Managing acute enigmatic chest pain.

The author comments on the report by Dr. Akbar Panju and associates (see pages 541 to 547 of this issue) on patient outcomes associated with a discharge diagnosis of "chest pain not yet diagnosed." Acute chest pain without evidence of cardiac involvement presents a diagnostic challenge for the clinician, particularly in the present climate of cost containment. Esophageal disorders and psychiatric conditions appear to be the most prevalent causes of noncardiac chest pain. Although screening by means of electrocardiography and cardiac enzyme testing may rule out acute ischemia, and other tests may clearly point to a gastrointestinal cause, it is possible for cardiac and gastrointestinal problems to present simultaneously. Understanding and managing persistent chest pain even after a diagnosis has been made continues to challenge clinicians and researchers, and further progress in this area will depend on multidisciplinary collaboration.     

肋间神经冷冻在胸外科术后镇痛作用的临床研究

目的探讨胸外科剖胸手术后肋间神经冷冻镇痛的效果.方法对100例胸外科开胸手术后患者进行随机分为肋间神经冷冻组和对照组各50例患者,按照视觉模拟评分法观察两组患者术后胸部疼痛和镇痛药物的使用情况,术后1、2、3周分别对每组患者行肺功能检查,客观评价肋间神经镇痛治疗在胸外科剖胸术后镇痛的作用.结果冷冻组术后镇痛效果满意,患者视觉模拟评分平均为2.01,对照组为8.13,两组比较有显著差异(P＜0.05).冷冻组患者术后肺功能恢复时间较快,在术后第1周与对照组相比有显著差异(P＜0.05),而术后第2周开始至第3周,两组患者肺功能比较无显著差异.结论肋间神经冷冻治疗对剖胸手术后镇痛效果明显,不会对肋间神经造成永久性损害,患者术后肺功能早期恢复,可有效降低肺部并发症,值得临床推广.     

双氯芬酸钾治疗拔牙术后疼痛的临床观察

目的：评价双氯芬酸钾治疗拔牙后疼产能的疗效和安全性。方法：将８０例技术术后疼痛患者随机机且和对照组,每组４０例,试验组给予双氯芬酸钾５０ｍｇ,３次／ｄ;对照组给予双氯芬酸钠５０ｍｇ,口服,３次／ｄ,疗程均为３天。结果：试验组和对照组的快效率分别为５５％和１５％,治愈率分别 烽７３％,试验线的快效率和治愈率均显著高于对照组,试验组和对照组的不良反应发生率分别为５％和７．５％。结论：双氯芬酸钾用于拔牙     

地佐辛应用于剖宫产术后硬膜外自控镇痛的效果观察

目的 观察地佐辛应用于剖宫产术后硬膜外自控镇痛的临床效果和不良反应.方法 选择择期剖宫产手术患者75例(ASA Ⅰ ～Ⅱ级)随机分为三组(n=25),A组负荷剂量:地佐辛1.0 mg+0.15％盐酸罗哌卡因10 ml;镇痛泵剂量:地佐辛10 mg+0.15％罗哌卡因100 ml.B组:负荷剂量:地佐辛1.5 mg+0.15％罗哌卡因10 ml;镇痛泵剂量:地佐辛10 mg+0.15％罗哌卡因100ml.C组:负荷剂量:吗啡1.5 mg+0.15％罗哌卡因10 ml;镇痛泵剂量:吗啡3 mg+0.15％罗哌卡因100ml.镇痛泵输注背景剂量2ml/h,PCA剂量0.5 ml,锁定时间15 min.记录术后2h、4h、8h、12h、24h、48h各时点的VAS评分,观察不良反应的发生情况.结果 术后4h、8h、12hA组VAS评分高于C组,C组术后不良反应明显高于A、B组,患者满意度B、C组高于A组,差异有统计学意义(P＜0.05)..结论 以1.5 mg地佐辛+0.15％罗哌卡因10ml为负荷剂量,10 mg地佐辛+0.15％罗哌卡因复合液行PCEA镇痛效果较好,不良反应少,患者满意度较高,值得临床选用.     

Analgesic efficacy and bioavailability of ketorolac in postoperative pain: a probability analysis

BACKGROUND: The analgesic efficacy and bioavailability of 30 mg intramuscular ketorolac was studied in 24 patients with severe or very severe postoperative pain. METHODS: Pain and pain relief were determined by a five-point verbal rating scale and data were submitted to a probability analysis. Ketorolac plasma levels were determined by high-performance liquid chromatography. RESULTS: Two patients chose not to finish the study; 22 patients completed the study achieving at least good pain relief. Of these 22 patients, 13 reached complete pain relief. Ketorolac was rapidly absorbed. Notwithstanding, pain relief increased gradually, showing considerable delay with regard to plasma concentrations. Analysis of the probability-time curves revealed that 25% of the patients obtained moderate pain relief at 7 min after ketorolac administration, 50% at 11 min, 75% at 29 min, and 95% at 60 min. Good pain relief was achieved in 25, 50, and 75% of the patients at 1.1, 1.8, and 2.7 h, respectively. Complete pain relief was achieved in 25% and 50% of the patients at 2.6 h and 3.7 h, respectively. The probability of exhibiting an acceptable pain relief in responsive patients for more than 5 h was 0.97. No serious side effects were detected. CONCLUSIONS: Results show that 30 mg intramuscular ketorolac is an adequate treatment for postoperative pain in the Mexican population. Therefore, the use of higher doses is not justified. Due to gradual installation of analgesia, administration of additional analgesic medication before 1 h is not recommended.     

Analgesic effect of intrathecal fluorocitrate on neuropathic pain in rats

Objective To investigate the analgesiac effect of intrathecal （IT） fluorocitrate （FC） （ a selective astrocyte metabolic inhibitor） on neuropathic pain induced by chronic constrictive injury （CCI） to sciatic nerve. Methods Thirty- two adult male SD rats weighing 220-280 g were randomly divided into 4 groups （ n = 8each） ： group A sham operation＋ （IT） vehicle; group B sham operation ＋ （IT） FC;group C CCI＋ （IT） vehicle and group D CCI＋ （IT） FC.     

Analgesic efficacy of valdecoxib for acute postoperative pain after bunionectomy

Two randomized, double-blind, placebo-controlled studies assessed the analgesic efficacy of valdecoxib in patients with moderate-to-severe pain after bunionectomy. Study 1 (N = 374) assessed the efficacy of two regimens of valdecoxib on the day after surgery (valdecoxib, 40 mg, with a 20-mg redose [n = 127]; valdecoxib, 40 mg, with a placebo redose [n = 122]; and placebo/placebo [n = 125]), and study 2 (N = 478) examined the efficacy of two different multiple-dose regimens on postoperative days 2 through 5 (valdecoxib, 20 mg, twice daily [n = 160]; valdecoxib, 20 mg, once daily [n = 159]; and placebo [n = 159]). Valdecoxib provided significant pain relief and reduced the use of opioid rescue medication. This efficacy was accompanied by improved global scores, decreased pain interference with function, and increased patient satisfaction.     

吗啡对卵巢切除术后神经病理性疼痛模型大鼠的镇痛作用

目的 研究雌激素干预吗啡对神经病理性疼痛的镇痛效应.方法 雌性Sprague-Dawley大鼠26只,体重为180～200 g,随机分为4组:卵巢切除术+吗啡1 μg组(OVX+M组,7只),卵巢切除术+0.9%氯化钠溶液组(OVX+S组,6只),卵巢切除假手术+吗啡1μg组(OVX-sham+M组,7只),卵巢切除假手术+0.9%氯化钠溶液组(OVX-sham+S组,6只).双侧卵巢切除术或假手术后21 d,所有大鼠行左侧坐骨神经分支选择结扎切断术,疼痛模型建立14 d后鞘内注射吗啡或0.9%氯化钠溶液,分别于给药前及给药后30、60、90、120、150、180 min采用yon Frey纤毛测定大鼠的机械刺激缩足阈值(PWT值),并予比较.结果 鞘内注射吗啡或0.9%氧化钠溶液后,各时间点OVX+M组和OVX-sham+M组的PWT值显著高于OVX+S组和OVX-Sham+S组(P值均<0.01);其中给药后120、150及180 min,OVX+M组的PWT值显著高于OVX-sham+M组(P值均<0.01).而各时间点OVX+S组与OVX-sham+S组PWT值的差异则无统计学意义(P值均>0.05).结论 双侧卵巢切除术后神经病理性疼痛模型大鼠对鞘内注射吗啡的镇痛效应敏感性增强,提示雌激素能影响吗啡对慢性病理性疼痛的镇痛作用.     

右美托咪定对奥沙利铂致神经性疼痛的镇痛作用及机制

目的探讨右美托咪定（Dex）对奥沙利铂（Oxa）致神经性疼痛的镇痛作用及其机制。方法采用单剂量Oxa腹腔注射诱发 大鼠神经性疼痛模型。SD大鼠随机分为4组:空白对照组（control组）、神经性疼痛组（model组）、右美托咪定处理组（Dex组）、 右美托咪定+阿替美唑组（Ati组）。在行为学上检测各组大鼠机械痛阈值(PWT)和冷热痛阈值（TWL）;应用免疫印记法和免疫 荧光法检测大鼠脊髓p-STAT3的蛋白表达。结果与control组比较,model组和Ati组PWT和TWL（冷）显著性缩短（P<0.05）; 脊髓p-STAT3 的表达水平显著性增加（P<0.01)。与model 组比较,Dex 处理后60~120 min PWT和TWL（冷）显著性延长（P< 0.05）;脊髓p-STAT3的表达显著性减少（P<0.01)。与Dex组比较,Ati组在Dex处理后60~120 min PWT和TWL（冷）显著性缩 短（P<0.05）,而脊髓p-STAT3的表达显著性增加（P<0.05）。结论Dex可通过抑制大鼠脊髓p-STAT3的增长,缓解Oxa所致的神 经性疼痛。     

氟比洛芬酯脂微球注射液治疗难治性癌症疼痛的临床观察

目的观察氟比洛芬酯脂微球载体注射液治疗难治性癌症疼痛的疗效和副作用。方法37例已使用麻醉性止痛药效果不佳的患者,每日静脉注射50 mg/5 ml氟比洛芬酯脂微球载体注射液,同时合并使用麻醉性止痛剂。分别就其疗效及不良反应等方面进行评价。结果氟比洛芬酯脂微球载体注射液治疗难治性癌症疼痛的总有效率为91.9%(34例/37例)。未见腹痛、消化道出血等副作用,也未见便秘、恶心、呕吐、嗜睡等不良反应。结论氟比洛芬酯脂微球载体注射液治疗难治性癌症疼痛疗效好,不良反应发生率低,在中、重度疼痛时,本药用于麻醉性止痛药治疗过程中的疼痛有良好效果。     

胸部手术肋间神经冷冻镇痛作用的临床研究

目的:探讨胸部手术肋间神经冷冻镇痛的疗效。方法:对120例开胸手术患者进行分组,分为肋间神经冷冻组和镇痛泵组各60例,按照视觉模拟评分法观察两组患者术后胸部疼痛情况,术后第1、3、7、14天分别对每组患者行肺功能检查。结果:冷冻组术后镇痛效果满意,患者视觉模拟评分明显低于对照组,两组比较差异有统计学意义(P<0.01),冷冻组患者术后肺功能恢复时间较快,在术后第1、3、7天与对照组相比差异有统计学意义(P<0.05),而术后第14天,两组患者肺功能比较差异无统计学意义(P>0.05)。结论:肋间神经冷冻治疗对开胸手术后镇痛效果明显,不会对肋间神经造成永久性损害,患者术后肺功能可早期恢复,能有效降低肺部并发症,值得临床推广。     

鸡Ⅱ型胶原镇痛的作用

目的观察一次性灌胃和口腔喷雾给予鸡Ⅱ型胶原(CⅡ)5、10、20 μg/kg对小鼠痛阈的影响.方法采用热板法和温浴甩尾法测定小鼠的痛阈.结果一次性灌胃给予CⅡ5、10、20μg/kg和腹腔注射哌替啶10 mg/kg可以明显升高小鼠的痛阈,且大剂量组(20 μg/kg)较哌替啶起效快,维持时间长.而口腔喷雾给予上述剂量的CⅡ有提高痛阈的趋势,但差异无显著性.结论口服CⅡ具有明显的镇痛作用.     

祛风息痛丸对小鼠实验性疼痛的镇痛作用

目的 观察祛风息痛丸的镇痛作用,为其临床应用提供一定的实验依据. 方法 制备小鼠实验性疼痛模型,观察祛风息痛丸的镇痛作用.①扭体法:取昆明种小鼠100只,随机分为5组,每组20只,雌雄各半.对照组灌胃给予生理盐水10 ml/kg;祛风息痛丸低、中、高剂量组分别灌胃祛风息痛丸0.36,1.08,3.24 g/kg.阳性对照组灌胃阿司匹林0.4 g/kg.每Et用药1次,10 d后观察各组动物腹腔注射醋酸后5-20 min内的扭体反应次数.②热板法将小鼠放在(55±1)℃的热板上,以小鼠舔后足为疼痛反应指标,观察小鼠的热痛阈值.选用痛觉阈值在5-30 s的雌性小鼠50只,随机分为5组,每组10只,分组与给药方法与①同.给药10 d后记录各组小鼠热板法痛阈值,比较各组间的差异. 结果 ①扭体法实验结果显示,祛风息痛丸0.36,1.08,3.24 g/kg灌胃10 d使腹腔注射醋酸所致的小鼠扭体反应次数较对照组明显减少,对扭体反应次数的抑制率分别为25.4%,30.0%和43.4%(P<0.05).②热板法实验结果显示,给药前各组小鼠热痛阈值无统计学差异(P>0.05);给药10 d后祛风息痛丸各剂量组小鼠热痛阈值均较给药前显著提高(P<0.05),与对照组比较,祛风息痛丸组给药后热痛阈值显著延长(P<0.05). 结论 祛风息痛丸对小鼠实验性疼痛具有良好的镇痛作用.     

天麻素对癌痛模型小鼠热痛觉过敏阈值的影响

目的:观察天麻素对小鼠转移性肿瘤诱发癌痛的镇痛作用。方法:将小鼠乳腺癌4T1细胞皮下注射于8周龄雌性Balb/c系小鼠足趾部建立肿瘤诱发癌痛模型;取小鼠35只,随机分为5组:对照组,溶剂组,低、高剂量天麻素组(90,180 mg/kg)和吗啡组(10 mg/kg),于肿瘤细胞接种后第11天,分别于局部注射给药后15,30,60,90,120,150和180 min行热痛觉过敏试验并进行比较。结果:给药后90 min,低剂量天麻素组小鼠热痛觉过敏阈值由给药前(3.63±0.33)s提高至峰值(6.19±0.23)s;高剂量天麻素组由给药前(3.83±0.14)s提高至峰值(6.97±0.33)s,但两组阈值增加幅度均明显低于吗啡组(P<0.01,P<0.05)。结论:天麻素对癌性疼痛可产生明确镇痛作用,其效果弱于吗啡。