针刺分娩镇痛临床研究进展

对针刺分娩镇痛的现代研究从产痛发生的机制、针刺镇痛的常用方法、作用机理等方面做一综述,针刺有较好的镇痛和促进产程作用,但是但手法不易掌握,镇痛效果差异较大。     

针刺镇痛中针刺深度相关因素分析

分别从疼痛病症、穴位、针具、针刺方法、组织层次等方面,对针刺深度与针刺镇痛的关系进行系统分析。认为针刺深度是影响针刺镇痛效应的主要因素之一;目前对针刺深度(特别是组织层次)与针刺镇痛关系的研究还不够深入。针刺深度与针刺镇痛关系的临床效应及机制研究,涉及疼痛病症、穴位、针具、针刺方法、组织层次等多因素,必须进行学科协作攻关的系统研究;针刺深度与针刺镇痛关系研究,可为优化针刺镇痛方案、针刺镇痛机制研究等提供相关依据。     

针刺及耳穴按压用于分娩镇痛的临床观察

目的:为探讨针刺及耳穴按压用于初产妇第一产程分娩镇痛的效果,通过分析本方法的镇痛效果,以及探讨其镇痛作用机制,从而提出了安全可靠无副作用的分娩镇痛方法,并进一步研究了针刺及耳穴按压分娩镇痛的作用机制。方法:(1)以公认的Keele标尺图评级法[1]及VRS疼痛分级法[2]作为镇痛效果评定标准,对105例产妇针刺及耳穴按压分娩镇痛的效果进行了观察,并与105例呼吸法分娩产妇的疼痛进行了对比,(2)通过记录产妇产程、产后出血量、新生儿Apgar评分及体重,来观察针刺及耳穴按压对母婴的影响,(3)通过观察针刺配合组治疗前后及相应时间产妇外周血中β-内啡肽及5-羟色胺浓度变化,探讨该方法的镇痛机理。结果:(1)针刺及耳穴按压能有效减轻第一产程分娩疼痛,与呼吸法对照组相比有显著性差异(p0.05),对母婴无不良影响且能缩短产程。(2(本方法能明显提高产妇外周血中β-内啡肽(β—EP)及5-羟色胺(5-HT)浓度。结论:(1)以针刺及耳穴按压作为分娩镇痛手段,具有操作方便、安全,镇痛效果可靠,无副作用等优点,适合基层临床应用推广。(2)其镇痛效果可能是通过中枢镇痛系统与对子宫的直接作用共同实现的。     

针刺辅助麻醉与器官保护作用

通过文献检索,旨在探求针刺辅助麻醉的器官保护作用.针刺辅助麻醉是我国医学工作者在针刺有镇痛和调整人体生理功能作用的启发下创造出来的,在术前使用可抗焦虑,术中使用可减少麻醉药物的使用量,术后有镇痛、防止术后恶心呕吐作用,并对脑、心肌、肺、肾、肝、胃肠道等脏器具有保护,对微循环及术后应激反应也有一定的益处.今后应对针刺辅助麻醉研究扩展到临床预后等关键问题.     

P38MAPK信号通路在电针分娩镇痛领域的研究进展

分娩疼痛具有典型的内脏痛及躯体痛,电针分娩镇痛是一种安全有效、操作简单、对母婴无创伤的非药物治疗方法。在针灸镇痛领域,MAPKs是较为重要的研究对象。p38MAPK信号通路可被应激刺激激活,对疼痛发生、发展起着重要的作用,从基因水平及细胞分子学理论了解P38 MAPK与分娩镇痛的关系,是研究电针分娩镇痛机制一个很好的侧重点,也为电针分娩镇痛的进一步研究提供科学依据和理论基础。     

非药物性无痛分娩的临床观察

分娩镇痛在国内外已大量开展,特别是发达国家方法很多,药物性镇痛有常用的氧化亚氮吸入性镇痛;吗啡、杜冷丁、硬膜外阻滞等。但一些人担心药物镇痛对产妇及胎儿造成影响而愿意选择非药物性镇痛。我院运用传统的中医理论,选用针刺方法对临产妇女进行分娩镇痛的临床观察,收到了良好的效果,现介绍如下。     

针刺对神经病理性疼痛的镇痛机制

通过分析近年来国内外有关针刺镇痛的研究进展,总结针刺对神经病理性疼痛的镇痛机制。分别从外周和中枢水平阐述了针刺对神经病理性疼痛的镇痛机制,包括外周敏化与免疫炎性反应、离子通道的改变、中枢敏化、细胞信号通路的调节、脊髓胶质细胞的活化等方面。认为借助多组学技术开展体外试验,检测针刺前后神经病理性疼痛患者体内相关代谢物质及各级信号通路分子的变化情况,进一步明确针刺的镇痛机制,应是今后研究的重点。     

针刺对分娩效果的Meta分析

目的:分析针刺对分娩的综合效果。方法:用Meta统计分析的方法,检索针刺在分娩中的作用相关文献,将研究内容相似的方面进行合并、统计。结果:针刺降低产时分娩疼痛,但不能改变分娩方式提高顺产率,对新生儿窒息率也没有影响。结论:针刺对产程进展及产时镇痛的作用效果显著。     

针刺镇痛效应个体差异机制研究进展

通过综述针刺镇痛效应个体差异性的相关研究文献,回顾了针刺镇痛效应个体差异与一些基因、多肽和神经系统等相关性,总结了针刺镇痛效应个体差异性研究对阐明针刺内在机制的贡献,最后在临床应用上展望针刺镇痛效应个体差异性的重要意义。     

针刺镇痛的研究现状

从实验和临床两方面对近10年来针刺镇痛的研究现状进行综述,阐述了针刺镇痛的作用机制和影响因素及临床研究,认为针刺镇痛可以通过神经系统、神经肽-细胞因子网络、结缔组织、特殊脂肪带等产生镇痛效果,影响因素主要有个体差异、心理因素、穴位特异性、针刺是否得气、针刺时间和刺激参数等。临床上针刺可治疗浅表躯体痛、深部躯体痛、内脏痛等。参考文献18篇。     

优化针药复合麻醉和镇痛的临床及机理研究

由复旦大学医学院牵头的国家“九五”攻关专题“优化针药复合麻醉和镇痛的临床及机理研究” ,于 1 998年 1 0月起执行 ,共 2年时间。本专题的攻关任务是 ,在“八五”攻关课题开展针药复合麻醉的基础上 ,深入探讨针药结合用于麻醉及镇痛的作用特点和优势 ,揭示针刺不仅具有镇痛作用 ,还具有重要的生理保护功能 ,从而为进一步发展中西医结合针药复合麻醉奠定良好的基础。在开展针药结合镇痛研究方面 :①北京妇产医院采用针药结合的方法 ,在分娩镇痛方面完成2 6 0例 ,分为Ｈａｎｓ刺激、Ｈａｎｓ 安定、安定、Ｈａｎｓ 曲马多、曲马多及对照…     

Acupuncture mechanisms: anesthesia, analgesia andprotection on organ functions

Acupuncture, as a healing art in traditional Chinese medicine, has been widely used to treat various diseases. In the history of acupuncture anesthesia, in the past decades, mechanisms of acupuncture analgesia has been widely investigated, and in recent years, acupuncture protection on organ functions has attracted great interest. This review summarized the research progress on mechanisms of acupuncture for analgesia and of its protection against organ function injury in anesthesia, and its perspective of analgesia, immunomodulation, neuroendocrine regulation and multiple organ protection. The current evidence supports that acupuncture analgesia and its organ protection in anesthesia is associated with the integration of neuroendocrine-immune networks in the level of neurotransmitters, cytokines, hormones, neuronal ensembles, lymphocytes, and endocrine cells. Although the mechanisms of acupuncture analgesia and its organ protection are still not completely understood, basic as well as clinic researches on the mechanisms and applications of acupuncture and related techniques are being carried out.     

Research progress of acupuncture analgesia for labor

Labor pain is a kind of severe pain the lying-in women of natural childbirth must undergo. The labor quality is decided by the tolerance to pain. Acupuncture analgesia for labor pain has been increasingly concerned and applied by more and more clinical workers because of its safety and efficacy. By summarizing and analyzing the choice and applications of various factors of acupuncture analgesia for labor pain such as acupoint selection, instrument analgesic coefficient, and the needling techniques in acupuncture analgesia for labor pain in the recent 12 years, this study aims to provide a theoretical foundation for the clinical application of acupuncture analgesia for labor pain.     

中枢乙酰胆碱与针刺镇痛关系的研究

<正> 乙酰胆碱(Ach)不论在种系发生或个体发生上都是最早出现的神经递质,在某些低等动物感觉传入神经全部是胆碱能的,高等动物痛觉的神经通路有一部分也和上行胆碱能网状激活系统一致;脑内一些重要的与痛和镇痛有关的结构是胆碱能的;因此我们认为 Ach 可能是研究针刺镇痛中枢神经化学原     

Using a consensus acupoints regimen to explore the relationship between acupuncture sensation and lumbar spinal postoperative analgesia: A retrospective analysis of prospective clinical cooperation

ObjectiveThis study evaluated the effectiveness of acupuncture treatment on postoperative pain in patients with degenerative lumbar spine disease, and explored the relationship between the postoperative analgesic effect of acupuncture and the sensation of acupuncture experienced by the patients.MethodsThis retrospective study analyzed the medical records of 97 patients who had undergone an operation by the same surgeon due to degenerative lumbar disease. These patients were divided into acupuncture group (n = 32), patient-controlled analgesia (PCA) group (n = 27), and oral analgesia group (n = 38) according to the different postoperative analgesic methods. During their hospitalization, patients completed daily evaluations of their pain using a visual analogue scale (VAS), and injection times of supplemental meperidine were recorded. Also, the Chinese version of the Massachusetts General Hospital Acupuncture Sensation Scale (C-MASS) was used in the acupuncture group.ResultsEach of the three treatment groups showed significant reductions in postoperative pain, as shown by reduced VAS scores. The acupuncture group, however, had less rebound pain (P < 0.05) than the other two groups. Both the acupuncture and PCA groups experienced acute analgesic effects that were superior to those in the oral analgesia group. In addition, the higher the C-MASS index on the second day after surgery, the lower the VAS score on the fourth day after surgery. There was also a significant difference in the “dull pain” in the acupuncture sensation.ConclusionThe results demonstrated that acupuncture was beneficial for postoperative pain and discomfort after simple surgery for degenerative spinal disease. It is worth noting that there was a disproportionate relevance between the patient’s acupuncture sensation and the improvement of pain VAS score.     

Role of transient receptor potential vanilloid subfamily 1 in mediating the analgesic effects of acupuncture on pathological pain: 瞬时受体电位香草酸亚家族1介导针刺治疗病理性疼痛的作用

Acupuncture, a traditional oriental intervention for chronic pain, has been gaining worldwide popularity. Transient receptor potential vanilloid subfamily 1 (TRPV1) is a key factor mediating pain production and sensitization. According to multiple studies, TRPV1 is involved the acupuncture-induced relief of pathological pain. Herein, we systematically screened the experimental reports on TRPV1 involvement in acupuncture analgesia, and reviewed the role of TRPV1 in acupuncture in inhibiting different pathological pain and unresolved problems, including inflammatory pain, neuropathic pain, visceral pain, fibromyalgia and cancer pain. At localized acupoints, TRPV1 was involved in the initiation of acupuncture signals. Acupuncture could inhibit the development of pathological pain as well as the transmission of pain signals by suppressing TRPV1 expression and opening activity from the peripheral dorsal root ganglia to the central spinal cord. Furthermore, acupuncture can not only inhibit the expression of TRPV1, but also promote the expression of TRPV1 in the brain to alleviate pain sensation and depression-like behavior. Moreover, the mechanism by which acupuncture regulates TRPV1 may involve neuro-immune crosstalk. In conclusion, the regulation of TRPV1 expression and function may be one of the primary mechanisms by which acupuncture relieves pathological pain, laying the groundwork for future basic research on acupuncture's pain-relieving effects.     

针麻和针麻加颅通定甲状腺手术中血浆β-内啡肽和皮质醇含量的观察

针麻镇痛不全可以选用非麻醉性镇痛药加以克服。本文通过放射免疫法测定针麻和针麻加颅通定甲状腺手术时病人血浆β-内啡肽和皮质醇．以了解颅通定对应激的阻断和对针麻的加强作用。结果针麻加颅通定（n=12）手术时血浆应激因子β-内啡肽和皮质醇的变化要小于针麻时这二种物质的变化，说明颅通定具有针麻镇痛的协同作用。     

针刺对于急性腰扭伤止痛效果上的临床观察

目的：观察针刺与痛点阻滞对于急性腰扭伤止痛效果上的差异。方法：选择急性腰扭伤病例65例,随机分成两组。针刺治疗组根据腰痛部位取人中、后溪、手三里、中渚、腰痛穴等穴止痛;痛点阻滞组用曲安奈德、利多卡因及生理盐水痛点阻滞。结果：治疗后两组VAS评分及总有效率比较,差异有显著统计学意义（P<0.01)。结论：针刺治疗急性腰扭伤疗效肯定,且无糖皮质激素类药物的副作用,值得推广应用。     

腹部针麻手术穴位选择和药物配伍研究进展

针刺麻醉创始于上世纪50年代末，在头颈部外科有较好的镇痛效果。目前针麻下颅窝手术、颈椎前路手术、甲状腺手术、拔牙术等已通过部级科研成果鉴定，进入常规麻醉手术行列。但在腹部外科仍存在镇痛不全、肌紧张、脏器牵拉反应等缺陷。制约了针刺麻醉的应用与推广。本文综述了近年针麻穴位选择与药物配伍方面的研究进展，以期为提高麻醉效果提供参考。     

齐刺法治疗原发性三叉神经痛临床研究

目的 评价齐刺法治疗原发性三叉神经痛的疗效、症状改善情况及安全耐受性,为临床提供规范、成熟、易推广的诊疗技术。方法 将患者192例随机分为针刺组与药物组各96例,针刺组各以颧（患侧）为主穴,阳陵泉、丰隆穴为配穴;药物组口服卡马西平。结果 两组疗效相近;针刺组在起效时间、止痛的远期效果方面优于药物组。结论 齐刺法治疗三叉神经痛疗效满意。