足跖炎症因子TNF-α含量显著降低(P0.05,P0.01)。结论:不同参数组合电针均具有抗炎镇痛作用,但不同参数组合电针镇痛效果有所不同,电针干预炎性疼痛时,以2(50μs)/100 Hz(200μs)最佳。     

夹脊穴注射加电针治疗腰椎间盘突出症128例

目的:观察夹脊穴注射加电针治疗腰椎间盘突出症的临床疗效。方法:取与病变相对应的双侧夹脊穴,以骨肽注射液4~8ml加10%葡萄糖注射液至20ml穴位注射,并配合电针治疗。结果:总有效率94.53%。提示:针刺可通过促进外周炎性组织阿片肽的释放而发挥免疫调控作用;电针能改善神经根周围微循环,消除炎性介质;而骨肽注射液穴位注射,兼有穴位刺激和药物的双重作用,抗炎镇痛、消除无菌性炎症。     

Differences of electroacupuncture-induced analgesic effect in normal and inflammatory conditions in rats

It has been reported by Stein et al. that the immune system and peripheral opioid receptors are involved in the control of pain accompanying inflammation. Electroacupuncture (EA) is used to relieve various kinds of pain. However, little is known about the effect of electroacupuncture analgesia (EAA) during hyperalgesia elicited by inflammation. The aim of the present study was to compare (1) the individual variation of EAA, (2) the durability of EAA, and (3) the effect of naloxone on EAA between normal rats and rats subjected to acute inflammatory pain. Carrageenan was subcutaneously administered by intraplantar (i.pl.) injection of the left hind paw to induce a nociceptive response. Nociceptive thresholds were measured using the paw pressure threshold (PPT). Rats received EA at 3 Hz in the left anterior tibial muscles for 1 hour after carrageenan injection. Naloxone was administered by intraperitoneal (i.p.) or i.pl. injection just before EA. EAA was elicited in 15 of 29 normal rats. These rats were divided into responders and non-responders. EAA in the responder group was almost completely antagonized by i.p. injection of naloxone. In contrast, in all the rats with carrageenan-induced inflammation, EAA was elicited, lasted for at least 24 hours after carrageenan injection, and was dose-dependently antagonized by i.pl. injection, but not significantly by i.p. injection of naloxone. It seems likely that the EAA in the rats with carrageenan-induced inflammation differs from that in normal rats, and these findings suggest that peripheral opioid receptors are involved in EAA during inflammatory conditions.     

脑室注射纳洛酮和肉桂硫胺对家兔电针镇痛的影响

<正> 应用阿片受体拮抗剂对抗针刺镇痛的实验观察已在人猴、猫、兔、大鼠及小鼠等动物上得到证实,说明中枢内源性阿片样物质(OLS)参与针刺镇痛;中枢5-羟色胺(5-HT)在针刺镇痛中的重要作用也已被确认。这两者在针刺镇痛过程中的作用具有密切的相互关系。本工作中,     

The attenuation effect of chlorpromazine on electro-acupuncture analgesia: involvement of dopamine system.

The effect of chlorpromazine (CPZ) (0.1 or 0.5 mg/kg, iv) on electroacupuncture analgesia (EAA) was examined by using potassium dolorimetry in rabbits. CPZ itself induced hyperanalgesia, whereas it attenuated EAA in terms of maximal increase of pain threshold as well as EAA after effect. Therefore, CPZ is not a good candidate for enhancing EAA in clinics. Monoamines and their metabolites in cerebrospinal fluid (CSF) of the rabbits were detected by high pressure liquid chromatography coupled to electrochemical detector (HPLC-ECD) method. It was revealed that CPZ enhanced DOPAC and HVA contents in CSF in both the presence and absence of electroacupuncture. CPZ attenuated EAA with elevations of DOPAC and HVA concentration in CSF. There was a positive correlation between the increases of DOPAC and HVA contents in CSF and attenuation effect of CPZ on EAA. These results suggested that activation of dopamine system be unfavorable for EAA.     

5-羟色胺在低频和高频电针镇痛中都起重要作用

<正> 我们在1975年首先报道,给家兔脑室注射5-羟色胺(5-HT)合成阻断剂对氯苯丙氨酸(PCPA)使间脑和低位脑干5-HT含量分别降低79.2％和48.5％,电针镇痛效果减弱63％。1976年又报道给大鼠腹腔注射pCPA300mg/kg使脑干、间脑、端脑5-HT含量分别降低73.2％、77.2％和85.1％,电针镇痛效果降低79％,上述效应并可为腔室注射5-羟色胺酸所翻转,从而认为中枢5-羟色胺在电针镇痛中起着重要作用。这一结论得到其后很多工作的支持。     

甲氧氯普胺加强电针镇内脏痛及其中枢机制

为进一步了解中枢DA系统与针刺镇痛的关系，寻找合理的加强针刺镇痛的药物，本文在家免内脏痛模型上观察了甲氧氯普胺对电针镇内脏病的影响。实验结果表明：甲氧氯普胺能够加强电针镇内脏病，并延长其后效应，该作用与阻断脑内DA受体有关。     

不同频率电针耐受对大鼠脊髓水平阿片肽心血管抑制作用的影响

<正> 在针刺镇痛原理的研究中,有资料表明,低频2赫电针引起的镇痛可被甲啡肽抗体对抗,高频100赫电针镇痛可被强啡肽抗体对抗,而变频2～15赫电针镇痛既可被甲啡肽抗体、也可被强啡肽抗体对抗,     

Analgesic effect of electric stimulation of peripheral nerves with different electric frequencies using the formalin test

Although electroacupuncture (EA) has been widely used to treat pain, the optimal frequency of EA therapy remains unclear. The study sought to determine the effect of different EA frequencies in a Sprague-Dawley (SD) rat model of pain. Electric stimulation (ES) at frequencies of 2 Hz, 15 Hz or 100 Hz was applied to the ipsilateral or contralateral sciatic nerve of the injected hindpaw of SD rats. Formalin (50 microl, 5%) was subcutaneously injected into the plantar surface of the left hindpaw to induce a nociceptive response. Behavior, including licking and biting, was observed to have two distinct periods, an early phase during the first 5 mins and a late phase from 21-35 mins after injection. The total biting or licking count served as an Indicator of nociceptive response. Our results indicate that ES of the ipsilateral sciatic nerve at a frequency of 2 Hz or 15 Hz reduced the nociceptive responses in both the early and the late phases of the formalin test, whereas ES at 2 Hz had greater antinociceptive effect than ES at 15 Hz in the early phase. No similar analgesic effect in the early phase was observed for ES at 100 Hz. Both pretreatment with ES at 2 Hz and naloxone (3 mg/kg, s.c.) produced a greater antinociceptive response in the late phase than when ES at 2 Hz was delivered immediately after formalin administration. In addition, ES of the neck muscle or contralateral sciatic nerve at a frequency of 2 Hz also decreased licking and biting activity in both phases. The results of this study indicate that different analgesic mechanisms are involved in the response to ES at frequencies of 2 Hz, 15 Hz and 100 Hz, and that ES at 2 Hz has a greater analgesic effect on formalin-induced nociceptive response, especially when it is delivered prior to the onset of pain. The analgesic effect of ES may be mediated via a central origin in the supraspinal level. These findings suggest that 2 Hz may be a good frequency selection for clinical EA applications in analgesia, and that pretreatment with EA at 2 Hz may be an effective method to treat post-operative pain.     

针刺复合小剂量硬膜外麻醉胆囊切除临床研究总结

目的 :针刺 (穴位电极刺激 )复合小剂量硬膜外麻醉胆囊切除临床研究。方法 :胆囊切除术共 1 0 6例 ,其中针硬组 (A组 ) 35例 ,电硬组 (B组 ) 35例 ,单纯硬膜外麻醉组 (C组 ) 36例。A组为针麻基础上复合小剂量硬膜外麻醉 ,B组为穴位电极刺激基础上复合小剂量硬膜外麻醉 ,C组为对照组 (单纯硬膜外麻醉 )。结果 :麻醉效果Ⅰ级率A组 80 0 0 %、B组 6 8 5 7%、C组 2 5 0 0 % ;硬膜外腔 1 5 %利多卡因用量 ,首次用量C组比A组、B组多用 35 43%、30 6 2 % (P <0 0 0 5 ) ;硬膜外腔首次用药量 9mL时A、B两组比C组多阻滞 2～ 3个神经节段 (A∶C、B∶C ,P <0 0 0 1 ) ;监测指标提示术中HR、BP、MBP、RR、TV、MV、SPO2 、ECG基本平稳 ,顺利、安全渡过手术。结论 :针刺(穴位电极刺激 )复合小剂量硬膜外麻醉可作为胆囊切除术麻醉方法之一。