头针超前镇痛对肠癌患者术后硬膜外吗啡镇痛的影响

目的:探讨头针超前镇痛的效果。方法:选择需做肠癌根治术的患者60例,随机分为两组,头针加硬膜外组(头针组)30例和硬膜外组30例。头针组患者在手术开始前20min即行头针刺激,持续刺激至手术结束,手术结束时给予硬膜外镇痛。硬膜外组只在手术结束时给予硬膜外镇痛。通过观察肠癌患者手术后视觉模拟评分(VAS)、布氏舒适评分(BCS)、胃肠功能恢复情况,探讨头针对肠癌患者术后硬膜外吗啡镇痛的影响。结果:头针组VAS评分在6h、12h、24h、48h4个时间点均较硬膜外组低,6h、12h两组间VAS评分比较差异具有显著性意义(P<0·05)。两组BCS评分在4个时间点比较,头针组均较硬膜外组低,差异均具有显著性意义(均P<0·05)。两组患者术后肠鸣音恢复时间以头针组快,组间差异有非常显著性意义(P<0·01);两组患者术后肛门排气恢复时间也以头针组快,差异有非常显著性意义(P<0·01)。结论:头针具有一定的超前镇痛作用,可减轻患者术后不适,促进患者胃肠功能恢复。     

针刺镇痛在肠镜检查中的应用

目的:评估针刺镇痛在减轻患者肠镜检查中不适的效果。方法:将80例门诊结肠镜检查患者随机分为电针组和对照组各40例。电针组在镜检前30min于右侧足三里、上巨虚,左侧阴陵泉、三阴交以电针刺激持续至镜检结束,同时针刺合谷;对照组不予任何防治措施。连续监测患者血压、心率的变化;分别观察两组患者结肠镜插镜时,过乙状结肠、脾区、肝区时的疼痛级别;记录插镜至回盲部时间、术后不良反应以及检查后患者满意度。结果:80例患者全部完成了肠镜检查,电针组患者在结肠镜插镜时、过乙状结肠以及脾区时其疼痛评分显著低于对照组(P<0.01);同时电针组患者插镜至回盲部的时间为(9.58±3.86)min,亦显著快于对照组的(12.96±6.4)min(P<0.05);电针组患者术后满意度亦显著高于对照组(P<0.05)。2组患者血压、心率并无显著差异。结论:针刺镇痛能够有效地缓解患者结肠镜检查的不适感,同时缩短肠镜检查时间,患者满意度高。     

Electroacupuncture analgesia for surgery in cattle

To establish the proper analgesic method by electroacupuncture (EA) for bovine surgery, the analgesic effect of dorsal and lumbar acupoints, in addition to the combination with dorsal and lumbar acupoints, were investigated in the present study. Four Korean native cattle (two males and two females) and 24 Holstein-Friesian cattle (all females) were used. The experimental animals were divided into four groups according to used acupoints: dorsal acupoint group (Tian Ping [GV-20] and Bai Hui [GV-5]: 7 heads), lumbar acupoint group (Yap Pang 1 [BL-21], Yao Pang 2 [BL-23], Yao Pang 3 [BL-24] and Yao Pang 4 [BL-25]; 5 heads), dorsal-lumbar acupoint group (Yao Pang 1 [BL-21], Yao Pang 2 [BL-23], Yao Pang 3 [BL-24] and Bai Hui [GV-5]; 8 heads) and control group (non-acupoints, the last intercostals space and the femoral area; 3 heads). The acupoints were stimulated with currents of 2-6 V (30 Hz) in dorsal acupoint group, 0.5-2.0 V (30 Hz) in lumbar acupoint group and 0.3-2.5 V (30 Hz) in dorsal-lumbar acupoint group. Recumbency time was 10 seconds to 1 minute (except one case) and induction time of analgesia was approximately 1 to 6 minutes in dorsal acupoint group. Analgesic effect was systemic, including the extremities in dorsal acupoint group. During the EA, the consciousness was evident and blepharo-reaction was still present under EA in dorsal acupoint group. During the surgery, grades of analgesic effect were 6 excellent (6/7, 87.5%) and 1 good (1/7, 14.3%). In addition, induction time for analgesia was about 10 minutes in both lumbar and dorsal-lumbar acupoint groups. Analgesic areas were found in abdominal areas from the last intercostal spaces to the femoral areas, except lower abdomen in lumbar and lumbar-dorsal acupoint groups. The consciousness was evident and standing position was maintained during EA stimulation in contrast to that of dorsal excellent (1/5, 20.0%), 3 good (3/5, 60.0%) and 1 poor (1/5, 20.0%) in the lumbar acupoint group. Additionally, grades of analgesic effect were 4 excellent (4/8, 50.0%), 3 good (3/8, 37.5%) and 1 poor (1/8, 12.5%). On the other hand, pain was present and analgesia was not accomplished under EA stimulation in control group. In conclusion, analgesia by EA was effective with decreasing order of dorsal acupoint > dorsal-lumbar acupoint > lumbar acupoint among groups. It was considered that dorsal acupoint group might be useful for operation with recumbent position, and lumbar and dorsal-lumbar acupoint groups might be proper for operation with standing position.     

两种镇痛方法在肛肠病术后的疗效观察

为了探讨肛肠病术后最佳的镇痛方法。将240例患者随机和自愿分为两组,治疗组采用自控镇痛泵装置：对照组采用局部联合方法镇痛。结果表明两组使用不同方法后2h、4h、8h、12h、24h、48h,镇痛效果评定有显著性差异（P〈0．01）。两组患者术后镇痛满意度有显著性差异（P〈0．01）。心率、血压、血氧饱和度无明显差异。提示：镇痛泵静脉输注芬太尼镇痛液效果优于传统止痛法,是一种安全、有效、持续、稳定、更有价值的镇痛方法。值得在广大基层医院推广使用。     

经络结构及其镇痛作用的机制

根据近年有关疼痛发生的"非神经元中心"理论,并结合针刺经穴镇痛的临床研究和经络结构研究的最新进展,提出针刺经穴镇痛作用的"经络机制"假说:针刺经穴的镇痛作用是通过对经络结构及功能的直接影响,改变了组织的酸化及炎性介质等对外周感觉神经元乃至中枢神经功能活动而起到镇痛作用。针刺经穴的镇痛作用主要是与经络结构运行气血、调节阴阳的作用直接相关,疼痛的"非神经元中心"机制为其提供了重要的神经生理学基础,而经络结构与神经系统间的相互作用可能仅只是其中的一个重要环节。     

不同配方的镇痛复合液用于PCEA术后镇痛的可行性比较

硬膜外术后镇痛因其简单、方便、成本低廉、镇痛效果良好等优点而成为临床最常用的术后镇痛方法之一。目前PCEA的药物配方主是局麻药复合阿片类镇痛药吗啡、芬太尼或非麻醉性镇痛药曲马多。随着PCEA的广泛应用，术后镇痛引起的并发症日益成为值得关注的问题。本研究通过对不同配方的镇痛药液用于PCEA镇痛、镇静效果和并发症的观察，旨在寻求一种安全、有效、并发症少、临床可行性更高的PCEA术后镇痛方法。     

The effect of the septal area in acupuncture analgesia]

This review summarized some articles on the effect of the septal area in acupuncture analgesia. The data showed that the pain threshold of animal was increased when septal area was stimulated by electro-acupuncture, and that electrical stimulation of septal area had a marked inhibitory effect on the pain discharges of cells in parafascicular nucleus of thalamus, lateral habenular nucleus, periaqueductal gray and dorsal raphe nucleus. The septal area play an important role in acupuncture analgesia. The majority of the cholinergic neurons in septal area are located in nucleus of the vertical limb of the diagonal band (VDB); gamma-aminobutyric acid of septal area is mainly found in the diagonal band nucleus(td); Dopamine is present in high levels in td and lateral septal nucleus(S1) of septal area; The S1 contain high densities enkephalin-containing neuronal cell bodies and terminals; In addition, substance P and norepinephrine are also high levels in the septal area. These substance above-mentioned have a relations with acupuncture analgesia of septal area. A large number of serotonin-containing neurons are found in the raphe nuclei. The serotonin play an important role in acupuncture analgesia. The serotonin-containing neurons in dorsal raphe nucleus project to S1. The fiber connections of the raphe nuclei with the td are reciprocation. The periaqueductal gray is a important structure on pain modulation. It projects to septal area and receives the fibers from S1. A number of adrenergic neurons are located within the locus coeruleus. The locus coeruleus participate pain modulation and acupuncture analgesia. The neuro-anatomy study demonstrated that locus coeruleus projects to septal area.(ABSTRACT TRUNCATED AT 250 WORDS)     

The role of the human caudate nucleus in acupuncture analgesia

The role of the caudate nucleus in acupuncture analgesia was studied in 17 patients receiving caudate stimulation through chronic implanted electrodes to relieve intractable pain caused by late malignancy. Electrical stimulation of the head of the caudate nucleus provided relief from intractable pain in all 17 patients. The pain and pain tolerance threshold were elevated, the alteration in skin galvanic activity, respiratory movement and fingertip plethysmography elicited by a given painful stimulus were depressed. The analgesia required a period of induction and persisted for some time after cessation of stimulation; it showed no obvious segmental topography. These characteristics are similar to those observed in acupuncture analgesia. The effect of caudate stimulation was similar to that of electric needling in depressing the late component of the somatosensory evoked potentials (SEPs) recorded over the scalp and from the centrum medianum of the thalamus. Evoked potentials could be recorded from the caudate nucleus when an acupuncture point was electrically stimulated. The evoked potential record was a complex wave of positive and negative components, the peak latencies of main components being 100-180 msec for positive wave and 148-332 msec for negative wave components. The present study supports the supposition that the caudate nucleus may play a role in acupuncture analgesia. The possibility that the effect of caudate stimulation is brought on by inhibiting the activity of the medial thalamus is discussed.     

不同浓度的丁卡因联合用药用于静脉穿刺镇痛的临床应用

静脉穿刺是一种有创护理操作技术,给病人造成了一定的身心痛苦.本课题探讨不同浓度的丁卡因溶液联合不同的皮肤渗透剂甘油、月桂酸氮卓酮在静脉穿刺中的应用,达到镇痛目的,从而推广无痛技术在护理操作中的可行性,最大程度减轻病人的痛苦,现将研究结果报到如下：     

常用单味镇痛中药研究进展

镇痛中药以其药效良好、无成瘾性、不良反应少及资源丰富等优势,一直被医药研究者所重视。随着生物医学的不断发展和实验手段的革新,镇痛中药的现代实验研究取得了长足的进展。本文将常用的单味镇痛中药及其现代医学研究进展作一综述。     

鞘内注射舒芬太尼用于分娩镇痛

19世纪70年代末,脊髓水平控制伤害感受的机制的发现使术后及癌症疼痛的节段性镇痛成为可能.1976年,Yaksh等[1]首先阐明阿片类药物在脊髓水平的直接镇痛机制,但早在1901年时,一名日本外科医生首次鞘内注射10mg吗啡复合优卡因用于癌症镇痛开了鞘内注射阿片类药物用于镇痛的先河[2].     

脊髓内催产素参与电针镇痛

<正> 催产素(Oxytocin,OT)是在下丘脑室旁核和视上核内合成的一种垂体肽类激素,除有促进排乳和使子宫收缩的作用外,它的另一些作用正日益引起人们的关注。一些研究表明,中枢神经系统内的OT在痛调制和针刺镇痛过程中发挥着一定作用,但脊髓水平的OT对电针镇痛是否发挥作用,     

推拿镇痛机制的研究进展及展望

疼痛是大多数疾病具有的共同症状,是人类共有而个体差异很大的一种不愉快的感觉[1、2].大量的研究已初步表明,在高等动物和人类的中枢神经系统中存在着一个对痛觉和痛反应起调节作用的复杂的机能系统,这一系统是多水平的,且具有复杂的神经环路和神经递质[3、4].临床上镇痛的方法可以有药物、手术、神经阻滞术和物理疗法等[5],但很多药物在镇痛时常出现不同程度的毒副作用,而作为物理疗法之一的中医推拿在治疗痛症时却显示出无创性,不扰乱机体正常生理功能,疗效显著的优点,正越来越受到人们的重视[6、7 ].因此,近几年来在推拿镇痛机理研究方面,开展了不少工作[8、9],取得了一些令人兴奋的结果,值得回顾.     

Central neurotransmitters and acupuncture analgesia

The role played by central neurotransmitters in acupuncture analgesia was evaluated by correlating neurochemical changes in central nervous system with the acupuncture effect, as well as modification of the acupuncture effects by pharmacological manipulations of central neurotransmitters. The results of experimental studies which were performed mainly on rats and rabbits indicated that central serotonin and endogenous opiate-like substances (OLS) seem to be the most important substrates for mediation of acupuncture analgesia while central catecholamines, especially norepinephrine through alpha receptors, may exert an antagonistic effect. It was also found that prolonged and repeated acupuncture resulted in a gradual decrease of the acupuncture effects. The development of some endogenous anti-opiate substrates (AOS) in central nervous system was tentatively implicated.