神经胶质细胞参与吗啡耐受机制及治疗的研究进展

 吗啡是临床上常用的强效镇痛药，然而长期应用会导致其镇痛效能降低，发生吗啡耐受。以往对吗啡耐受机制的研究主要集中在脊髓神经元敏化等中枢神经元机制，近年来越来越多的学者开始关注神经胶质细胞，特别是小胶质细胞和星形胶质细胞，在吗啡耐受形成中的作用。本文简要综述了神经胶质细胞参与吗啡耐受的作用机制及其治疗的研究进展，为解决临床上中重度疼痛治疗中的难点问题提供新的解决思路与依据。     

Kynurenic acid and zaprinast diminished CXCL17-evoked pain-related behaviour and enhanced morphine analgesia in a mouse neuropathic pain model

Background

The G protein-coupled receptor 35 (GPR35), is considered important for nociceptive transmission, as suggested by accumulating evidence. This receptor was discovered in 1998; however, a lack of pharmacological tools prevented a complete understanding of its function and how to exploit it therapeutically. We studied the influence of CXCL17, kynurenic acid and zaprinast on nociceptive transmission in naïve and neuropathic mice. Additionally, we investigated the influence of kynurenic acid and zaprinast on morphine effectiveness in neuropathic pain.

Association of Multimodal Pain Control with Patient-Reported Outcomes in Children Undergoing Surgery

IntroductionOur aim was to describe practices in multimodal pain management at US children's hospitals and evaluate the association between non-opioid pain management strategies and pediatric patient-reported outcomes (PROs).MethodsData were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial. Non-opioid pain management strategies included use of preoperative and postoperative non-opioid analgesics, regional anesthetic blocks, and a biobehavioral intervention. PROs included perioperative nervousness, pain-related functional disability, health-related quality of life (HRQoL). Associations were analyzed using multinomial logistic regression models.ResultsAmong 186 patients, 62 (33%) received preoperative analgesics, 186 (100%) postoperative analgesics, 81 (44%) regional anesthetic block, and 135 (73%) used a biobehavioral intervention. Patients were less likely to report worsened as compared to stable nervousness following regional anesthetic block (relative risk ratio [RRR]:0.31, 95% confidence interval [CI]:0.11–0.85), use of a biobehavioral technique (RRR:0.26, 95% CI:0.10–0.70), and both in combination (RRR:0.08, 95% CI:0.02–0.34). There were no associations of non-opioid pain control modalities with pain-related functional disability or HRQoL.ConclusionUse of postoperative non-opioid analgesics have been largely adopted, while preoperative non-opioid analgesics and regional anesthetic blocks are used less frequently. Regional anesthetic blocks and biobehavioral interventions may mitigate postoperative nervousness in children.Level of evidenceIII.     

我国门诊癌症患者阿片类镇痛药使用的现状研究

摘 要 目的：分析我国门诊癌症患者阿片类镇痛药的使用情况。方法：从医院处方分析合作项目数据库中随机提取我国5个城市89家医院门诊癌痛患者2016年中40 d的使用阿片类镇痛药处方数据,对其用药频度（DDDs）及限定日费用（DDC）、总费用等指标进行分析。 结果：共纳入13 803例患者的阿片类镇痛药处方,其中男8 522例,患者年龄分布在3~96岁。按照阿片类镇痛药使用人次由多到少的顺序排列依次为羟考酮及其复方制剂、曲马多及其复方制剂、可待因及其复方制剂、吗啡和芬太尼。羟考酮及其复方制剂的处方总金额和DDDs均最高。口服是最主要的给药途径,人次占比和金额占比分别为86.6%和83.3%。结论：阿片类镇痛药使用的基本面比较合理,但是在部分药品使用方面与国外情况有所区别,其合理性需要通过处方点评等方法进行进一步研究。     

吗啡镇痛对晚期肝癌患者血清TNF-α及IL-6水平影响的分析

目的考察吗啡镇痛对晚期肝癌患者血清TNF-α及IL-6水平影响。方法将120例晚期肝癌患者随机分为曲马多缓释片组和吗啡组,每组60例。曲马多缓释片组给予曲马多缓释片片口服治疗,吗啡组给予口服硫酸吗啡缓释片治疗。比较两组患者镇痛效果、不良反应和血清TNF-α及IL-6水平。结果吗啡组镇痛效果显著优于曲马多缓释片组(P<0.05)。吗啡组患者不良反应发生率显著高于曲马多缓释片组(P<0.05)。吗啡组患者镇痛后1周和1个月时血清TNF-α及IL-6水平显著低于曲马多缓释片组(P<0.05)。结论吗啡镇痛可有效降低晚期肝癌患者血清TNF-α及IL-6水平。     

小剂量MK—801加强100Hz电针抑制大鼠吗啡戒断症状的作用

目的 :观察小剂量MK 80 1(dizocilpine)是否能加强 10 0Hz电针 (electroacupuncture ,EA)抑制大鼠吗啡戒断症状的作用。方法 :大鼠皮下注射递增剂量的吗啡 5天 (每天 3次 ) ,使其对吗啡形成依赖 ,最后一次注射吗啡后 1h ,分别腹腔 (i.p .,0 .0 3mg/kg)或蛛网膜下腔 (i.t.,10 0ng/ 10 μl)注射MK 80 1,注射后 15min给予 10 0HzEA。MK 80 1注射和 10 0HzEA共进行 3次 ,两次之间相隔5h。最后一次EA结束后 30mini.p .纳洛酮 (1mg/kg)催促戒断症状 ,并观察记录 5种戒断症状的表现。结果 :(1)单纯i.p .MK 80 1仅能显著降低直立症状 ;单纯 10 0HzEA能够显著降低直立和振翼样抖动 ;i.p .MK 80 1联合 10 0HzEA能显著降低跳跃、直立、振翼样抖动和体重丢失等 4种戒断症状。 (2 )单纯i.t.MK 80 1能显著降低振翼样抖动 ;i.t .MK 80 1联合EA能显著降低上述四种戒断症状。结论 :小剂量的MK 80 1可加强 10 0HzEA抑制戒断症状的作用 ;联合使用的效果优于单纯应用EA或MK 80 1。     

盐酸托烷司琼和氟哌利多预防吗啡硬膜外自控镇痛引起的恶心呕吐效果观察

目的探讨盐酸托烷司琼和氟哌利多预防术后吗啡硬膜外自控镇痛（PCEA）引起恶心呕吐的效果和不良反应？方法选择硬膜外麻醉下行开腹妇科手术患者120例，ASAⅠ～Ⅱ级，分3组各40例，A组用盐酸托烷司琼5mg，B组用氟哌利多5mg，两组的药物分别将药加入PCEA药盒注入硬膜外腔，C组PCEA药液不加其他药物。术毕行吗啡PCEA镇痛，镇痛方法采用负荷量＋连续量，负荷量为吗啡2mg，连续量为2ml／h，自控量为0．5ml／15min，PCEA药液为吗啡8mg＋布比卡因150mg＋生理盐水至100ml。术后连续监测BP、RR、ECG、SpO2，定时观察记录视觉模拟评分法（VAS）的评分、恶心、呕吐发生率。结果3组患者手术后镇痛效果满意，组间比较差异无显著性（P〉0．05），恶心呕吐发生率，A、B组明显低于C组，差异有显著性意义（P〈0．05），A组与B组相比：A组明显低于B组，差异有显著性意义（P〈0．05）。结论盐酸托烷司琼较氟哌利多能更有效地预防术后吗啡PCEA引起的恶心呕吐。