经皮内镜腰椎间盘摘除术中后颈部疼痛与腰段硬膜外腔压力的相关性

目的探讨经皮内镜腰椎间盘摘除术(percutaneous endoscopic lumbar discectomy,PELD)中后颈部疼痛与腰段硬膜外腔压力(lumbar epidural pressure,LEP)的相关性。方法本研究采用前瞻性设计,选择择期经椎板间隙入路PELD患者86例,男46例,女40例,年龄19~71岁,ASAⅠ或Ⅱ级。采用腰段硬膜外麻醉,并经硬膜外导管接换能器连续监测LEP,记录手术开始前LEP基础值(LEPbase)、后颈部开始疼痛时LEP(LEPpain)和术中LEP最大值(LEP_(max)),采用趋势卡方检验分析LEP_(max)与后颈部疼痛发生率的关系。结果有30例(34.9%)患者术中出现后颈部疼痛。LEP_(max)最低为31.0mm Hg,最高为77.0mm Hg。后颈部疼痛患者LEP_(max)为(60.6±8.8)mm Hg,明显高于无疼痛患者的(50.7±9.5)mm Hg(P0.01)。后颈部疼痛的发生与LEP_(max)呈显著正相关(P0.01)。结论经皮内镜腰椎间盘摘除术中腰段硬膜外腔压力最大值越高的患者,后颈部疼痛发生的可能性越大。     

鞘内注射Roscovitine缓解大鼠慢性神经病理性疼痛

目的 在SD大鼠脊髓后根神经节慢性压迫(CCD)模型上观察鞘内注射Roscovitine的镇痛效果.方法 用不锈钢棒(长4 mm,直径0.7 mm)持续件压迫脊髓背根神经节(DRG)建立慢性神经病理性疼痛模型.术后第7天鞘内注射溶解于DMSO 10 μl中的Roscovitine 50 μg(R组);同时设CCD术后第7天只给予鞘内注射二甲基亚砜(DMS0)10 μl的CCD组(C组)和非CCD处理、并给予鞘内注射DMSO 10 μl的假手术组(S组).三组均于CCD术前、术后第7天(给药前)及给药后2、24、72 h榆测机械痛缩足阈值(PWMT)和热痛缩足潜伏期(PWTL).CCD术前及给药后72 h用免疫组化技术检测脊髓背角N-甲基-D天冬门氨酸(NMDA)受体2A亚基(NR2A)的表达水平.结果 R组和C组给药前PWMT均较术前显著降低[(3.64±0.40)g vs.(14.38±1.53)g,(3.50±0.77)g vs(13.25±2.21)g],也明显低于S组的(11.31±1.13)g(P<0.05).R组和C组给药前PWTL均较术前显著缩短[(9.28±1.18)s vs(18.34±1.23)s,(8.91±1.08)s vs.(18.59±1.92)s],也短于S组的(18.45±1.44)s(P<0.05).R组PWMT在给药后24 h较给药前和C组显著增加[(7.32±0.69)g vs.(3.64±0.40)g,(3.86±1.14)g](P<0.05),而给药后2 h PWTL,较给药前和C组显著延长[(15.464±1.51)s vs.(9.28±1.18)s,(9.91±1.07)s(P<0.05).给药后72 h,R组脊髓背角NR2A受体表达水平明显低于C组[(0.21±0.02)vs.(0.26±0.01)](P<0.05).结论 鞘内注射Roseovitine能有效改善CCD大鼠痛行为学反应;其作用可能与抑制脊髓背角NR2A受体表达有关.     

瑞芬太尼对BV-2小胶质细胞沉默调节蛋白2及炎症因子的影响

目的探讨瑞芬太尼对BV-2小胶质细胞沉默调节蛋白2(silent information regulator 2, SIRT2)及炎症因子的影响。方法将培养的BV-2小胶质细胞分为4组(每组1孔):空白对照组(C组)、瑞芬太尼10 μmol/L组(R1组)、瑞芬太尼50 μmol/L组(R2组)、瑞芬太尼100 μmol/L组(R3组), 待细胞基本贴满板底后, R1组、R2组、R3组分别将培养液更换为单纯DMEM/F12培养液配置的瑞芬太尼2 ml(R1组瑞芬太尼10 μmol/L、R2组瑞芬太尼50 μmol/L、R3组瑞芬太尼100 μmol/L), 孵育2 h。另取培养的BV-2小胶质细胞分为4组(每组1孔):空白对照2组(C2组)、15 min组(T1组)、1 h组(T2组)、2 h组(T3组), 待细胞基本贴满板底后, T1组、T2组、T3组将培养液更换为单纯DMEM/F12培养液配置的100 μmol/L瑞芬太尼2 ml(T1组刺激15 min、T2组刺激1 h、T3组刺激2 h)。Western blot法检测各组细胞SIRT2、离子钙接头蛋白1(ionized cal...     

CB2受体激动剂JWH015对大鼠神经病理性疼痛的治疗作用

Objective To test whether activation of CB2 receptor would induce antinociception and investigate the role of in-trathecal JWH015 in the modulation of Tyr-1472 phosphorylation of the spinal NR2B subunit in a model of neuropathic pain. Meth-otis 84 male SD rats with intrathecal catheter insertion were randomly divided into 3 groups: sham + 50% DMSO group (Sham group); CCD + 50%DMSO group(Vehicle group); CCD+JWH015 group(JWH015 group). Seven days after Sham or CCD(without in-trathecal injection), the lumbosacral spinal cords of 6 Sham rats and 6 CCD rats were collected for immunohistochemical study to de-termine the spinal expression of Tyr-1472 phosphorylated NR2B subunit(baseline). The rest were intrathcally injected with 50%DMSO 10 μl or JWH015 10 μg seven days after Sham or CCD. For behavioral studies, the data of paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured in Sham group or CCD group, before intrathecal injection and 1, 2, 4, 8, 24, 72 h after intrathecal injection (n=6). For immunohistochemical study, the lumbosacral spinal cords were collected 4, 8, 24, 72 h after intrathecal injection(n=6). Results Compared with the baseline before operation, the PWMT and the PWTL of Vehicle group and JWHOI5 group began to decrease before intrathecal injection(P<0.01). Compared with Vehicle group, PWMT and PWTL of JWH015 group increased markedly 1, 2 and 4 h after intrathecal injection (P0.05). Tyr-1472 phosphorylated NR2B subunit expression in the superficial dorsal horn was weak in all sham groups, but increased significantly 7 days after CCD. While intrathecal 50%DMSO did not decrease the expres-sion of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn, the expression of Tyr-1472 phosphorylated NR2B sub-unit in the superficial dorsal horn decreased obviously 4 h and 8 h after intrathcal JWH015. However, the expression of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn increased again 24 h and 72 h after intrathcal JWH015. Conclusion In-trathecal administration of CB2 receptor agonist JWHOI5 may provide analgesic effect, which is probably attributed to the decrease in the spinal expression of Tyr-1472 phosphorylated NR2B subunit.     

CB2受体激动剂JWH015对大鼠神经病理性疼痛的治疗作用

Objective To test whether activation of CB2 receptor would induce antinociception and investigate the role of in-trathecal JWH015 in the modulation of Tyr-1472 phosphorylation of the spinal NR2B subunit in a model of neuropathic pain. Meth-otis 84 male SD rats with intrathecal catheter insertion were randomly divided into 3 groups: sham + 50% DMSO group (Sham group); CCD + 50%DMSO group(Vehicle group); CCD+JWH015 group(JWH015 group). Seven days after Sham or CCD(without in-trathecal injection), the lumbosacral spinal cords of 6 Sham rats and 6 CCD rats were collected for immunohistochemical study to de-termine the spinal expression of Tyr-1472 phosphorylated NR2B subunit(baseline). The rest were intrathcally injected with 50%DMSO 10 μl or JWH015 10 μg seven days after Sham or CCD. For behavioral studies, the data of paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured in Sham group or CCD group, before intrathecal injection and 1, 2, 4, 8, 24, 72 h after intrathecal injection (n=6). For immunohistochemical study, the lumbosacral spinal cords were collected 4, 8, 24, 72 h after intrathecal injection(n=6). Results Compared with the baseline before operation, the PWMT and the PWTL of Vehicle group and JWHOI5 group began to decrease before intrathecal injection(P<0.01). Compared with Vehicle group, PWMT and PWTL of JWH015 group increased markedly 1, 2 and 4 h after intrathecal injection (P0.05). Tyr-1472 phosphorylated NR2B subunit expression in the superficial dorsal horn was weak in all sham groups, but increased significantly 7 days after CCD. While intrathecal 50%DMSO did not decrease the expres-sion of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn, the expression of Tyr-1472 phosphorylated NR2B sub-unit in the superficial dorsal horn decreased obviously 4 h and 8 h after intrathcal JWH015. However, the expression of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn increased again 24 h and 72 h after intrathcal JWH015. Conclusion In-trathecal administration of CB2 receptor agonist JWHOI5 may provide analgesic effect, which is probably attributed to the decrease in the spinal expression of Tyr-1472 phosphorylated NR2B subunit.     

肌肉注射不同剂量右美托咪定对芬太尼诱发咳嗽反射的影响

目的观察全麻诱导前肌肉注射不同剂量右美托咪定（dexmedetomidine,DEX）对芬太尼诱发咳嗽反射的影响。方法200例美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级择期手术患者,完全随机分为对照组（c组）和DEX组（D1组、D2组、D3组）4组,每组50例。诱导前D1组、D2组、D3组分别肌肉注射DEX1、1．5、2IAg／kg,C组肌肉注射等容量的生理盐水。15min后静脉注射芬太尼3μg／kg,过1min后静脉注射异丙酚2mg／kg、罗库溴铵0．6mg／kg行快速诱导气管插管。记录注射DEX前（R）、注射芬太尼前（T1）、插管前即刻（T2）、插管后即刻（T3）、插管后1min（T4）、插管后3min（T5）、插管后5min（T6）的收缩压（systolic blood pressure,SBP）、舒张压（diastolic blood pressure,DBP）、平均动脉压mean artery pressure,MAP）、心率（heart rate,HR）以及咳嗽反射情况。结果D1组、D2组、D3组咳嗽反射的发生率（分别为8％、6％、4％）明显低于c组（32％）（P〈0．01）;D。组、D：组、D3组之间咳嗽反射的发生率比较差异无统计学意义（P〉0．05）;各组T1时点MAP、HR[（89±10）、（91±11）、（94±9）、（90±9）mmHg（1mmHg=0．133kPa）,（68±9）、（70±10）、（68±8）、（70±12）次／min]与T0时点MAP、HR[（9±8）、（89±10）、（92±8）、（88±9）mmHg,（73±11）、（74±9）、（71±7）、（72±8）次／min]比较差异无统计学意义（P〉o．05）;与Tn时点MAP、HR[（91±8）、（89±10）、（92±8）、（88±9）mmHg,（73±11）、（74±9）、（71±7）、（72±8）次／rain]比较,各组T2时点MAP、HR[（80±8）、（78±10）、（71±9）、（69±9）mmHg,（64±9）、（65±10）、（58±7）、（56±8）次／min]明显降低（P〈0．05）;T2时点D2组、D3组MAP、HR[（71±9）、（69±9）mmHg,（58±7）、（56±8）次／min]低于C组、D1组[（80±8）、（78±10）mmHg,（64±9）、（65±10）次／min]（P〈0．05）;诱导后D,组有11例（22％）发生低血压,明显高于c组[2例（4％）]（P〈0．01）;D2、D3组分别有10例（20％）和12例（24％）发生心动过缓,明显高于C组[1例（2％）]（P〈0．01）;D,组、C组之间低血压和心动过缓的发生率比较差异无统计学意义（P〉0．05）。结论全麻诱导前预先肌肉注射小剂量（1μg／kg）DEX能显著减少芬太尼诱发咳嗽反射的发生率,且对诱导期间血流动力学无明显影响。     

CB2受体激动剂JWH015对大鼠神经病理性疼痛的治疗作用

Objective To test whether activation of CB2 receptor would induce antinociception and investigate the role of in-trathecal JWH015 in the modulation of Tyr-1472 phosphorylation of the spinal NR2B subunit in a model of neuropathic pain. Meth-otis 84 male SD rats with intrathecal catheter insertion were randomly divided into 3 groups: sham + 50% DMSO group (Sham group); CCD + 50%DMSO group(Vehicle group); CCD+JWH015 group(JWH015 group). Seven days after Sham or CCD(without in-trathecal injection), the lumbosacral spinal cords of 6 Sham rats and 6 CCD rats were collected for immunohistochemical study to de-termine the spinal expression of Tyr-1472 phosphorylated NR2B subunit(baseline). The rest were intrathcally injected with 50%DMSO 10 μl or JWH015 10 μg seven days after Sham or CCD. For behavioral studies, the data of paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured in Sham group or CCD group, before intrathecal injection and 1, 2, 4, 8, 24, 72 h after intrathecal injection (n=6). For immunohistochemical study, the lumbosacral spinal cords were collected 4, 8, 24, 72 h after intrathecal injection(n=6). Results Compared with the baseline before operation, the PWMT and the PWTL of Vehicle group and JWHOI5 group began to decrease before intrathecal injection(P<0.01). Compared with Vehicle group, PWMT and PWTL of JWH015 group increased markedly 1, 2 and 4 h after intrathecal injection (P0.05). Tyr-1472 phosphorylated NR2B subunit expression in the superficial dorsal horn was weak in all sham groups, but increased significantly 7 days after CCD. While intrathecal 50%DMSO did not decrease the expres-sion of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn, the expression of Tyr-1472 phosphorylated NR2B sub-unit in the superficial dorsal horn decreased obviously 4 h and 8 h after intrathcal JWH015. However, the expression of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn increased again 24 h and 72 h after intrathcal JWH015. Conclusion In-trathecal administration of CB2 receptor agonist JWHOI5 may provide analgesic effect, which is probably attributed to the decrease in the spinal expression of Tyr-1472 phosphorylated NR2B subunit.     

鞘内注射大麻素受体2激动剂JWH015对骨癌痛小鼠痛行为的影响

目的 观察鞘内注射大麻素受体2(CB2)激动剂JWH015对骨癌痛小鼠痛行为的影响.方法 雄性C3H/HeN小鼠32只随机分为4组(n=8):空白组(C),假手术组(s),DMSO(D,二甲基亚砜)组和JWH015(J)组.D组和J组在小鼠右侧股骨远端骨髓腔接种溶于最小必需培养基(α-MEM)的NCTC2472谘骨性纤维肉瘤细胞,建立骨癌痛模型;s组接种不含细胞的α-MEM;c组不予任何处理.在接种肿瘤细胞后的第14天按照分组D组和J组分别鞘内注射DMSO 5μl和溶于20%DMSO的JWH015 1 μg;S组注射DMSO.各组于接种前,接种后的3d、5d、7d、10d、14d以及给药后的1h、6h、24h、48h、72h测定小鼠的机械性缩足阈值(FWMT)和热缩腿潜伏期(FWTL).结果 与术后14d给药前的基础值[PWMT(0.45±0.09)g,PWTL(11.87±1.1)s]相比,鞘内注射JWH015后6h小鼠骨癌痛即缓解[PWMT(1.20±0.21)g,PWTL(15.35±2.42)s](P<0.05);24h缓解作用达到高峰[PWMT(1.85±0.28)g,PWTL(18.80±2.93)s](P<0.05);在72h作用衰退到给药前水平[PWMT(0.48±0.10)g,PWTL(11.83±1.19)s]P>0.05).结论 鞘内注射JWH015能够显著改善骨癌痛小鼠的痛行为.     

CB2受体激动剂JWH015对大鼠神经病理性疼痛的治疗作用

Objective To test whether activation of CB2 receptor would induce antinociception and investigate the role of in-trathecal JWH015 in the modulation of Tyr-1472 phosphorylation of the spinal NR2B subunit in a model of neuropathic pain. Meth-otis 84 male SD rats with intrathecal catheter insertion were randomly divided into 3 groups: sham + 50% DMSO group (Sham group); CCD + 50%DMSO group(Vehicle group); CCD+JWH015 group(JWH015 group). Seven days after Sham or CCD(without in-trathecal injection), the lumbosacral spinal cords of 6 Sham rats and 6 CCD rats were collected for immunohistochemical study to de-termine the spinal expression of Tyr-1472 phosphorylated NR2B subunit(baseline). The rest were intrathcally injected with 50%DMSO 10 μl or JWH015 10 μg seven days after Sham or CCD. For behavioral studies, the data of paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured in Sham group or CCD group, before intrathecal injection and 1, 2, 4, 8, 24, 72 h after intrathecal injection (n=6). For immunohistochemical study, the lumbosacral spinal cords were collected 4, 8, 24, 72 h after intrathecal injection(n=6). Results Compared with the baseline before operation, the PWMT and the PWTL of Vehicle group and JWHOI5 group began to decrease before intrathecal injection(P<0.01). Compared with Vehicle group, PWMT and PWTL of JWH015 group increased markedly 1, 2 and 4 h after intrathecal injection (P0.05). Tyr-1472 phosphorylated NR2B subunit expression in the superficial dorsal horn was weak in all sham groups, but increased significantly 7 days after CCD. While intrathecal 50%DMSO did not decrease the expres-sion of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn, the expression of Tyr-1472 phosphorylated NR2B sub-unit in the superficial dorsal horn decreased obviously 4 h and 8 h after intrathcal JWH015. However, the expression of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn increased again 24 h and 72 h after intrathcal JWH015. Conclusion In-trathecal administration of CB2 receptor agonist JWHOI5 may provide analgesic effect, which is probably attributed to the decrease in the spinal expression of Tyr-1472 phosphorylated NR2B subunit.     

盐酸达克罗宁胶浆和无痛导尿管在全麻导尿中的联合应用

目的观察盐酸达克罗宁胶浆和无痛导尿管联合应用在患者全麻苏醒期间减轻导尿管刺激症状的效果。方法选择全身麻醉的成年男性患者60例,随机分成研究组和对照组各30例,研究组注入盐酸达克罗宁胶浆10 m L,对照组注入生理盐水10 m L,观察患者全麻苏醒后尿道的刺激症状和疼痛程度。结果在尿道刺激症状方面,研究组CRBD源性躁动发生率为13.33%,对照组CRBD源性躁动发生率为66.67%,差异有统计学意义(P<0.05);在疼痛程度方面,研究组疼痛发生率为10.00%,对照组疼痛发生率为56.67%,差异有统计学意义(P<0.05)。结论盐酸达克罗宁胶浆和无痛导尿管联合应用可以明显减轻患者全麻苏醒后导尿管的尿道刺激症状和疼痛程度。