舒芬太尼用于腹腔镜胆囊切除术后替代性镇痛的临床研究

目的评价舒芬太尼用于瑞芬太尼和丙泊酚静脉复合麻醉下腹腔镜胆囊切除术（LC）后替代性镇痛的临床效果和安全性。方法 ASAⅠ~Ⅱ级择期行腹腔镜胆囊切除术患者90例,随机分为3组,每组30例,分别于停用瑞芬太尼后静脉注射舒芬太尼0.1μg/kg（S1组）,舒芬太尼0.2μg/kg（S2组）和芬太尼0.5μg/kg（F组）。记录3组患者在静脉镇痛后15min（T1）、30min（T2）、1h（T3）、2h（T4）、4h（T5）等各时间点镇痛、镇静评分,需要再次镇痛的例数及各组可能出现的尿潴留、皮肤瘙痒、恶心、呕吐等不良反应。结果 S1、S2组在同一时间点上疼痛视觉模拟评分（VAS）差异无统计学意义（P〉0.05）,与F组对应值比较,S1、S2组患者在T3、T4时VAS评分显著降低（P〈0.05）,而且主动要求再次镇痛的例数也少于F组（P〈0.05）。S2组患者在T1时镇静评分（Ramsay）较S1、F组显著增加（P〈0.05）。结论静脉注射舒芬太尼可作为瑞芬太尼和丙泊酚静脉复合麻醉下LC术后替代性镇痛的有效方法 ,推荐剂量为0.1μg/kg。     

舒芬太尼用于前列腺电切术后镇痛的临床研究

目的观察舒芬太尼复合罗哌卡因用于前列腺电切术后患者硬膜外自控镇痛（PCEA）的临床效果和不良反应。方法选择ASAⅠ～Ⅱ级行前列腺电切术的患者60例,随机分为两组（Ⅰ组和Ⅱ组）各30例,术后行PCEA。Ⅰ组镇痛用药为：芬太尼0.4mg＋罗哌卡因200mg＋生理盐水,总量为100ml。Ⅱ组镇痛用药为：舒芬太尼0.05mg＋罗哌卡因200mg＋生理盐水,总量为100ml。两组均采用负荷剂量（5ml）＋持续输注背景剂量（2ml/h）＋患者自控镇痛（PCA）剂量（0.5ml/次）,锁定时间15min。分别于术后6,12,24,48h双盲对照观察两组各时间段镇痛药的用量、PCA的实际按压次数及有效按压次数、视觉模拟评分（VAS）、生命体征以及恶心、呕吐、头晕、嗜睡、呼吸抑制和皮肤瘙痒等不良反应的发生情况。结果两组患者总体镇痛效果满意,生命体征稳定。两组间各时间点VAS评分、PCA实际按压次数及不良反应发生率的比较差异均有统计学意义（P〈0.05）。结论舒芬太尼与罗哌卡因复合应用于前列腺电切术后的患者行PCEA,镇痛效果明确,不良反应发生率低。     

电针对佐剂性关节炎大鼠镇痛作用及内啡肽影响

目的观察电针腰夹脊穴对佐剂性关节炎(AA)大鼠的镇痛效应及中枢β-内啡肽(β-EP)的影响,探讨电针镇痛的部分中枢机制。方法以AA大鼠为疼痛模型,以局部痛阈、足跖容积为指标观察电针的镇痛作用,并采用放射免疫法测定大鼠下丘脑、脊髓β-EP含量。结果电针可显著提高AA大鼠痛阈、降低其足跖容积,并能显著提高其下丘脑、脊髓的β-EP含量。结论电针有良好的镇痛治疗作用,其机制可能与其调节中枢β-EP的含量有关。     

《脾胃论》药物性味配伍法探析

目的:探讨《脾胃论》中药物五味配伍疗效关系。方法:研究原著及参考文献,用统计分析原著作中所有方剂中的药物分类、关联性,进一步总结药物的性味配伍方法。结果:《脾胃论》中药物性味配伍,多以辛甘苦并用,起到补脾升举阳气、泻阴火、疏肝理气、除湿热、行气止痛、散结消痞六个方面的作用。     

星状神经节阻滞联合普瑞巴林治疗胸背部带状疱疹病理性神经痛的临床研究

目的:观察普瑞巴林联合星状神经节阻滞治疗胸背部带状疱疹病理性神经痛的疗效和安全性。方法:120例胸背部带状疱疹病理性神经痛的患者,按入组顺序随机分为3组:A组:星状神经节阻滞治疗;B组:口服普瑞巴林治疗;C组:普瑞巴林联合星状神经节阻滞治疗。治疗中,B组和C组口服普瑞巴林,剂量为每次150 mg,bid,连续服用8周。结果:治疗后,3组的NRS评分均明显降低(P<0.05);B组和C组的NRS评分相当,组间比较无显著差异;但B组和C组的NRS评分均较A组明显降低(P<0.05)。不良反应主要是声音嘶哑、局部血肿、头晕、嗜睡和水肿。结论:普瑞巴林联合星状神经节阻滞治疗胸背部带状疱疹病理性神经痛安全有效。     

A pilot study of preemptive morphine analgesia in preterm neonates: effects on head circumference, social behavior, and response latencies in early childhood

Use of preemptive analgesia in Neonatal Intensive Care Units is recommended for severe and/or invasive procedures. However, the potential long-term consequences of such analgesia, which may be prolonged, are only beginning to be studied. In this pilot study, a subset of subjects previously enrolled in the Neurological Outcomes and Preemptive Analgesia in Neonates (NEOPAIN) trial was assessed at early childhood. These ex-preterm infants (born at 23-32 weeks of gestational age) required intubation within 72 h postpartum and were randomized to receive either preemptive morphine analgesia (maximum of 14 days) or placebo within 8 h post-intubation. At 5-7 years of age, neuropsychological outcomes, morphometrics, adaptive behavior, parent-rated behavior, motivation, and short-term memory were measured. Although overall IQ and academic achievement did not differ between the morphine treated (n = 14) and placebo (n = 5) groups, preemptive morphine analgesia was associated with distinct differences in other outcome variables. Head circumference of morphine treated children was approximately 7% smaller (Cohen's d: 2.83, effect size large) and body weight was approximately 4% less (Cohen's d: 0.81, effect size large); however, height did not differ. In the short-term memory task (delayed matching to sample), morphine treated children exhibited significantly longer choice response latencies than placebo children (3.86 ± 0.33 and 2.71 ± 0.24 s, respectively) (p < 0.03) and completed approximately 27% less of the task than placebo children (Cohen's d: 0.96, effect size large). Parents described morphine treated children as having more social problems, an effect specific to creating and maintaining friendships (Cohen's d: − 0.83, effect size large). Despite the small sample size and the preliminary nature of this study, these results are strongly suggestive of long-lasting effects of preemptive morphine analgesia. A larger investigation with more comprehensive assessments of some of these key features will enable a more complete understanding of the relationship between preemptive morphine treatment and long-term neurocognitive, behavioral, and adaptive outcomes.     

The Mu-Opioid Receptor and the NMDA Receptor Associate in PAG Neurons: Implications in Pain Control

The capacity of opioids to alleviate inflammatory pain is negatively regulated by the glutamate-binding N-methyl--aspartate receptor (NMDAR). Increased activity of this receptor complicates the clinical use of opioids to treat persistent neuropathic pain. Immunohistochemical and ultrastructural studies have demonstrated the coexistence of both receptors within single neurons of the CNS, including those in the mesencephalic periaqueductal gray (PAG), a region that is implicated in the opioid control of nociception. We now report that mu-opioid receptors (MOR) and NMDAR NR1 subunits associate in the postsynaptic structures of PAG neurons. Morphine disrupts this complex by protein kinase-C (PKC)-mediated phosphorylation of the NR1 C1 segment and potentiates the NMDAR–CaMKII, pathway that is implicated in morphine tolerance. Inhibition of PKC, but not PKA or GRK2, restored the MOR–NR1 association and rescued the analgesic effect of morphine as well. The administration of N-methyl--aspartic acid separated the MOR–NR1 complex, increased MOR Ser phosphorylation, reduced the association of the MOR with G-proteins, and diminished the antinociceptive capacity of morphine. Inhibition of PKA, but not PKC, CaMKII, or GRK2, blocked these effects and preserved morphine antinociception. Thus, the opposing activities of the MOR and NMDAR in pain control affect their relation within neurons of structures such as the PAG. This finding could be exploited in developing bifunctional drugs that would act exclusively on those NMDARs associated with MORs.     

鼻腔喷雾剂给药装置的性能考察

目的:考察所选鼻腔喷雾剂给药装置的性能,建立评价该类装置性能的方法。方法:参考2010年版《中国药典》喷雾剂项下有关要求,分别以失重率和增重率为指标考察高温(60℃)和高湿(95%)条件下装置的密闭性,以及室温、40℃、60℃条件下的每喷喷量。结果:该装置在高温和高湿条件下失重率和增重率均<1%,3种条件下以60℃时的每喷喷量不准确、差异较大。结论:该装置的密闭性良好,在40℃及以下温度环境中放置时的每喷喷量准确、精密度好,符合鼻腔给药装置的要求。本文建立的方法可用于该类装置的性能考察。     

曲马多应用于不同骨伤手术后患者自控静脉镇痛的临床观察

目的:观察曲马多对不同类型的骨伤手术后患者自控静脉镇痛的临床效果。方法:将按美国麻醉师协会(ASA)分级标准评为Ⅰ～Ⅱ级的择期骨伤手术患者192例根据手术部位分为6组:上肢长骨干组(Ⅰ组)、肩肘关节组(Ⅱ组)、下肢长骨干组(Ⅲ组)、足踝组(Ⅳ组)、髋膝关节组(Ⅴ组)、脊柱骨盆组(Ⅵ组)。手术结束前10min将镇痛泵与患者连接并开启进行自控静脉镇痛,镇痛用药为曲马多15mg·kg-1(联合格拉司琼9mg止吐)。分别于术毕清醒时及术后2、4、12、24及48h记录生命体征指标,进行疼痛评分(视觉模拟评分法,VAS)及镇静评分(Ramsay评分法)并观察不良反应发生率及调查患者对术后镇痛的满意度。结果:各组各时间点相关生命体征指标差异无统计学意义(P>0.05);术后各组各时间点Ramsay评分差异无统计学意义(P>0.05);术后2、4h各组VAS评分在3～6分左右,均高于其他时间点,差异有统计学意义(P<0.05),并且Ⅱ、Ⅳ组术后2、4、12、24h的VAS评分在3～6分左右,均高于同时间点其他各组的1～3分,差异有统计学意义(P<0.05);不良反应发生率各组差异无统计学意义(P>0.05),且均未发现严重不良反应;Ⅱ、Ⅳ组患者满意率显著低于其他组,差异有统计学意义(P<0.05)。结论:曲马多15mg·kg-1进行患者自控静脉镇痛对于大多数骨伤手术能达到较好的镇痛效果,无明显的不良反应,但对于肩肘关节及足踝部位的手术镇痛效果相对欠佳。     

硬膜外隙预注小剂量吗啡超前镇痛对高龄患者术后认知功能的影响

目的观察术前硬膜外隙预注小剂量吗啡超前镇痛对高龄患者术后认知功能的影响。方法选择在硬膜外麻醉下行单侧人工全髋关节置换术且麻醉效果确切的的高龄患者84例,随机均分为A、B两组。A组在麻醉平面出现后,0.75%布比卡因5～10mL注入硬膜外隙前,吗啡1.5mg注入硬膜外隙。B组在术毕将吗啡1.5mg注入硬膜外隙。观察并记录两组患者术后镇痛持续时间、术后镇痛中恶心、呕吐等不良反应。分别于术后4、8、12、20、24、30、36和48h进行镇痛及舒适度评分。并分别于术前1d、术后1d、术后3d和术后7d由本院同一心理医师采用神经心理学测试技术简易智力状态检查(MMSE)评定患者认知功能。结果 A组综合镇痛质量明显优于B组,镇痛时间长于B组(P<0.05);与术前1d比较,B组于术后1d及术后3d时MMSE评分明显降低(P<0.05);与B组比较,A组于术后1d及3d时MMSE评分明显升高(P<0.05),A、B两组POCD的发生率分别为6.1%和14.2%,A组明显低于B组(P<0.05)结论硬膜外隙预注小剂量吗啡超前镇痛可降低高龄患者术后认知功能障碍的发生率