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咪唑安定对大鼠丘脑束旁核感受伤害性刺激神经元的干预反应研究 总被引:4,自引:2,他引:2
目的 研究咪唑安定对大鼠丘脑束旁核感受伤害性神经元对感受外周伤害性刺激的干预反应。方法 微电极探查束旁核神经元(n=6),对找到的每个感受伤害性刺激神经元均实施以下步骤:(1)记录基础放电(A组)。(2)记录基础的伤害性刺激的放电反应(B组)。(3)平静5min后(原则上放电恢复到刺激前水平),静脉给予咪唑安定0.2mg,2min后记录伤害性刺激下的放电反应(C组)。(4)5min后,静脉给入咪唑安定的特异性拮抗剂吗泽尼0.05mg,2min后记录伤害性刺激的放电反应(D组)。结果 A组和B组差异有显著性,符合外周伤害性刺激使中枢痛敏神经元兴奋的正常重量反应。C组与B组差异有显著性,与A组差异无显著性,提示在咪唑安定的干预下,外周的伤害性刺激不能使中枢痛敏神经元兴奋,即咪唑安定对痛觉有抑制作用。D组与C、A组有显著性差异,而与B组无显著性差异,提示氟吗泽尼拮抗了咪唑安定的抑痛作用后,使中枢痛敏神经元恢复对外周伤害性刺激的敏感性。结论 咪唑安定可以显著性的抑制大鼠丘脑束旁核感受伤害性神经元对外周伤害性刺激的兴奋反应。 相似文献
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围术期伤害性刺激可诱发机体过度应激反应,引起免疫功能(以细胞免疫为主)抑制,影响预后[1].有效的麻醉方法可控制应激反应.临床常采用BIS监测麻醉深度[2],BIS指导下异丙酚复合麻醉和七氟醚复合麻醉是临床常用的麻醉方法.这两种方法对于围术期免疫功能的影响尚有待研究.本研究拟比较BIS指导下七氟烷复合麻醉与异丙酚复合麻醉对胆囊切除术患者围术期细胞免疫功能的影响,为临床麻醉方法的选择提供参考. 相似文献
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脑电图(electroencephalogram, EEG)及EEG相关指标是反映大脑意识状态的重要指标,目前临床主要依赖于BIS进行术中麻醉管理,进一步理解EEG波形的意义有助于更好地开展麻醉管理,预防术后不良事件的发生。文章系统介绍了不同麻醉药物诱发的EEG波性特征,以及EEG特征波形与围手术期神经认知功能障碍(p... 相似文献
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围手术期心理支持疗法用于术后镇痛的临床研究 总被引:22,自引:1,他引:21
笔者将一系列心理方法试用于32例围手术期病人以观察其术后镇痛效应。结果显示该法具有较强的心理镇痛效应,与膜外注射吗啡合用可攻得满意的术后镇痛,提出其机理可能为通过影响病人的认知过程激活内源性痛调制系统,抑制伤害性刺激在中枢的传递和整合,最终发挥心理镇痛作用。 相似文献
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Reuben SS 《Current opinion in anaesthesiology》2007,20(5):440-450
PURPOSE OF REVIEW: Although NSAIDs have been shown to reduce postoperative analgesics, their ability to reduce opioid-related adverse effects and improve functional outcomes is questioned. Further, perioperative NSAID use may contribute to cardiovascular toxicity and impaired bone healing. This review highlights recent advances in our understanding of the role perioperative NSAIDs have on modulating nociception, their benefits when utilized as components of a multimodal analgesic regimen, and potential deleterious cardiovascular and osteogenic effects. RECENT FINDINGS: Recent research indicates that, in addition to peripheral blockade of prostaglandin synthesis, central inhibition of cyclooxygenase-2 may play an important role in modulating nociception. Although nonspecific NSAIDs provide analgesic efficacy similar to coxibs, their use has been limited in the perioperative setting because of platelet dysfunction and gastrointestinal toxicity. Coxibs may be a safer alternative in that setting. Both coxibs and traditional NSAIDs may contribute to a dose-dependent increase in cardiovascular toxicity and impaired osteogenesis. When used short term at the lowest effective dose, however, NSAIDs may provide for analgesic benefit without significant toxicity. SUMMARY: When utilized as a component of a multimodal analgesic regimen for acute pain, short-term NSAID administration reduces opioid-related side effects and may contribute to improved functional outcomes without significant adverse effects. 相似文献
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《Cardiovascular surgery (London, England)》1998,6(5):490-495
Purpose: This study was designed to determine whether the preoperative, baseline electroencephalogram (EEG) can be used for intraoperative decision making during carotid endarterectomy, and to identify circumstances where the EEG can be eliminated. Methods: The charts of all patients undergoing carotid endartectomy at the authors' institution from June 1991 to May 1995 were reviewed to identify those patients that had adequate pre- and intraoperative EEG monitoring. EEGs during 331 carotid endartectomies in 303 patients were coded without knowledge of outcome; primary and secondary endpoints were EEG changes with clamping and clinical outcome, respectively. Results: The incidence of mortality and major neurological morbidity was 1.8%. Baseline-EEGs were abnormal in 105 patients (32%). Whereas baseline-EEG changes were highly predictive of EEG changes after anesthetic induction (P<.0001), they were not predictive of EEG changes with clamping or of clinical outcome. Prior stroke (CVA) predicted abnormal baseline-EEGs (P<.0001) and abnormal post-anesthetic EEGs (P<.0001) but did not predict changes with clamping or perioperative CVA. EEG changes with clamping occurred during 18% of operations; such changes were predicted only by contralateral occlusion (P<.0016) and EEG changes during a prior contralateral carotid endartectomy (P<.0001). The only variable that predicted an adverse neurological outcome was the presence of contralateral occlusion, which increased the likelihood of a perioperative neurological event seven-fold (P=.0038). Clinical outcomes in the 57 of 105 patients with abnormal baseline-EEGs and the 49 of 83 with prior CVA who were shunted were not different from those who were not. Conclusions: baseline-EEG is not of value for the prediction of adverse events during carotid endartectomy and can be eliminated. Because contralateral occlusion is highly predictive of changes with clamping, and patients undergoing a second carotid endartectomy will usually manifest EEG changes identical to those at the first, operative EEG monitoring can also be eliminated from both these circumstances. Finally, prior stroke does not lead to a higher incidence of clamp-induced EEG changes, and thus is not an indication for shunting in and of itself. 相似文献
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Pain diagnosis and management would benefit from the development of objective markers of nociception and pain. Current research addressing this issue has focused on five main strategies, each with its own advantages and disadvantages. These encompass: (i) monitoring changes in the autonomic nervous system; (ii) biopotentials; (iii) neuroimaging; (iv) biological (bio‐) markers; and (v) composite algorithms. Although each strategy has shown areas of promise, there are currently no validated objective markers of nociception or pain that can be recommended for clinical use. This article introduces the most important developments in the field and highlights shortcomings, with the aim of allowing the reader to make informed decisions about what trends to watch in the future. 相似文献
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Finkel JC Besch VG Hergen A Kakareka J Pohida T Melzer JM Koziol D Wesley R Quezado ZM 《Anesthesiology》2006,105(2):360-369
BACKGROUND: Age-related changes in nociception have been extensively studied in the past decades. However, it remains unclear whether in addition to the increased incidence of chronic illness, age-related changes in nociception contribute to increased prevalence of pain in the elderly. Although a great deal of evidence suggests that nociception thresholds increase with aging, other studies yield disparate results. The aim of this investigation was to longitudinally determine the effect of aging on nociception. METHODS: The authors developed a nociception assay for mice using electrical stimuli at 2,000, 250, and 5 Hz that reportedly stimulate Abeta, Adelta, and C sensory nerve fibers, respectively. A system was designed to automate a method that elicits and detects pain-avoiding behavior in mice. Using a Latin square design, the authors measured current vocalization thresholds serially over the course of mice's life span. RESULTS: For 2,000-Hz (Abeta), 250-Hz (Adelta), and 5-Hz (C) electrical stimuli, current vocalization thresholds first decreases and then increases with aging following a U-shaped pattern (P < 0.001). In addition, average current vocalization thresholds at youth and senescence are significantly higher than those at middle age for the 250-Hz (Adelta) and 5-Hz (C fiber) electrical stimulus (P < 0.05). CONCLUSIONS: Using a novel and noninjurious nociception assay, the authors showed that over the life span of mice, current vocalization threshold to electrical stimuli changes in a U-shaped pattern. The findings support the notion that age-related changes in nociception are curvilinear, and to properly study and treat pain, the age of subjects should be considered. 相似文献
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Background and objectivesPatient self‐rating based scales such as Numerical Rating Scale, Visual Analog Scale that is used for postoperative pain assessment may be problematic in geriatric or critically ill patients with communication problems. A method capable of the assessment of pain in objective manner has been searched for years. Analgesia nociception index, which is based on electrocardiographic data reflecting parasympathetic activity, has been proposed for this. In this study we aimed to investigate the effectiveness of analgesia nociception index as a tool for acute postoperative pain assessment. Our hypothesis was that analgesia nociception index may have good correlation with Numerical Rating Scale values.MethodsA total of 120 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing any surgical procedure under halogenated‐based anesthesia with fentanyl or remifentanil were enrolled for the study. At the 15th minute of arrival to the Postoperative Care Unit the patients’ pain was rated on a 0-10 point Numerical Rating Scale. The patients’ heart rate, blood pressure, and analgesia nociception index scores were simultaneously measured at that time. The correlation between analgesia nociception index, heart rate, blood pressure and Numerical Rating Scale was examined.ResultsThe study was completed with 107 patients, of which 46 were males (43%). Mean (SD) analgesia nociception index values were significantly higher in patients with initial Numerical Rating Scale ≤ 3, compared with Numerical Rating Scale > 3 (69.1 [13.4] vs. 58.1 [12.9] respectively, p < 0.001). A significant negative linear relationship (r2 = ‐0.312, p = 0.001) was observed between analgesia nociception index and Numerical Rating Scale.ConclusionAnalgesia nociception index measurements at postoperative period after volatile agent and opioid‐based anesthesia correlate well with subjective Numerical Rating Scale scores. 相似文献
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《Journal of orthopaedic science》2023,28(4):814-820
BackgroundAspirin has gained increasing use-popularity on account of its multiple benefits. The present study aimed to investigate how a pre-existing long-term aspirin use (L-AU) would affect perioperative complications and postoperative pain in primary total knee arthroplasty (TKA) patients.MethodsUtilizing the National Inpatient Sample (NIS) database, primary TKAs were divided into L-AU and non-L-AU cohorts. Propensity score matching (PSM) was performed to match the demographics and comorbidities characteristics. Chi-square test and logistic regression analysis were calculated for the risk analysis of perioperative complications and postoperative pain.ResultsThe popularity of L-AU in primary TKA patients had significantly increased from 1.5% (2005) to 10.5% (2014) in the U.S. Pre-existing L-AU was associated with decreased risks of most perioperative complications (any complication, adjusted odds ratio [aOR]: 0.920), in-hospital mortality (aOR: 0.367), and shortened hospitalization stay (LOS) (aOR: 0.647), etc. However, L-AU was recognized as a risk factor of acute postoperative pain (aOR: 1.466) and slightly higher total cost (aOR: 1.047).ConclusionsFor the first time in the present study, it is found that pre-existing long-term aspirin use is benefic in reducing perioperative complication risk. According to this finding, future research might determine the optimal pre-operational taking time and dose of aspirin use. Consequently, orthopedic surgeons and healthcare providers could provide this valuable advice to specific patients prior to a planned arthroplasty and subsequently gain feasible clinical benefits. 相似文献
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Pogatzki-Zahn EM Zahn PK Brennan TJ 《Best Practice & Research: Clinical Anaesthesiology》2007,21(1):3-13
Postoperative incisional pain is a unique and common form of acute pain. Although ample evidence indicates that an efficeous postoperative pain treatment reduces patient morbidity and patient outcome, recent studies demonstrate that about 50-70% of patients experience moderate to severe pain after surgery indicating that postoperative pain remains poorly treated. Perhaps important reasons for this quandary are distinct mechanisms of incisional nociception compared to other pain conditions limiting our regimen to drugs designed for other clinical pain problems. Another reason might be the lack of an in depth knowledge about the pathophysiology and neuropharmacology of postoperative pain. Basic research offers important insights in the mechanisms of postsurgical incisional pain and the translation of experimental results into clinical practice will have important implications on the improvement of new multimodal treatment regimens based postoperative pain mechanisms. In the present review, recent developments in experimental postsurgical incisional pain research will be described and their possible relevance for clinical practice discussed. 相似文献