CB2受体激动剂JWH015对大鼠神经病理性疼痛的治疗作用

Objective To test whether activation of CB2 receptor would induce antinociception and investigate the role of in-trathecal JWH015 in the modulation of Tyr-1472 phosphorylation of the spinal NR2B subunit in a model of neuropathic pain. Meth-otis 84 male SD rats with intrathecal catheter insertion were randomly divided into 3 groups: sham + 50% DMSO group (Sham group); CCD + 50%DMSO group(Vehicle group); CCD+JWH015 group(JWH015 group). Seven days after Sham or CCD(without in-trathecal injection), the lumbosacral spinal cords of 6 Sham rats and 6 CCD rats were collected for immunohistochemical study to de-termine the spinal expression of Tyr-1472 phosphorylated NR2B subunit(baseline). The rest were intrathcally injected with 50%DMSO 10 μl or JWH015 10 μg seven days after Sham or CCD. For behavioral studies, the data of paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) were measured in Sham group or CCD group, before intrathecal injection and 1, 2, 4, 8, 24, 72 h after intrathecal injection (n=6). For immunohistochemical study, the lumbosacral spinal cords were collected 4, 8, 24, 72 h after intrathecal injection(n=6). Results Compared with the baseline before operation, the PWMT and the PWTL of Vehicle group and JWHOI5 group began to decrease before intrathecal injection(P<0.01). Compared with Vehicle group, PWMT and PWTL of JWH015 group increased markedly 1, 2 and 4 h after intrathecal injection (P0.05). Tyr-1472 phosphorylated NR2B subunit expression in the superficial dorsal horn was weak in all sham groups, but increased significantly 7 days after CCD. While intrathecal 50%DMSO did not decrease the expres-sion of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn, the expression of Tyr-1472 phosphorylated NR2B sub-unit in the superficial dorsal horn decreased obviously 4 h and 8 h after intrathcal JWH015. However, the expression of Tyr-1472 phosphorylated NR2B subunit in the superficial dorsal horn increased again 24 h and 72 h after intrathcal JWH015. Conclusion In-trathecal administration of CB2 receptor agonist JWHOI5 may provide analgesic effect, which is probably attributed to the decrease in the spinal expression of Tyr-1472 phosphorylated NR2B subunit.     

利多卡因持续静脉泵注对鼻内窥镜术中异氟醚用量及术后疼痛的影响

目的 观察术中持续静脉泵注利多卡因对鼻内窥镜术术中异氟醚用量及术后短期内疼痛的影响.方法 40例择期鼻内窥镜术患者随机均分为利多卡因组(L组)和对照组(C组).L组麻醉诱导前缓慢静注利多卡因1 mg/kg,给予2 mg·kg-1·h-1泵注至手术结束;C组以生理盐水替代.两组均行丙泊酚、雷米芬太尼、阿曲库铵和异氟醚吸入复合全麻.调整异氟醚的吸入浓度,保持BIS值45～55.观察并记录入室后诱导前、诱导后、插管后1、5 min、拔管前5 min、拔管时、拔管后5、30 min、术后2、6 h的血压、心率;术中异氟醚用量;拔除气管导管前后行躁动评分;PACU期间需芬太尼镇痛例数及拔管后30 min、术后2、6 h VAS.结果 两组术中血压、心率基本平稳.L组较C组术中异氟醚用量明显减少、PACU期间芬太尼用量减少、拔管时间缩短,术后2、6h VAS明显降低(P＜0.05).结论 术中静脉持续泵注利多卡因在鼻内窥镜术中能减少异氟醚用量,减轻术后疼痛.     

慢性手术后疼痛的研究进展

慢性手术后疼痛（chronic postsurgical pain，CPSP）是外科手术后引起的疼痛综合征，指术后至少存在2个月的连续性或间歇性疼痛，除外慢性感染、恶性肿瘤复发等原因引起的疼痛。     

超声引导神经阻滞辅以瑞芬太尼用于膝部以下手术麻醉的观察

目的 观察超声引导下单纯腘窝坐骨神经阻滞或联合股神经阻滞辅以瑞芬太尼用于膝部以下手术的麻醉效果.方法 拟行膝部以下手术患者40例,随机均分为腘窝坐骨神经阻滞联合股神经阻滞组(FSB组)与单纯腘窝坐骨神经阻滞组(SB组),所有患者均静脉连续输注瑞芬太尼.记录神经阻滞操作时间、术中VAS疼痛评分、瑞芬太尼输注速率、患者满意度及不良反应.结果 与SB组比较,FSB组VAS疼痛评分明显降低,瑞芬太尼输注速率减慢,患者满意度明显升高,药物相关并发症发生率明显降低(P＜0.05或P＜0.01).结论 联合股神经阻滞辅以低于0.1μg·kg-1·min-1瑞芬太尼可安全有效地用于膝部以下手术麻醉.     

右美托咪定预先给药对术后疼痛及瑞芬太尼痛觉过敏的影响

目的观察术前静脉预注射右美托咪定对术后疼痛及大剂量瑞芬太尼麻醉痛觉过敏的影响。方法选择ASAⅠ或Ⅱ级择期行妇科腹腔镜手术的患者80例,随机分为小剂量右美托咪定组(L组)、中剂量右美托咪定组(M组)、大剂量右美托咪定组(H组)和对照组(C组),每组20例。L、M组和H组患者分别于诱导前静脉注射右美托咪定0.2、0.4和0.8μg/kg。C组患者静脉注射生理盐水。记录手术时间、苏醒时间、拔管后Ramsay评分,拔管后30 min、1、4、8、24 h VAS评分及恶心呕吐、寒颤等不良反应的发生情况。结果 L、M和H组拔管后VAS评分明显低于C组(P<0.05),且呈现剂量依赖性。L组改善VAS评分的作用一直持续到拔管后8 h,而M组和H组则持续了至少24 h。C组术后使用曲马多例数明显多于L、M和H组(P<0.05)。术后恶心呕吐发生率C组明显高于L、M和H组(P<0.05)。结论术前预注右美托咪定能明显改善患者的术后疼痛及大剂量瑞芬太尼麻醉所导致的痛觉过敏,并减少术后恶心呕吐的发生率。     

Role of spinal cord TNF-α in the development of bone cancer pain in mice

Objective To investigate the role of spinal cord TNF-a in the development of bone cancer pain in mice. Methods Seventy-two 4-6 week old C3H/He mice weighing 18-25 g were randomly divided into 3 groups (n = 24 each) : group I sham operation (group S) ; group II bone cancer pain (group BCP) and group Ⅲ etanercept (group E). Bone cancer pain was induced by implantation of osteosarcoma NCTC 2472 cells into the intramedullary space of right femur in group II and Ⅲ . Group Ⅲ received intraperitoneal etanercept 100 μg at 3 days before and immediately before and day 3 and 6 after tumor cell inoculation. In group S culture medium α-MEM containing no cancer cell was injected instead. The paw withdrawal threshold to mechanical stimuli (PWMT) and paw withdrawal latency to thermal stimuli ( PWTL) were measured before inoculation (baseline) and at day 3, 5,7, 10, 14 after inoculation respectively. Eight animals were killed on the 7th, 10th, and 14th day after inoculation in each group. The spinal cords were removed and TNF-α mRNA expression in the spinal cord was determined by RT-PCR. Results Cancer pain was significantly attenuated by pretreatment with etanercept. The TNF-α mRNA expression in the spinal cord was significantly increased after inoculation and was significantly attenuated by pretreatment with etanercept in group Ⅲ . Conclusion Spinal cord TNF-a is involved in the development of bone cancer pain in mice.     

氯胺酮预防瑞芬太尼痛觉过敏的实验研究

目的 观察预先皮下注射氯胺酮对瑞芬太尼诱发切口痛模型大鼠痛觉过敏的影响.方法 雄性SD大鼠60只,将大鼠随机分为5组:对照组(C组)、切口痛组(Ⅰ组)、氯胺酮(K组)、瑞芬太尼组(R组)、氯胺酮+瑞芬太尼组(K+R组).Ⅰ组,K组,R组和K+R组行右后足跖肌切口;K组和K+R组术前单次皮下注射氯胺酮0.1 ml(10mg/kg);R组和K+R组切皮开始同时皮下泵注瑞芬太尼0.4 nl(0.04 mg/kg),泵注时间为30 min,所有动物手术和接受微量泵皮下输注均在吸入七氟醚麻醉下进行.于术前24 h、术后2、6、24、48 h检测痛行为学指标,包括机械缩足阈值(paw withdrawal mechanical threshold,PWMT)和热缩足反射潜伏期(paw withdrawal thermal latency,PWTL).结果 与C组和基础值比较,Ⅰ组术后各时间点PWMT和PWTL均降低(P＜0.05);与Ⅰ组相比,R组术后2 h PWMT(6.48±1.23)g和PWTL(11.13±1.95)s即开始降低,此水平持续至术后48h(P<0.05);K+R组术后各时间点PWMT(9.36±1.76,9.41±1.50,10.18±1.42,10.15±1.48)g和PWTL(15.66±2.42,16.24±2.55,15.13±3.07,15.66±2.44)s均高于R组(P＜0.05).结论 术前预先皮下注射氯胺酮可有效预防瑞芬太尼诱发的切口痛模型大鼠痛觉过敏.