心理因素对针刺镇痛的影响

目的 研究不同产妇性格分型对于针刺镇痛效果的影响.方法 将175例初产妇根据艾森克人格问卷神经质得分,分为稳定型性格、不稳定型性格;根据内外向得分,分为外向型性格、内向型性格;根据镇痛前后VAS评分比较,进行统计学分析,研究不同性格心理因素对针刺镇痛的影响.结果 性格稳定与否对镇痛效果以及产妇对镇痛满意度有显著影响.内外向性格对镇痛效果影响不显著,两者结合分析,将产妇分为外向稳定型、内向稳定型、外向不稳定型、内向不稳定型,镇痛效果由高到低依次为:内向稳定型、外向稳定型、外向不稳定型、内向不稳定型.结论 性格类型不同对针刺镇痛效果有显著性影响.测评产妇性格类型对于分娩镇痛方式的选择具有一定的指导意义.     

电针对慢性炎症疼痛大鼠背根神经节牛肾上腺髓质22肽及其受体基因表达的影响

【目的】观察电针对完全福氏佐剂（completefreund’sadjuvant,CFA）致慢性疼痛大鼠患侧腰背根神经节（dorsalrootganglion,DRG）牛肾上腺髓质22肽（BAM22）与其感觉神经元特异性受体（SNSR）、MOR与DOR基因表达的影响。[方法]200＋20g雄性sD大鼠30只,随机分成正常对照组、模型对照组、电针组,每组10只,模型对照组、电针组右足CFA造模。电针组从造模24h开始治疗,患侧“足三里”穴,2／100Hz,30min,1次／d,治疗10d,其余2组不予治疗。采用辐射热法检测大鼠缩爪潜伏期观察大鼠患侧热痛敏变化,免疫组化法检测患侧背根神经节BAM22多肽的含量,定量PCR（quantitativepotymerasechainreaction,qPCR）法检测患侧背根神经节SNSR、MOR与DORmRNA的表达。[结果]经过10d的治疗,电针组的痛阈与模型对照组相比,有显著提高（P〈0．05）。免疫组化结果显示,电针干预后,患侧背根神经节的BAM22阳性细胞率比模型对照组有显著的提高（P〈0.01）。定量PCR结果显示,电针极大地促进了SNSR（P〈0．01）、MOR（P〈0．01）与DORmRNA（P〈0．01）在患侧DRG中的表达。[结论]电针对CFA大鼠慢性疼痛有良好的干预作用,推测该作用与电针增强患侧腰背根神经节BAM22多肽表达,增强其非阿片受体SNSR与其阿片受体MoR与DoRmRNA表达相关。     

术后硬膜外镇痛泵的临床应用与疗效观察

目的：本文观察术后病人使用硬膜外自控镇痛泵(PCEA)和持续镇痛泵(CEA)的方法和临床效果。方法：60例ASAⅠ～Ⅱ级腹部手术患者，随机分为二组：A组(PCEA组)30例，吗啡15mg、氟哌利多5mg、布比卡因150mg 0．9％NS至100ml。持续量1ml／h，PCA量0．5ml／次，安全锁定时间15min。B组(CEA组)30例，吗啡10mg、氟哌利多5mg、布比卡因150mg、 0．9％NS至100ml。持续量2ml／h。均于手术结束时将镇痛泵于硬膜外导管连接，观察并记录疼痛评分、SpO2、呼吸频率、血压、镇静状态及恶心呕吐等指标。结果和结论：二组病人上述观察指标无显著性差异，疼痛控制率均达98％。总之我们认为两种给药方法均为较好的术后止痛法。     

Ambulatory postoperative ward-based epidural analgesia: a retrospective review of 1,147 cases

Background

A retrospective review of 1,147 patients who received epidural analgesia (EA) in surgical wards from January 2008 to December 2009 to determine the prevalence of early ambulation and assess the efficacy and safety of EA for postoperative pain management.

Aim

Outcome measures were the prevalence of ambulation, pain scores at rest/movement and adverse events.

Methods

Patients (N = 1,147) who received postoperative EA between January 2008 and December 2009 were included. Motor function was assessed using the Bromage scale. Ambulation was defined as: Day 1: mobilisation from bed to chair, walking on the spot, taking a few steps, thereafter walks of increasing duration and distance at least twice daily. Pain scores were measured using the verbal numerical rating scale (0–10), ≤4 signifying successful analgesia. Daily assessments and data recordings were performed by clinical nurse specialists (CNSs) using standardised charts. Data collected included patient demographics, surgical procedure, ambulation achieved, pain scores at rest/movement and adverse events. The data was analysed using Microsoft Excel^®.

Results

The prevalence of ambulation was 88 % and this was maintained for the duration of EA. Ninety-eight percent of patients reported pain scores of ≤4 at rest and 88 % reported pain scores of ≤4 on movement. Adverse events included motor block 12 %, nausea 9 %, hypotension 8 %, catheter dislodgement 3.8 %, leakage from insertion site 1.6 %, decubitus ulcers 0.58 % and infection 0.001 %. Mean duration of EA was 4 days.

Conclusions

Ward-based EA facilitates early ambulation, provides excellent postoperative pain relief and is associated with low prevalence of adverse events.     

电针对佐剂性关节炎大鼠镇痛作用及内啡肽影响

目的观察电针腰夹脊穴对佐剂性关节炎(AA)大鼠的镇痛效应及中枢β-内啡肽(β-EP)的影响,探讨电针镇痛的部分中枢机制。方法以AA大鼠为疼痛模型,以局部痛阈、足跖容积为指标观察电针的镇痛作用,并采用放射免疫法测定大鼠下丘脑、脊髓β-EP含量。结果电针可显著提高AA大鼠痛阈、降低其足跖容积,并能显著提高其下丘脑、脊髓的β-EP含量。结论电针有良好的镇痛治疗作用,其机制可能与其调节中枢β-EP的含量有关。     

电针四白穴预处理对内脏痛大鼠的镇痛作用

目的探讨电针四白穴对内脏痛大鼠的镇痛作用及其机制。方法将成年SD大鼠30只,随机分为空白组（组Ⅰ）、内脏痛组（组Ⅱ）、电针四白穴组（组Ⅲ）、电针非穴位＋内脏痛组（组Ⅳ）、电针四白穴位＋内脏痛组（组Ⅴ）。采用腹腔注射乙酸复制内脏痛模型。组Ⅲ、组Ⅳ和组V分别电针刺激双侧四白穴及四白穴外侧旁开1cm处20min;电针结束后,分别腹腔注射9．0g／L氯化钠注射液和乙酸。观察各组大鼠的扭体反应以及孤柬核（nucleusoftractussolitarii,NTS）内c—fos表达水平。结果组Ⅰ和组Ⅲ未观察到大鼠的扭体反应;组Ⅱ大鼠出现显著的扭体反应;组Ⅳ和组Ⅴ大鼠扭体反应次数显著低于组Ⅱ（P〈0．05,或P〈0．01）。组工大鼠NTS内c-fos低水平表达;组Ⅱ大鼠NTs内c—los表达水平显著高于组工（P〈0．01）;与组Ⅱ比较,组Ⅲ、组Ⅳ和组V大鼠NTS内c—fos表达水平显著降低（P〈0．05,或P〈0．01）。结论电针四白穴对大鼠内脏痛有显著的镇痛作用,面口部穴位的躯体感觉传入在孤束核对内脏感觉传入的抑制作用可能是电针四白穴对内脏痛产生镇痛效应的基础。     

Effect of pre-electroacupuncture on p38 and c-Fos expression in the spinal dorsal horn of rats suffering from visceral pain

Background Acupuncture is an effective way to relieve pain, but the mechanism by which electroacupuncture （EA） decreases the visceral pain state still remains unclear. This study aimed to evaluate the effects of pre-electroacupuncture on pain behaviors, p38 phosphorylation, and c-Fos protein and mRNA expression in both the colonic wall and spinal dorsal horn of rats suffering from visceral pain. This study also investigated the probable signaling regulatory mechanism of the analgesic effect induced by electroacupuncture. Methods All rats were randomized into the control （Con） group, the Con＋EA group, the visceral pain （VP） group, and VP＋EA group （n=8 for all groups）. The visceral pain model was established using 40 ul of 5% formalin solution injected into the colon of rats. EA was applied to the bilateral Jiaji acupoints for 20 minutes before application of visceral pain. Parameters for EA were set at a continuous wave （20 Hz） and intensity where the rats shook their whiskers but did not scrabble （≤1 mA）. The visceral pain score was recorded and the expressions of p38 and c-Fos protein were detected using Western blotting. Real-time quantitative PCR was also used to determine the expression of c-Fos mRNA. Results Rats in the VP group immediately presented with obvious visceral pain behaviors after being injected with formalin. p38 activity and c-Fos protein and mRNA expression in both the colonic wall and spinal dorsal horn were higher in the VP group than in the Con group （P 〈0.05）. By contrast, visceral pain behaviors were delayed in rats from the VP＋EA group. p38 activity and c-Fos protein and mRNA expression were lower in the VP＋EA group than that in the VP group （P〈0.01）. Conclusions Pre-electroacupuncture of the Jiaji acupoint has prophylactic analgesic effects on rats suffering from visceral pain. The p38 signal transduction pathway may be partly involved in the regulatory mechanism of this analgesic effect.     

The change of unit discharges in the dorsomedial nucleus of the hypothalamus and the effect of electroacupuncture on it in tr

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侧脑室注射生长抑素对大鼠痛阈和电针镇痛作用的影响

观察脑内生长抑素对痛阈和针刺镇痛的影响。以钾离子透入引起大鼠甩尾为测痛方法,侧脑室注射生长抑素,生长抑素的耗竭剂半胱胺和抗生长抑素血清,电针刺激大鼠足三里。侧脑室注射ＳＳ使大鼠痛阈升高并使电针镇痛的效应增强,侧脑室分别注射ＣＳＨ和ＡＳＳＳ使大鼠前阈降低并使电针镇痛的效应减弱。     

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.     

电针调控新西兰兔骨关节炎性疼痛及对脊髓IL-17、IL-17R表达的影响

目的 研究电针是否通过抑制脊髓内白细胞介素(IL)-17及IL-17R的表达来调控新西兰兔骨关节炎性疼痛.方法 新西兰兔随机分为假手术组、炎症模型组、假手术+IL-17组、炎症+抗IL-17组、炎症+电针组、炎症+假电针组,每组8只,4％木瓜蛋白酶构建兔骨关节炎模型,IL-17及IL-17抗血清采用椎管内注射,电针组选择电针刺激足三里(30 min,2 Hz连续波,1～2 mA),假电针组采用非穴位刺激,测定兔痛阈,采用实时荧光定量PCR(RT-qPCR)检测兔脊髓组织IL-17、IL-17R的mRNA表达,Western bolt检测IL-17、IL-17R蛋白表达.结果 在构建骨关节炎模型后新西兰兔痛阈显著下降(P＜0.05),椎管注射IL-17后可以显著降低假手术新西兰兔痛阈(P＜0.05),而椎管注射IL-17抗血清后可明显增加骨关节炎模型兔痛阈值.选择足三里电针刺激可显著提升兔痛阈(P＜0.05).骨关节炎模型组IL-17、IL-17R的mRNA及蛋白表达显著增加(P＜0.05),而电针刺激后其表达显著下降(P＜0.05).结论 新西兰兔骨关节炎性疼痛发生可能涉及脊髓IL-17异常表达,而电针可能通过抑制脊髓IL-17、IL-17R的表达来调控骨关节炎性疼痛.     

针刺大钟穴治疗足跟痛临床疗效观察

目的：观察针刺大钟穴治疗足跟痛的临床疗效并探讨其作用机制。方法：38例足跟痛的患者用0.3mm×40mm的毫针,直刺患侧大钟穴,施以提插捻转手法使其酸胀得气后留针30min,观察其疗效。结果 ：以疼痛彻底消失为治愈,以疼痛消失偶有反复为显效,以疼痛缓解为有效,未缓解为无效。针刺大钟穴治疗足跟痛38例患者的总有效率为100%。结论：针刺大钟穴治疗足跟痛具有显著的临床疗效,单穴针刺,操作简便,值得广泛应用。     

硬膜外麻醉分娩镇痛临床观察

目的观察硬膜外微泵用于分娩镇痛的效果及对产程的影响，探讨小剂量麻醉复合物的分娩镇痛作用。方法采用低浓度的布比卡因与芬太尼硬膜外微泵持续给药对120例产妇进行分娩镇痛（作为观察组）与同期未干预的产妇150例相对照，用视觉模拟疼痛评分进行疼痛分级，观察记录孕妇三个产程所用的时间及胎儿的健康情况，比较两组的镇痛效果，产程时间。结果观察组的阵痛强度明显低于对照组（“P〈0.05”），观察组的第一产程缩短。结论硬膜外麻醉用于分娩镇痛效果可靠，对母婴未发现不良影响。     

An appraisal of symptom relief after coronary bypass grafting.

Subjective symptomatic improvement is experienced by 90% of patients after coronary bypass surgery. Objective exercise testing reduces this incidence to 70%. An analysis of the multifactorial genesis of pain relief based on data of non-randomized trials reveals that graft patency plays a dominant but not unique role in causing improved symptomatology. In a number of cases, intra-operative myocardial infarctions seem to explain the pain relief but may also have opposite effects. Changes in left ventricular function operate bidirectionally but data on this variable in relation to changes in symptomatology are not amenable for detailed analysis. Progression in native vessel lesions apparently opposes pain relief and has its greatest impact in connection with graft closure. Residual post-operative angina is evidently related also to incomplete revascularization.     

呼吸减痛法在自然分娩中的应用与效果观察

目的研究呼吸减痛法在自然分娩中的应用以及临床效果的观察。方法选取2012年5月-2013年5月该院接收的足月妊娠自然分娩产妇180例,随机分为研究组和对照组,每组90例,对照组给予产科常规护理,研究组在对照组的基础上应用呼吸减痛法,比较两组产中疼痛程度、产程时间、产后出血和新生儿Apgar评分。结果研究组总产程时间、产中疼痛程度、产后出血以及新生儿Apgar评分均优于对照组,两组比较差异有统计学意义（P〈0．05）。结论呼吸减痛法是一种简单、安全可靠、可以控制的分娩镇痛方法,临床疗效较好,值得推广应用。     

电针对大鼠慢性神经源性痛的治疗作用

目的　观察大鼠慢性神经源性痛时的抬腿潜伏期变化及电针对其治疗作用。方法　72只SD大鼠制作慢性神经源性痛模型 ,随机分为对照组、慢性疼痛组、电针治疗组各 2 4只。电针取坐骨神经压迫侧环跳、阳陵泉穴。痛阈测定采用热辐射测痛法 ,术前、术后d2、d4、d7、d14、d2 8测后肢抬腿潜伏期 ,电针组并于每次电针前后各测 1次抬腿潜伏期。结果　电针治疗组术后d2开始抬腿潜伏期缩短 ,与慢性疼痛组基本相似。随电针次数增加 ,抬腿潜伏期逐渐延长 ,到d14坐骨神经压迫侧与慢性疼痛组相比明显延长 (P <0 .0 5 )。d2 8已显著延长 ,但仍低于实验对照组假手术侧 (P <0 .0 5 )。结论　多次电针后对坐骨神经压迫引起的慢性神经源性痛大鼠的热痛敏具有明显的逆转作用。     

脑室注射促甲状腺素释放激素对电针镇痛及脑内亮氨酸脑啡肽含量的影响

实验用大鼠76只,用辐射热-甩尾法测痛,以电针后痛阈变化的百分率评价镇痛效应;用放射免疫分析法测定脑内L-Enk含量。发现脑室注入三肽-促甲状腺素释放激素(TRH)后,能显著降低电针镇痛效果;提高丘脑内L-Enk含量,但痛阈与脑内L-Enk含量的变化无相关关系。本文证明,TRH在电针镇痛过程中是对抗作用。已知针刺镇痛与脑内多种神经质和肽类有关,在不利于针刺镇痛的因素中,TRH是新添的“一员”。     

192例晚期癌症病人美施康定止痛临床观察

目的:评价美施康定治疗晚期癌症病人中、重度癌痛的疗效。 方法:192例中、重度癌痛患者使用美施康定期间 ,观察用药前后及应用不同剂量药物后疼痛的缓解率及不良反应发生情况。 结果 :美施康定治疗后疼痛缓解率为 98.9%。不良反应主要为便秘 (34.4 % ) ,恶心、呕吐 (19.8% )。结论:美施康定对各类癌痛都有良好的镇痛效果 ,其产生的不良反应可以预防并进行有效处理。     

电针对创伤痛模型大鼠血浆褪黑素的影响

目的：研究电针抗创伤痛与血浆褪黑素之间的关系。方法：经过痛阈筛选的192只SD大鼠被随机分为空白对照组（不截肢,不电针）、空白电针对照组（不截肢,仅电针）、截肢模型组（只截肢,不电针）、截肢电针组（截肢,同时处以电针）,每组8只;电针穴位选择为健侧的“足三里”穴、“环跳”（动物穴位需加引号）穴。每组均设置6个时间点：8：00（ZT0）、12：00（ZT4）、16：00（ZT8）、20：00（ZT12）、24：00（ZT16）、4：00（ZT20）,在相应的时间点对动物进行处理,每一时间点处理结束24h后处死动物,取血浆,采用EuSA法测定血浆褪黑激素水平。结果：正常大鼠血MT浓度具有明显的昼夜节律;截肢后血浆MT浓度明显降低,节律出现双峰的变化趋势;截肢同时施加电针对血浆MT浓度较截肢模型组有所升高,昼夜节律与空白电针组相近。结论：针刺作为一种较轻微的应激刺激,对正常动物的松果体分泌褪黑素功能有一定影响,且能对抗创伤痛所致的MT节律紊乱。     

Efficacy of bupivacaine injection after pulsed radiofrequency ablation in the management of trigeminal facial pain: A prospective,randomized, and double-blind study

Objectives:To assess the effect of bupivacaine application following pulsed radiofrequency (PRF) ablation on trigeminal facial pain.Methods:A total of 73 patients with trigeminal facial pain refractory to conservative therapy were randomized into 2 groups. Group I subjects underwent PRF ablation procedure, followed by the injection of 1 ml of bupivacaine. Whereas, Group II underwent the same procedure followed by the injection of 1 ml of normal saline. Pain relief duration, the time of onset of pain relief, and analgesic effect evaluated by numerical pain rating scale were considered as outcomes.Results:Thirty-nine patients in Group I and 34 in Group II. The duration of pain relief in the 2 groups was comparable (5 months in Group I vs. 6 months in Group II, p=0.53). The onset of pain relief in the patients of Group I was shorter than Group II (0 days vs. 4.5 days, p<0.001). The binary logistic regression analysis revealed that the application of bupivacaine alone had a significant effect on the reduction of the intake of medications (p<0.05).Conclusion:In situations involving patients who require rapid pain relief, bupivacaine injection following PRF ablation can be employed to provide immediate relief without subjecting the patients to the risks associated with major complications.