芬太尼透皮贴剂预防脾栓塞后疼痛的临床观察

目的 观察芬太尼透皮贴剂预防脾栓塞术后疼痛的疗效. 方法 29例接受脾栓塞治疗的血液病患者（治疗组）,在术前10～12 h应用芬太尼透皮贴剂5 mg,观察其镇痛效果［采用视觉模拟评分（VAS）评分］及不良反应.同时回顾性分析14例接受脾栓塞治疗而未应用芬太尼透皮贴剂（对照组）的情况.结果 治疗组疼痛完全缓解9例(31.03%),疼痛部分缓解16例(55.17%),疼痛未缓解4例（13.8%）,镇痛满意率86.2%,VAS评分（1.93±1.77）分;对照组VAS评分（6.43±2.90）分,两组间差异有极显著性 (P<0.01).芬太尼透皮贴剂不良反应发生率低,主要有恶心、呕吐、食欲减退、便秘等,1例发生了肠麻痹及腹胀. 结论 芬太尼透皮贴剂预防脾栓塞术后疼痛的效果好,使用方便,不良反应发生率低，建议作为脾栓塞治疗前的常规用药.     

穴位注药治疗精神分裂症的研究

目的　观察穴位注射丹参合并小剂量抗精神病药物与单用抗精神病药物治疗精神分裂症的疗效。方法16 0例患者随机分为治疗组 10 0例 ,对照组 6 0例 ;辨证分为 5型 ,用阴阳经相配取穴的方法 ,根据疾病的虚实 ,用迎随和徐疾补泻手法 ,治疗组每日注射 1次 ,10次为 1疗程 ,共治疗 3个疗程 ;用简明精神症状量表 (BPRS)和药物副反应量表 (TESS)评定疗效和副反应 ,治疗结束后随访两年。结果　治疗组痊愈率、显效率与对照组间差异有显著性意义 (P <0 0 5 )。BPRS和TESS量表于每疗程结束后两组评分比较差异均有显著性意义 (P <0 0 5 ) ;复发率与对照组间差异有显著性意义 (P <0 0 5 )。结论　穴位注射丹参具有见效快、副作用少、远期疗效好的特点。实施有效的护理 ,适时的健康教育是提高患者依从性 ,保证有效治疗、取得良好效果的重要手段。     

小剂量纳洛酮对吗啡镇痛效能的影响

目的 研究能够增强吗啡镇痛效能的纳洛酮剂量范围.方法 84只雄性SD大鼠,取42只随机分为7组(n=6),即生理盐水组对照组(NS)、吗啡对照组(M组,皮下注射吗啡6mg/kg),吗啡复合纳洛酮组(MN组,皮下注射吗啡6mg/kg及纳洛酮),根据纳洛酮剂量的不同(分别为1μg/kg、100、10、1和0.1ng/kg),MN组又分为MN1、MN2、MN3、MN4和MN5组.测定各组大鼠在注药前及注药后不同时间点的痛阈.另外42只大鼠分组方法 同上,仅将M组和各MN组吗啡剂量改为2mg/kg,在大鼠后爪建立急性疼痛模型后,分别皮下注射生理盐水或相应药物,观察各组大鼠在1h内的累积疼痛评分.结果 与NS组比较,M组和各MN组大鼠的痛阈在5～120min显著增高(P＜0.01);累积疼痛评分显著降低(P＜0.01).与M组比较,MN1组大鼠在30、40、50min的疼痛阈值显著降低(P＜0.01),累积疼痛评分升高(P＜0.01);MN2、MN3、MN4组大鼠的疼痛阈值在注药后20～120min内显著升高(P＜0.01),累积疼痛评分降低(P＜0.05);MN5组疼痛阈值、累积疼痛评分与M组比较无统计学差异(P＞0.05).结论 1～100ng/kg的纳洛酮能够增强吗啡对大鼠的镇痛效能,1μg/kg的纳洛酮可拮抗吗啡的镇痛效能,而剂量在0.1ng/kg时则不增强吗啡的镇痛效能.     

刺激视上核对大鼠痛阈及电针镇痛的影响

以钾离子透引起的大鼠甩尾反应为痛指标，观察了电和化学刺激视上核（ＳＯＮ）对大鼠痛阈（ＰＴ）和电针（ＥＡ）镇痛的影响。电刺激ＳＯＮ后，ＰＴ明显高于假刺激组（Ｐ＜０．０５～０．００１），电刺激ＳＯＮ后电针足三里，镇痛效应明显提高，并有明显的量效关系。电刺激ＳＯＮ的近旁部位（０．５—１ｍｍ）对ＰＴ及电针镇痛无明显影响。ＳＯＮ内注射Ｌ－谷氨酸（Ｌ－Ｇｌｕ）后痛阈和电针镇痛效应都明显对照组，也有明显的量效关     

论神经在腧穴针感形成中作用

腧穴针感在针刺防治疾病过程中发挥着重要作用。本文从针刺作用的感受器,腧穴针感的外周传入神经,以及针感与中枢神经的关系,诸方面,列举大量实验结果和理论,阐明针感形成的物质基础是神经系统。     

Retardation of pain development: a case of recovery from congenital insensitivity to pain

Congenital analgesia is a rare genetic disorder. We report here that a 12-year-old boy was able to recover from congenital insensitivity to pain. Neurological examinations revealed that there was a 'stocking' distribution of pain decrement on the lower extremities under the patient's knee joints. Magnetic Resonance Imaging (MRI) of his brain showed gyrus thinning with sulcus widening at both sides of the parietal lobe. Southern blot hybridization probed with cDNAs of various opioid receptors did not detect any significant abnormality. Our results suggest that this rare case may not be genetically determined.     

褪黑素和哌替啶对小鼠的镇痛作用比较

利用热板法或甩尾法测定小鼠痛阈，发现褪黑素１０～４０ｍｇ·ｋｇ－１ｉｐ后６０ｍｉｎ时镇痛作用最强，１５０ｍｉｎ时仍有镇痛作用。哌替啶１０～４０ｍｇ·ｋｇ－１ｉｐ后３０ｍｉｎ时镇痛作用最强，１２０ｍｉｎ时已无镇痛作用。在６０ｍｉｎ时两者镇痛作用相近。是示两者的作用特点不同。     

Ambulatory laparoscopic fundoplication

Background: Increasingly larger series of laparoscopic fundoplications (LF) are being reported. A well-documented advantage of the laparoscopic approach is shortened hospital stay. Most centers report typical lengths of stay (LOS) for LF of 2–3 days. Our success with LF with a LOS of 1 day led to an attempt at performing LF on an ambulatory basis. Methods: Sixty-one consecutive patients with appropriate criteria for LF underwent surgery at our institution. Patients were counseled by the authors as to the usual postop course and progression of diet. All patients received preemptive analgesia (PEA) consisting of perioperative ketorolac and preincisional local infiltration with bupivicaine. Anesthetic management included induction with propofol, high-dose inhalational anesthetics, minimizing administration of parenteral narcotics, and avoidance of reversal of neuromuscular blockade. Immediate postop pain management included parenteral ketorolac and oral hydro- or oxycodone. All patients were given oral fluids and soft solids after transfer from the recovery room to the postoperative observation unit. Two patients were excluded from ambulatory consideration due to excessive driving distance from our hospital. Another two were hospitalized for observation after experiencing intraoperative technical problems. Results: Of 57 patients in whom same-day discharge was attempted, there were three failures requiring overnight hospitalization: All were due to pain and nausea; one patient also suffered transient urinary retention. There were no adverse outcomes related to early discharge, and there were no readmissions. One patient returned to the emergency room after delayed development of urinary retention. Median time from conclusion of operation to discharge was less than 5 h. No patients expressed dissatisfaction with early discharge on follow-up interview. Conclusions: LF can be safely performed as an ambulatory procedure. Analgesic and anesthetic management should be tailored to minimize nausea and provide adequate pain control. Received: 1 April 1996/Accepted: 29 May 1997     

青黛颗粒抗炎、镇痛作用的实验研究

目的 :通过对青黛颗粒抗炎、镇痛作用的实验研究 ,探讨该药治疗溃疡性结肠炎的作用机理。方法 :采用小鼠醋酸扭体法、大鼠棉球肉芽肿法和角叉菜胶所致大鼠足肿胀方法。结果 :青黛颗粒给药高、中、低剂量组和阳性对照药组均明显降低小鼠扭体次数 (P<0 .0 5～P<0 .0 1)。对大鼠棉球肉芽肿和大鼠足肿胀有显著的抑制作用 (P <0 .0 1～P <0 .0 0 1)。结论 :青黛颗粒分别对大鼠具有抗炎、对小鼠具有镇痛作用。且镇痛作用呈量效关系