Evidence for opioid and non-opioid forms of stress-induced analgesia in the snail, Cepaea nemoralis

Exposure to either cold or warm stress increased the thermal nociceptive thresholds of the terrestrial snail, Cepaea nemoralis. The warm stress-induced 'analgesia' was blocked by the prototypic opiate antagonist, naloxone, and the delta-opiate antagonist, ICI 154,129, and was suppressed by a 24-h pretreatment with the irreversible opiate antagonist, beta-funaltrexamine (B-FNA). In contrast, cold stress-induced analgesia was unaffected by either naloxone, ICI 154,129 or B-FNA. These results indicate that this mollusc displays both opioid and non-opioid forms of stress-induced analgesia in a manner analogous to that reported for mammals. These findings suggest an early evolutionary development and phylogenetic continuity of opioid and non-opioid mediated stress responses to aversive environmental stimuli.     

心理干预对高血压病人围手术期血压和心率的影响

目的探讨心理干预对高血压病人围手术期血压和心率的影响。方法将120例准备接受手术的高血压病人随机分为观察组和对照组（各60例），对照组未接受心理干预，观察组接受特定的心理干预措施，测定并比较两组病人入院时的血压，心率和手术前1d，入手术室后的血压和心率。结果入院时血压和心率两组间比较无差异P〉0．05，入室后两组间比较有显著性差异P〈0．01，组内比较对照组入室后与手术前1d有差异P〈0．05。结论针对性的心理干预可缓解围手术期高血压病人心理焦虑，有助于稳定血压和心率，少不良事件的发生。     

合并肝萎缩的肝胆外科病人围手术期处理

目的探讨合并肝萎缩的肝胆病人的围手术期处理。方法回顾性分析2001年3月～2008年8月在我院手术的38例进展型肝萎缩型、代偿性区域性肝萎缩型、肝硬化性肝萎缩型肝胆病人的临床资料。结果进展型肝萎缩3例,代偿性区域性肝萎缩27例,肝硬化性肝萎缩8例。术后死亡1例,其余37例治愈。结论术前合并肝萎缩增加了手术风险,但完善手术前评估、加强围手术期的处理可提高手术的安全性,降低手术死亡率和并发症发生率。     

高乌甲素复合布比卡因用于老年食管癌术后自控镇痛

目的 探讨高乌甲素复合布比卡因用于老年食管癌术后硬膜外自控镇痛（PCEA）的临床效果及不良反应。方法 AsA Ⅰ～Ⅱ级，择期行食管癌根治术后病人50例，随机分为两组，高乌甲素复合布比卡因组（IJB）、芬太尼复合布比卡因组（FB），每组25例，术毕LB组以0．02％高乌甲素复合0.125％布比卡因，FB组以0．0004％芬太尼复合0．125％布比卡因行PCEA。测定麻醉前5min（To）、术后4（T1）、8（T2）、24（T3）和48h（T4）血浆肾上腺素（E）及去甲肾上腺素（NE）浓度。结果 两组镇痛效果优良，视觉模拟评分（VAS）比较差异无统计学意义（P〉0．05）；血浆E和NE浓度，两组比较差异无统计学意义（P〉0.05）。结论 高乌甲素复合布比卡因硬膜外自控镇痛，用于老年食管癌术后镇痛效果确切，安全有效。     

老年妇女病人围手术期处理64例分析

目的：探讨老年妇女病人围手术期处理及合并症防治。方法：对60岁以上老年妇女病人64例围手术期资料进行回顾性统计分析。结果：老年妇女容易合并高血压、心脏病及糖尿病。老年妇科手术疾病中生殖器良性肿瘤23例（35．93％），恶性肿瘤9例（14．06％），子宫脱垂伴阴道壁膨出30例（46．87％）。64例病人经手术治疗均安全度过围手术期。少数出现肺部感染、应激性溃疡、下肢静脉血栓等。结论：手术选择合理，术前准备充分，术中术后加强监护，大多数老年妇科病人都能恢复健康。     

吗啡布比卡因对前列腺术后镇痛的疗效

目的：观察吗啡、布比卡因用于硬膜外自控镇痛（PCEA）在前列腺术后的镇痛效果。方法：21例前列腺切除患者术后以吗啡、布比卡因进行PCEA治疗，取一般情况与PCEA组类似的24例前列腺患者后行常规镇痛，术后以疼痛视觉模拟评分（VAS）间接评估镇痛，记录膀胱痉挛发生情况。结果：PCEA组术后VAS评分及控制膀胱痉挛的发生明显优于常规镇痛组。结论：吗啡、布比卡因通过PCEA技术用于前列腺术后镇痛、效果确切、简单方便、用药量小、副作用少、有利于术后恢复。     

Contribution of brainstem GABAergic circuitry to descending antinociceptive controls: I. GABA-immunoreactive projection neurons in the periaqueductal gray and nucleus raphe magnus

The fact that GABA receptor agonists and antagonists influence nociceptive thresholds when microinjected into the rostroventral medulla or in the spinal cord may reflect the involvement of GABAergic neuronal elements in endogenous antinociceptive pathways. In the present study we used immunocytochemistry and retrograde tract tracing to investigate the contribution of GABAergic projection neurons to the antinociceptive network linking the midbrain periaqueductal gray matter (PAG), the nucleus raphe magnus (NRM), and the spinal cord dorsal horn. The tracer, WGAapoHRP-Au was injected into either the NRM or the spinal cord and the distribution of labeled neurons in sections of the PAG and medulla, respectively, was studied. The same sections were immunostained to demonstrate GABA-immunoreactive neurons. Although GABA-immunoreactive neurons were abundant in the PAG, only 1.5% were retrogradely labeled from the NRM. Similarly, very few GABA-immunoreactive neurons within the cytoarchitectural boundaries of the NRM were retrogradely labeled from the spinal cord. A much higher proportion of GABA-immunoreactive neurons in the region lateral to the NRM, however, were retrogradely labeled from the spinal cord. Eighteen percent of GABA-immunoreactive neurons were retrogradely labeled in the nucleus reticularis paragigantocellularis; conversely, 15% of the retrogradely labeled neurons in this region were GABA-immunoreactive. These results indicate that GABAergic projections constitute a very minor component of the PAG-NRM-spinal cord pathway; however, there is a significant contribution of GABAergic neurons to the spinal projections that originate lateral to the NRM. The majority of GABAergic neurons in the PAG and NRM are presumed to be inhibitory interneurons that directly or indirectly regulate activity in efferent pathways from these regions.     

粘膜康乳剂的药效试验

目的：研究粘膜康乳剂治疗放疗后口腔糜烂、咽痛溃疡的药效。方法：应用动物实验评价粘膜康乳剂的抗炎镇痛作用及对毛细血管通透性，非特异性免疫作用和邻苯三酚自氧化速率的影响。结果：粘膜康乳剂有明显的抗炎镇痛作用，能显著降低组胺所致毛细血管通透性，抑制PY自氧化速率，保护细胞膜免遭自由基损伤，对单核细胞吞噬功能有明显的增强、激活作用。结论：粘膜康乳剂对临床放疗引起的口腔糜烂，咽痛溃疡有良好的治疗作用。     

Contribution of brainstem GABAergic circuitry to descending antinociceptive controls: II. Electron microscopic immunocytochemical evidence of GABAergic control over the projection from the periaqueductal gray to the nucleus raphe magnus in the rat

Pharmacological, physiological, and behavioral studies suggest that inhibitory GABAergic neurons influence the projection from the midbrain periaqueductal gray matter to the medullary nucleus raphe magnus. The present study used electron microscopic immunocytochemical techniques to examine the morphology and synaptic relationships of GABA-immunoreactive terminals in the ventrolateral periaqueductal gray. These putative GABAergic terminals comprise almost 40% of all axon terminals in the periaqueductal gray. GABA-immunoreactive terminals contain small, clear, pleomorphic or round, vesicles, and 46% also contain some dense-cored vesicles. In some experiments we also used a colloidal gold-conjugated retrograde tracer to label periaqueductal gray neurons that project to the nucleus raphe magnus. About half of the synaptic inputs onto the cell bodies and proximal dendrites of retrogradely labeled neurons are GABA-immunoreactive; these putative GABAergic synapses, which directly control activity in neurons projecting from the periaqueductal gray to the nucleus raphe magnus, might mediate the antinociception-related effects of exogenous GABAA receptor ligands.     

肥胖病人全膝关节表面置换术后疗效观察

[目的]本研究回顾性研究肥胖（根据体重指数）是否是全膝关节表面置换术的危险因素。[方法]由同一组医生使用同一种假体对320例520个膝骨性关节炎患者行全膝关节表面置换手术治疗。[结果]术前肥胖组功能评分较超重组、非肥胖组为低（分别P〈0．05），但关节评分无显著性差异。通过平均28．3个月的随访，无论膝评分和功能评分各组术后均明显提高，各组提高的幅度比较在统计学上无显著性差异（分别P〉0．05）。肥胖组围手术期并发症明显增高。[结论]肥胖病人膝关节置换手术可以取得满意疗效，但围手术期并发症增多，包括伤口愈合、感染、内侧副韧带损伤，注意伤口缝合技术和保护内侧副韧带可减少此类并发症。