鞘内埋入式自控吗啡泵治疗重度癌痛的疗效观察

癌性疼痛是恶性肿瘤在其发展过程中出现的剧烈的持续性疼痛,是晚期癌症患者常见的伴随症状.重度癌痛是影响患者情绪和生活质量的主要因素,缓解这部分患者的疼痛在临床上具有重要意义.     

持续鞘内吗啡联合布比卡因用于中重度晚期癌痛患者的疗效和安全性

目的评估持续鞘内吗啡联合布比卡因用于中重度晚期癌痛患者的疗效和安全性。方法 42例中重度晚期癌痛患者,随机分为单纯鞘内吗啡组(A组)与吗啡联合布比卡因组(B组),每组21例。植入鞘内导管外接电子PCA泵实施持续鞘内镇痛,分别给予A组0.2mg/ml吗啡,B组0.2mg/ml吗啡+0.75mg/ml布比卡因混合液起始按口服吗啡转换剂量持续鞘内泵入+单次冲击量(24h背景量的1/10,锁定时间1h);记录患者术前、术后1周、2周、1月的静息及运动VSA疼痛评分、吗啡用量、便秘症状评分及WHOQOL-BREF生活质量评分,并观察镇痛后头痛、恶心呕吐、尿潴留、皮肤瘙痒、下肢麻木、运动阻滞不良反应的发生率。结果两组患者鞘内镇痛后静息VAS评分及便秘症状评分均显著下降(P<0.01),两组间差异无统计学意义。B组鞘内镇痛后运动VAS评分低于A组(P<0.05),每日吗啡用量低于A组(P<0.01),WHOQOL-BREF生理领域评分高于A组(P<0.05)。两组均有少数患者出现恶心呕吐、皮肤瘙痒、尿潴留、下肢麻木及运动阻滞,但差异无统计学意义。结论持续鞘内吗啡联合布比卡因用于中重度癌痛效果确切,运动痛及生活质量改善优于单纯鞘内吗啡。     

鞘内注射吗啡和可乐定对切口痛大鼠脊髓背角pCREB表达的影响

目的 观察鞘内注射吗啡和可乐定对切口痛大鼠脊髓背角磷酸化环腺苷酸反应原件结合蛋白(pCREB)表达的影响.方法 选择雄性SD大鼠80只,随机均分为五组:切口痛组(A组)、鞘内注射吗啡2.5μg组(B组)、鞘内注射可乐定5μg组(C组)、鞘内注射吗啡2.5μg+可乐定5μg组(D组)和假手术组(E组).观察大鼠术后2h机械缩足反射阈值(MWT)、热缩足潜伏期(TWL)和脊髓背角pCREB表达的变化.结果 与E组比较,A、B、C、D组MWT降低,TWL缩短,脊髓背角pCREB免疫反应阳性神经元数量和pCREB蛋白表达增加(P<0.01).与A组比较,D组MWT升高,TWL延长,脊髓背角pCREB免疫反应阳性神经元数量和pCREB蛋白表达减少(P<0.01).结论 鞘内注射吗啡加可乐定可抑制大鼠切口痛,这可能与其引起的脊髓背角pCREB的表达增加有关.     

可乐定布比卡因硬膜外手术后镇痛的观察

本文比较硬膜外腔单次注入小剂量可乐定和低浓度布比卡因，单独或联合应用的镇痛效果及对血流动力学的影响。资料与方法全麻下行全髋关节置换术病人３０例，ＡＳＡⅠ～Ⅱ级，年龄３５～７６岁。全麻前，在Ｌ２～３间隙置硬膜外导管。以硫喷妥钠５ｍｇ／ｋｇ、芬太尼８μｇ...     

鞘内注舒芬太尼-布比卡因-可乐定作分娩镇痛

联合腰麻-硬膜外(CSE)麻醉时先在鞘内注舒芬太尼10μg加布比卡因2.5mg对分娩早期的镇痛很有效。作者曾将上述两药量减半则可减少低血压、镇静和运动阻滞等副作用,但是起效时间慢而且作用时间缩短。因此,作者给产妇鞘内注舒芬太尼5μg、布比卡因1.25mg时再加可乐定(氯压定)作分娩镇痛,重点观察量-效关系群找出最佳剂量。     

吗啡复合芬太尼硬膜外病人自控镇痛治疗晚期癌痛的效果

近几年治疗晚期癌症顽固性疼痛的病人自控镇痛(PCA)技术,大多是皮下PCA(PCSA)或静脉PCA(PCIA),其用药量、疗效等差异较大[1]。本研究旨在探讨吗啡复合芬太尼硬膜外PCA(PCEA)治疗晚期癌痛的效果。资料和方法 选择WHO三阶梯止痛第三级药物治疗效果差的腹部及其以下部位疼痛(按VAS评分法[2],均为9～10分)的癌症病     

硬膜外自控镇痛病人布比卡因血药浓度的测定

硬膜外病人自控镇痛 (ＰＣＥＡ)已在临床上广泛开展 ,很多病人应用长效局麻药———布比卡因 ,由于其有一定的心脏毒性 ,因此 ,我们对部分术后ＰＣＥＡ病人测定布比卡因血药浓度。资料与方法2 0例肝、肾功能正常病人 ,在全麻下行上腹部择期手术 ,年龄 2 3～ 49(30 8± 5 6 )岁 ,体重 5 1～ 73(6 0 7± 6 9)ｋｇ,全麻诱导前Ｔ9～ 10 间隙行硬膜外穿刺 ,2 %利多卡因 5ｍｌ试验明确阻滞效果后开始诱导 ,术中主要以安氟醚、氧化亚氮、异丙酚静吸复合维持麻醉。手术结束时接Ｇｒａｓｅｂｙ 930 0镇痛泵开始ＰＣＥＡ。应用 0 2 5 %布比卡因 ,…     

鞘内药物输注系统用于癌痛治疗时患者和药物的选择

背景 应用鞘内药物输注系统(intrathecal drug delivery systems,IDDS)是目前癌痛介入治疗的有效方法之一.选择合适的患者和镇痛药物,以及有效的管理是获得良好效果的基础.虽然国际上有相关共识和指南,但关于癌痛患者和药物的选择尚无定论. 目的 通过文献检索和阅读,综述最新关于晚期癌痛患者IDDS镇痛治疗时患者和药物的选择的观点,旨在为临床实践提供新的方法和思路. 内容 随着鞘内镇痛药物和管理的进展,目前认为预期寿命小于3个月的患者也可应用IDDS;植入前测试在癌痛患者并非必须；药物的选择主要取决于病因是神经病理性、伤害性或者混合性疼痛；加强鞘内镇痛初期和换药时的监测. 趋向 肿瘤的日趋高发及其治疗后生存率的提升使得癌痛发生日趋增多,WHO癌痛三阶梯指南不能完全有效镇痛,而应用IDDS将是顽固性癌痛治疗的不可替代的方法之一.     

吗啡控释片治疗重度癌痛的临床体会

为了使癌症病人少受疼痛折磨，提高患者的生活质量，本文对１１５例重度癌痛患者采用口服吗啡控释片治疗癌痛取得满意疗效。现将结果总结如下。资料与方法一般资料本文随机选择了１９９４年９月～１９９７年１１月门诊收治１１５例晚期肿瘤伴重度疼痛的病人。其中，男７６...     

曲马多与布比卡因混合液在术后病人自控

术后病人自控硬膜外镇痛（PCEA）近年来得到广泛开展，本研究旨在观察曲马多在PCEA中的镇痛效应。     

鞘内注射罗哌卡因、左旋布比卡因和布比卡因后运动阻滞效能的比较

目的测定罗哌卡因、左旋布比卡因和布比卡因鞘内注射后运动阻滞的半数有效量（ED50）及其运动阻滞的相对效能。方法104例在腰麻、硬膜外联合麻醉下行择期剖宫产的产妇随机分为3组，分别鞘内注射0．5％（质量／体积）的罗哌卡因、左旋布比卡因和布比卡因，起始剂量是4mg，试验递增剂量为1mg.有效的定义是：鞘内注药5分钟内任一下肢出现运动阻滞（改良的Bromage评分和臀部运动功能评分）。结果鞘内注射罗哌卡因运动阻滞的ED50值为5．79mg（95％CI：4．62～6．96）；左旋布比卡因的ED50为4．83mg（95％CI：4．35～5．32）；布比卡因的ED50为3．44mg（95％CI：2．55～4．34）（P〈0．0007）。运动阻滞效能的相对比例：罗哌卡因／布比卡因为0．59（95％CI：0．42—0．82）；罗哌卡因／左旋布比卡因为0．83（95％CI：0．64～1．09）；左旋布比卡因／布比卡因为0．71（95％CI：0．51～0．98）。结论3种酰胺类局麻药鞘内注射后运动阻滞效能由低到高分别是：罗哌卡因、左旋布比卡因和布比卡因。     

硬膜外吗啡或／和可乐定缓解晚期癌症的恶痛

12例晚期肿瘤恶痛病人,单盲法进行随机交叉硬膜外注药研究,观察吗啡2mg 或(和)可乐定150ug 的镇痛效应,NRS-101法记分测痛,记录病人用药后的不良反应。结果表明,硬膜外注射吗啡,镇痛效果较差,持续时间(330±86min)比可乐定短;可乐定较吗啡为好,但仍有部分病人感镇痛不全,持续时间为389±112min;联合应用吗啡和可乐定,镇痛效应明显增强(P<0.05),作用持续时间达645±123min。吗啡的不良反应主要是皮肤搔痒和排尿困难,可乐定则为血压略降和心率稍慢,联合用药时并不因而加剧。     

鞘内注射腺苷A1受体激动剂对吗啡和可乐定镇痛作用的影响

目的 观察鞘内注射腺苷A1受体激动剂苯基异丙基腺苷(R-PIA)对吗啡和可乐定镇痛作用的影响.方法 健康雄性SD大鼠,鼠龄8～10周,体重250～300g,鞘内置管成功的85只大鼠随机分为17组,每组5只,对照组、R-PIA0.4组、R-PIA0.8组、R-PIA1.0组、茶碱组、吗啡2.0组、吗啡5.0组、可乐定2.0组、可乐定15.0组、R-PIA+吗啡2.0组、R-PIA+吗啡5.0组、R-PIA+可乐定2.0组、R-PIA+可乐定15.0组、可乐定+吗啡组均鞘内注射生理盐水,15min后分别注射生理盐水、R-PIA 0.4μg、R-PIA 0.8μg、R-PIA 1.0 μg、茶碱50 μg、吗啡2.0μg、吗啡5.0μg、可乐定2.0μg、可乐定15.0μg、R-PIA 0.4μg+吗啡2.0μg、R-PIA 0.4μg+吗啡5.0μg、R-PIA 0.4μg+可乐定2.0μg、R-PlA 0.4μg+可乐定15.0μg、可乐定2.0μg+吗啡2.0μg;R-PIA+吗啡+茶碱组、R-PIA+可乐定+茶碱组、可乐定+吗啡+茶碱组鞘内注射茶碱50μg,15 min后分别注射R-PIA 0.4μg+吗啡5.0μg、R-PIA 0.4μg+可乐定15.0μg、可乐定2.0μg+吗啡2.0μg,每次给药容积均为10μl.注药后5、10、20、30、40、60min时测定大鼠热辐射甩尾反应潜伏期(TFL),用最大效应百分比(MPE)[(注药后TFL-TFL的基础值)/(10.0-TFL的基础值)γ100%]评价镇痛效果.结果 高剂量R-PIA、吗啡、可乐定可升高MPE,R-PIA可增强吗啡、可乐定的镇痛作用,可被茶碱完全阻断,吗啡可增强可乐定的镇痛作用,可被茶碱部分阻断;可乐定可增强吗啡的镇痛作用.结论 大鼠鞘内注射R-PIA可增强吗啡和可乐定的镇痛作用,其机制可能与活化脊髓内腺苷受体有关.     

韩氏仪对晚期癌痛病人吗啡静脉自控镇痛作用的影响

在晚期癌痛治疗中,吗啡是最常用的阿片类药物,长时间使用易于产生耐受性.比较而言,镇痛与欣快感耐药性常产生较快,而镇静和呼吸抑制的耐受性产生稍慢[1],晚期癌痛患者大多年老体弱,易导致呼吸衰竭.韩氏(HANS)仪是通过特定频谱的电脉冲刺激,促使神经系统中阿片类的3种化学物质(脑啡肽、内啡肽、强啡肽)以及其他神经递质释放[2、3],发挥镇痛和治疗作用.本文将HANS仪应用于吗啡静脉自控镇痛(PCIA)的晚期胃癌病人,观察其对脑脊液脑啡肽与血浆皮质醇的影响,并了解HANS仪能否提高吗啡镇痛作用和减少吗啡用量.     

老年人贲门术后布比卡因复合曲马多及吗啡病人自控硬膜外镇痛效果和对肺功能的影响

病人自控硬膜外镇痛(PCEA)现已被广泛地运用于临床手术后镇痛治疗。本文通过临床观察和测定，比较曲马多和吗啡在老年患者贲门手术后镇痛效果及对肺功能、PaO2、PaCO2以及在治疗中出现的不良反应。     

鞘内注射吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A催化亚单位表达的影响

Objective To observe the effect of intrathecal clonidine plus morphine on expression of protein kinase A (PKA) catalytic subunit in the spinal dorsal horn in a rat model of incisional pain. Methods Eighty male Sprague-Dawley rats were divided randomly into five groups: sham group, control group, pre-incisional morphine 2.5 μg group, pro-incisional clonidine 5 μg group and preincisional morphine 2.5 μg plus clonidine 5 lag group (n=16). lntrathecal catheter and the model of incisional pain were pro-duced according to Yaksh and Brennan's described method respectively. Changes of pain behavior were assessed by mechanical with-drawal threshold (MWT) and thermal withdrawal latency(TWL). The expressions of PKA catalytic subunit in the spinal dorsal horn were assessed by immunohistochemical method and western blotting analysis. Results Compared with sham group, MWT and TWL in control group were decreased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were increased significantly in control group (P<0.01). Compared with control group, MWT and TWL in pre-incision morphine 2 μg plus clonidine 5 lag group were increased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were decreased significantly in pre-incision morphine 2 μg plus clonidine 5 μg group (P<0.01). However, MWT, TWL and the number of positive cells and pro-tein expression of PKA catalytic subunit in the spinal dorsal horn changed with no statistical significance in pre-incisional morphine 2.5 μg group and pre-incisional clonidine 5 μg group compared with control group. Conclusion lntrathecal clonidine significantly enhances the antinociceptive effect of intrathecal morphine in a rat model of incisional pain, which might be associated with inhibi-tion of the increased expression of PKA catalytic subunit in spinal cord.     

鞘内注射吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A催化亚单位表达的影响

Objective To observe the effect of intrathecal clonidine plus morphine on expression of protein kinase A (PKA) catalytic subunit in the spinal dorsal horn in a rat model of incisional pain. Methods Eighty male Sprague-Dawley rats were divided randomly into five groups: sham group, control group, pre-incisional morphine 2.5 μg group, pro-incisional clonidine 5 μg group and preincisional morphine 2.5 μg plus clonidine 5 lag group (n=16). lntrathecal catheter and the model of incisional pain were pro-duced according to Yaksh and Brennan's described method respectively. Changes of pain behavior were assessed by mechanical with-drawal threshold (MWT) and thermal withdrawal latency(TWL). The expressions of PKA catalytic subunit in the spinal dorsal horn were assessed by immunohistochemical method and western blotting analysis. Results Compared with sham group, MWT and TWL in control group were decreased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were increased significantly in control group (P<0.01). Compared with control group, MWT and TWL in pre-incision morphine 2 μg plus clonidine 5 lag group were increased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were decreased significantly in pre-incision morphine 2 μg plus clonidine 5 μg group (P<0.01). However, MWT, TWL and the number of positive cells and pro-tein expression of PKA catalytic subunit in the spinal dorsal horn changed with no statistical significance in pre-incisional morphine 2.5 μg group and pre-incisional clonidine 5 μg group compared with control group. Conclusion lntrathecal clonidine significantly enhances the antinociceptive effect of intrathecal morphine in a rat model of incisional pain, which might be associated with inhibi-tion of the increased expression of PKA catalytic subunit in spinal cord.     

鞘内注射吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A催化亚单位表达的影响

目的 观察鞘内注射(intrathecal injection,IT)吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A(protein kinaseA,PKA)催化亚单位表达的影响.方法 选择鞘内置管成功的雄性SD大鼠80只,随机分为5组,每组16只,分别为假手术组、对照组、吗啡2.5μg组、可乐定5 μg组和吗啡2.5 μg+可乐定5μg组.按Yaksh法鞘内置管,按Brennan法制作大鼠足底切口疼痛模型,用机械缩爪反射阈值(mechanical withdrawal threshold.MWT)和热缩爪潜伏期(thermal withdrawal latency,TWL)观察疼痛行为学变化,应用免疫组织化学法和免疫印迹法测定大鼠脊髓背角PKA催化亚单位表达的变化.结果 与假手术组比较,术后2h对照组大鼠的MWT明显降低,TWL明显缩短(P<0.01),脊髓背角PKA催化亚单位免疫反应阳性神经元数量和神经元胞浆内PKA催化亚单位表达明显增加(P<0.01);与对照组比较,吗啡2.5μg+可乐定5μg组大鼠的MWT明显增加,TWL明显延长(P<0.01),脊髓背角PKA催化亚单位免疫反应阳性神经元数量和神经元胞浆内PKA催化哑单位表达明显减少(P<0.01);而吗啡2.5μg组和可乐定5μg组大鼠的MWT、TWL、脊髓背角PKA催化亚单位免疫反应阳性神经元数量和神经元胞浆内PKA催化亚单位表达与对照组比较均无统计学意义.结论 在大鼠切口痛模型中,IT可乐定能增强吗啡的抗伤害作用,其机制可能与其抑制切口痛引起的脊髓背角PKA催化亚单位的表达增加有关.     

鞘内注射吗啡加可乐定对切口痛大鼠脊髓背角蛋白激酶A催化亚单位表达的影响

Objective To observe the effect of intrathecal clonidine plus morphine on expression of protein kinase A (PKA) catalytic subunit in the spinal dorsal horn in a rat model of incisional pain. Methods Eighty male Sprague-Dawley rats were divided randomly into five groups: sham group, control group, pre-incisional morphine 2.5 μg group, pro-incisional clonidine 5 μg group and preincisional morphine 2.5 μg plus clonidine 5 lag group (n=16). lntrathecal catheter and the model of incisional pain were pro-duced according to Yaksh and Brennan's described method respectively. Changes of pain behavior were assessed by mechanical with-drawal threshold (MWT) and thermal withdrawal latency(TWL). The expressions of PKA catalytic subunit in the spinal dorsal horn were assessed by immunohistochemical method and western blotting analysis. Results Compared with sham group, MWT and TWL in control group were decreased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were increased significantly in control group (P<0.01). Compared with control group, MWT and TWL in pre-incision morphine 2 μg plus clonidine 5 lag group were increased significantly at 2 h after incision (P<0.01) and the number of positive cells and protein expression of PKA catalytic subunit in the spinal dorsal horn were decreased significantly in pre-incision morphine 2 μg plus clonidine 5 μg group (P<0.01). However, MWT, TWL and the number of positive cells and pro-tein expression of PKA catalytic subunit in the spinal dorsal horn changed with no statistical significance in pre-incisional morphine 2.5 μg group and pre-incisional clonidine 5 μg group compared with control group. Conclusion lntrathecal clonidine significantly enhances the antinociceptive effect of intrathecal morphine in a rat model of incisional pain, which might be associated with inhibi-tion of the increased expression of PKA catalytic subunit in spinal cord.