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.     

腰椎间盘热凝治疗术

腰椎间盘源性疼痛(discogenic pain)是目前脊柱外科领域的一种常见病。几十年来，人们对于腰椎间盘源性疼痛的治疗进行了多方面的尝试，最初主要是通过融合手术来稳定病变水平的腰椎、减轻疼痛，但效果并不理想；随着人们对其发病机制的进一步认识和微创技术的发展，一些微创手术开始广泛应用于临床，如腰椎间盘热凝治疗术，近年来悄然兴起并因其微创、安全等优点，逐渐引起人们的重视。     

痛立消治疗闭合性软组织损伤

闭合性软组织损伤为西医病名，属中医学“伤筋”范畴，其原因多为外力伤害所致，临床表现为受损的软组织肿胀疼痛、皮肤青紫或皮下瘀血、功能受限等。笔者自1999年起采用痛立消局部外敷治疗患者225例，疗效颇佳，现报告如下。     

胆囊切除术后致胆漏及胆肠内瘘医患纠纷分析

1案情及病史 某女，现47岁。11年前因患慢性胆囊炎、胆囊结石入住某医院，入院录显示：间歇性上腹疼痛10余年，频繁发作2年，B超提示胆囊炎、胆囊结石。于10月12日在持续硬膜外麻醉下行胆囊切除术，     

腰椎穿刺置管持续腰池引流方法的改进

目的 观察改进后的持续腰池引流方法的效果,为降低引流并发症提供依据.方法 将72例蛛网膜下腔出血患者随机分为观察组和对照组各36例,对照组按常规方法行腰穿置管引流.观察组改进穿刺手法,用中心静脉导管置管,依次连接输液延长管、三通及引流袋.结果 两组置管引流时间比较,差异无显著性意义(P＞0.05).观察组堵管、疼痛发生率分别为0、2.78%,对照组分别为16.67%、28.57%,两组比较,差异有显著性意义(均P＜0.05).结论 改进后的腰池置管引流方法可减少引流管堵塞率、减轻患者局部疼痛.     

利多卡因加阿托品宫颈注射在取环术中的应用

已婚育龄妇女 ,放置宫内节育器 (简称环 ) ,已成为计划生育的重要组成部分 ,同样取环时的难易、疼痛 ,也是带环妇女所关注的问题。为了降低已绝经妇女取环时的难度和未绝经妇女取环时的疼痛 ,近年来 ,我院对 15 3例取环的妇女采用利多卡因加阿托品宫颈注射 ,获得满意扩张宫颈及     

心理疗法在分娩镇痛中的应用

目的 探讨心理疗法对分娩的影响。方法 对无明显手术指征的产妇进行心理护理以缓解紧张、恐惧心理。结果 心理干预可以有效地减轻紧张和疼痛，提高自然分娩率。结论 过度的紧张和焦虑可以影响产程进展，增加手术产率，在分娩过程实施心理疗法对分娩有积极的促进作用。     

社区相关性MRSA：儿科医师的警钟

患者为一名来自非洲的11岁男童,因左侧髋部疼痛、发热、体力不支1d而被收入当地医院治疗。该患儿1d前踢足球时摔伤左侧髋部,不久后症状出现。患儿既往无明显病史。4个月前,他家搬到英国居住。当时他的身体