夜来香正丁醇提取物镇痛作用的研究

目的：探讨夜来香正丁醇提取物对小鼠的镇痛作用。方法：采用醋酸扭体法、热板致痛法、电刺激致痛法研究夜来香正丁醇提取物对小鼠镇痛作用的影响。结果：夜来香正丁醇提取物对醋酸诱发小鼠扭体反应，热板致痛、电刺激致痛诱发的疼痛有显著的镇痛作用，且呈剂量依赖性。但纳洛酮不能对抗其镇痛作用。结论：夜来香正丁醇提取物有明显的镇痛作用。     

“分步给药”在低氧易感患者无痛苦胃镜检查中安全性的探讨

目的 探讨在低氧易感患者无痛苦胃镜检查中采用分步给药的安全性和镇静/镇痛效果.方法 接受胃镜检查的180例患者,其中有鼾症、或咳嗽、咳痰症状的患者120例单双号随机入选Ⅰ组(分步给药组)和Ⅱ组(普通组),60例无鼾症、咳嗽、咳痰症状的患者为Ⅲ组(常规给药组),Ⅰ组采用分步给药法,Ⅲ组采用常规给药法对患者实施胃镜检查前的镇静/镇痛术,Ⅱ组则进行普通胃镜检查,分析2种镇静法对SBP、DBP、SpO2、HR、清醒时间、患者反应、患者对检查过程的感受以及是否愿意再次接受检查的影响,评价分步给药法在低氧易感患者无痛苦胃镜检查中的安全性和镇静/镇痛效果.结果 Ⅰ组、Ⅲ组检查中SBP、DBP变化无明显差异(均P＞0.05),Ⅰ组检查前、中SpO2的变化小于Ⅲ组(均P＜0.01);Ⅰ组进镜时咽部受刺激产生的恶心咽吐、流涎、咳嗽、躁动反应多于Ⅲ组(均P＜0.01),但较Ⅱ组少(均P＜0.01);Ⅰ组对胃镜检查的评价与Ⅲ组无明显差异(P＞0.05),与Ⅱ组相比有明显差异(P＜0.01).结论 分步给药法是一种适用于低氧易感患者无痛胃镜检查的安全、有效的镇静/镇痛方法.     

Spinal cholinergic and monoamine receptors mediate the antinociceptive effect of morphine microinjected in the periaqueductal gray on the rat tail, but not the feet

The antinociceptive effects of morphine (5 μg) microinjected into the ventrolateral periaqueductal gray were determined using both the tail flick and the foot withdrawal responses to noxious radiant heating in lightly anesthetized rats. Intrathecal injection of appropriate antagonists was used to determine whether the antinociceptive effects of morphine were mediated byα₂-noradrenergic, serotonergic, opioid, or cholinergic muscarinic receptors. The increase in the foot withdrawal response latency produced by microinjection of morphine in the ventrolateral periaqueductal gray was reversed by intrathecal injection of the cholinergic muscarinic receptor antagonist atropine, but was not affected by the a2-adrenoceptor antagonist yohimbine, the serotonergic receptor antagonist methysergide, or the opioid receptor antagonist naloxone. In contrast, the increase in the tail flick response latency produced by morphine was reduced by either yohimbine, methysergide or atropine. These results indicate that microinjection of morphine in the ventrolateral periaqueductal gray inhibits nociceptive responses to noxious heating of the tail by activating descending neuronal systems that are different from those that inhibit the nociceptive responses to noxious heating of the feet. More specifically, serotonergic, muscarinic cholinergic andα₂-noradrenergic receptors appear to mediate the antinociception produced by morphine using the tail flick test. In contrast, muscarinic cholinergic, but not monoamine receptors appear to mediate the antinociceptive effects of morphine using the foot withdrawal response.     

Electronic and disposable patient-controlled analgesia systems

We have compared the performance of the Baxter disposable with the Graseby electronic patient-controlled analgesia system in 30 patients following major gynaecological surgery. Patients were allocated randomly to receive analgesia via the Baxter or Graseby device for postoperative pain relief. There were no significant differences between the two groups with regard to postoperative pain relief or sedation as measured by visual analogue scale. Requirements for antiemetic drugs and patient acceptability were similar. Mean (SEM) morphine demanded over 30 h was 35.7 (6.6) in the Graseby group and 35.1 (8.5) in the Baxter group.     

Effects of metamizol on nociceptive responses to stimulation of the ureter and on ureter motility in anaesthetised rats

In this study, we have examined the effects of metamizol (dipyrone), a non-opioid analgesic which is effective in relieving renal colic pain, on nociceptive responses evoked by stimulation of the ureter, on pyeloureteral motility and on intraureter pressure after ureter obstruction in anaesthetised rats. Metamizol (5–50 mg/kg i.v.) dose-dependently inhibited reflex pressor responses evoked by distensions of the ureter to pressures of 30, 55 and 75 mmHg for 30 s (ID50=8±1 mg/kg). Metamizol also dose-dependently reduced intraureter pressure during total ureter occlusion (25 mg/kg produced a reduction of 25% in 10 min). However, metamizol at doses up to 50 mg/kg had no effect on pyleoureteric motility (contraction amplitude, rate or intraureter pressure) under normal pressure conditions. We conclude that metamizol has a direct antinociceptive action on pain of ureteric origin, and spasmolytic effects after ureter obstruction (but not under normal conditions) which may also contribute to pain relief.accepted by K. Brune     

硬膜外混合不同浓度舒芬太尼分娩镇痛时罗哌卡因的半数有效浓度

目的测定产妇硬膜外分娩镇痛时不同浓度舒芬太尼混合罗哌卡因的半数有效浓度(EC50),寻找舒芬太尼混合罗哌卡因的适宜浓度。方法100例ASAⅠ或Ⅱ级的足月初产妇,妊娠37～42周,随机分为2组:0.4μg/ml舒芬太尼混合罗哌卡因组(A组)(n=45)和0.6μg/ml舒芬太尼混合罗哌卡因组(B组)(n=55)。2组均在宫口扩张至2～3 cm时行硬膜外穿刺,置管。2组第1例产妇罗哌卡因浓度均为0.12%,随后的罗哌卡因浓度按序贯法确定:即前1例若镇痛有效(注药后30 min时VAS评分≤3分)。则下1例接受的药物降低一个浓度梯度,若镇痛无效,则上升一个浓度梯度,浓度梯度0.01%。若镇痛效果可疑,则下1例接受的药物维持原浓度,计算罗哌卡因的EC50及其95%可信区间。观察镇痛期间发生的不良反应。结果A组、B组皮肤瘙痒发生率分别为11.9%、29.4%(P< 0.05),A组、B组各有1例发生恶心呕吐(P>0.05)。A组罗哌卡因的EC50为0.059%(95%可信区间为0.056%～0.062%),B组罗哌卡因的EC50为0.054%(95%可信区间为0.053%～0.055%)。结论硬膜外混合0.4、0.6μg/ml舒芬太尼分娩镇痛时,罗哌卡因的EC50分别为0.059%、0.054%;舒芬太尼的推荐浓度为0.4μg/ml。     

腹部手术后患者静脉输注丁丙诺啡镇痛的可行性

目的 评价腹部手术后患者静脉输注丁丙诺啡镇痛的可行性.方法 采用多中心、随机、开放、平行、阳性药物对照进行研究,择期全身麻醉下行腹部手术患者200例,年龄18～64岁,ASAⅠ级或Ⅱ级,性别不限,体重50～100 kg,随机分为丁丙诺啡组(B组)和芬太尼组(F组),每组100例.2组术后分别静脉输注丁丙诺啡0.3 μg·kg-1·h-1、芬太尼0.3 μg·kg-1·h-1.采用视觉模拟评分法(VAS评分)评价术后6、12、24、36和48 h的疼痛程度,于各时点行镇静评分及Prince-Henry评分,监测心率、呼吸频率(RR)和脉搏血氧饱和度(SpO2),记录不良反应的发生情况.结果 与F组比较,B组各时点VAS评分、镇静评分和Prince-Henry评分差异无统计学意义(P＞0.05),恶心发生率较低(P＜0.05);两组各时点RR和SpO2差异无统计学意义(P＞0.05).结论 静脉输注丁丙喏啡0.3 μg·kg-1·h-1可有效缓解腹部手术后患者疼痛,且不良反应少.     

痛力克用于术后镇痛的临床观察

４５例ＡＳＡⅠ－Ⅱ级成人患者随机分为痛力克组，布比卡因－吗啡组和痛力克与布比卡因－吗啡联用组，比较术后镇痛效果。结果显示，痛力克具有良好的术后镇痛作用；痛力克与硬膜外吗啡混合液联用时可提供更为有效地术后镇痛，且能显著减少阿片药妲及其副作用。     

麻醉诱导前给予右美托咪定对脊柱侧弯矫形术患者的影响

探讨麻醉诱导前给予右美托咪定对脊柱侧弯矫形术患者唤醒时间、镇痛效应及血流动力学的影响。方法 选取2021年1月～2021年12月间于我院行脊柱侧弯矫形术的患者113例为研究对象,按照简单随机法分为观察组（n=57）和对照组（n=56）,观察组在麻醉诱导前给予0.8 μg/kg的右美托咪定10 min内静脉泵注体内,对照组在相同时间内泵入等量的生理盐水,而后两组患者均行全身麻醉,比较两组麻醉插管前（T0）、插管后10 min（T1）、唤醒前10 min（T2）、唤醒期间（T3）、唤醒后5 min（T4）、加深麻醉后10 min血流动力学指标［心率（HR）、平均动脉压（MAP）、血氧饱和度(SpO2)］变化,术后唤醒时间、唤醒质量、唤醒时躁动发生率,拔管即刻、术后2、6、24 h镇痛效果［视觉模拟评分法（VAS）］,麻醉前、术后2 h及6 h应激反应［血清皮质醇（Cor）、醛固酮（ALD）、血糖（Glu）］水平及药物安全性。结果 HR、MAP组间、时间点、组间×时间点比较,差异均有统计学意义（P＜0.05）,观察组T3、T4时间段HR、MAP比较差异有统计学意义（P＜0.05）,SpO2组间、时间点、组间×时间点比较差异均无统计学意义（P＞0.05）。观察组唤醒质量显著高于对照组（P＜0.05）,唤醒时躁动发生率显著低于对照组（P＜0.05）,两组唤醒时间比较差异无统计学意义（P＞0.05）。VAS评分组间、时间点、组间×时间点比较,差异均有统计学意义（P＜0.05）,组内各时间段比较差异均有统计学意义（P＜0.05）,观察组术后2、6 h VAS评分显著低于对照组（P＜0.05）。Cor、ALD、Glu组间、时间点、组间×时间点比较,差异均有统计学意义（P＜0.05）,组内各时间段内外周血Cor、ALD、Glu水平均依次递增（P＜0.05）,且观察组术后2、6 h外周血Cor、ALD、Glu水平均显著高于对照组（P＜0.05）。观察组与对照组不良反应率比较,差异无统计学意义（2=0.154,P=0.694）。结论 脊柱侧弯矫形术麻醉诱导前给予右美托咪定有利于提高术中唤醒质量,降低术中血流动力学波动,改善术后疼痛及应激反应,具有良好的应用价值