胶质细胞源性神经营养因子对疼痛的调节作用

胶质细胞源性神经营养因子(glial cell derived neurotrophic factor,GDNF)属转化生长因子β超家族成员,其成熟蛋白由134个氨基酸残基组成,而GDNF受体广泛分布于外周和中枢神经系统。GDNF不仅可以促进多巴胺能神经元、运动神经元的存活,对交感、副交感以及感觉神经元具有营养作用,还能够影响神经元的发育、分化并对非神经系统的发育也具有重要作用。近年来随着人们对疼痛认识的深入,疼痛的机制也不再限于神经元功能的改变,还受胶质细胞活化、多种营养因子、细胞因子及相应受体、离子通道等多方面因素的影响。为此,本文就近年来GDNF参与疼痛调节的相关研究进展做一简要综述。     

辣椒辣素对大鼠急性切割痛的作用

目的:研究辣椒辣素对足底切开大鼠疼痛相关行为的影响.方法:32只Wister雄性大鼠随机分为四组:生理盐水组、0.05％辣椒辣素组(C0.05)、0.1％辣椒辣素组(C0.1)、赋形剂组(吐温80),各200微升.切开前一天足底给药,分别测定给药前的基础值,给药后24小时,术后2小时及1、2、3天对热刺激的反应,并记录累积疼痛得分,术后三天进行组织病理学评估.结果:预先给予的辣椒辣素能够减弱热痛觉过敏和降低累积疼痛得分.组织病理学检查证实:与生理盐水比较辣椒辣素影响切口的恢复.结论:辣椒辣素预处理具有预防术后痛的作用.对切口组织学的影响可能与药物抑制疼痛行为有关,而不一定是药物的局部作用.     

浅谈癌症疼痛的临床护理

本文探讨了肿瘤患者疼痛的有效护理措施。对癌症疼痛患者加强非药物止痛、药物止痛护理,心理护理以及控制疼痛的用药指导做了论述。指出加强癌症患者的心理护理及药物指导能有效的控制癌症疼痛,更好的配合治疗。     

中西医治疗慢性盆腔疼痛192例疗效分析

目的观察抗生素、中药灌肠及加用理疗等方法治疗慢性盆腔疼痛的临床疗效。方法将192例慢性盆腔疼痛患者随机分为三组,第1组是月经期或月经期后用抗生素;第2组是中药经期后灌肠;第3组是中药灌肠加用理疗、应用抗生素、激素、透明质酸酶等综合治疗。治疗持续1~3个疗程,跟踪随访临床治疗效果。结果治疗总有效率1组<2组,2组<3组,两组均P<0.05。结论提示综合组治疗效果较好。     

臂丛神经撕脱伤后慢性疼痛患者脑区葡萄糖代谢的研究

臂丛神经撕脱伤后慢性疼痛是一种临床上顽固性神经病理性疼痛.然而,对于其潜在的中枢机制还知之甚少.为了进一步探讨臂丛神经撕脱伤后慢性疼痛的相关脑区活动,利用18F-脱氧葡萄糖(FDG)正电子断层扫描(PET)技术观察臂丛神经撕脱后慢性疼痛患者的脑葡萄糖代谢.选择左侧臂丛神经撕脱伤后慢性疼痛行脊髓后根入髓区(DREZ)切开术后疼痛减轻>75%的患者,共5例,分别在术前和术后14天行PET扫描采集数据,同时行视觉模拟评分(VAS),汉密尔顿(Hamilton)抑郁和焦虑评分.用统计参数图(SPM2)软件分析数据.与术前疼痛状态下相比,术后葡萄糖代谢明显减低的脑区有双侧尾状核,眶额回(OFC)(BA11),对侧扣带下回(BA25)和同侧前额叶背外侧区域(DLPFC)(BA46/47).葡萄糖代谢明显增高的脑区有对侧丘脑,枕核和同侧项叶(BA7).研究结果提示,涉及情绪、注意和疼痛内在调节的脑区在臂丛神经撕脱伤后慢性疼痛的调制中发挥重要作用.     

Pain perception and its genesis in the human brain

In the past two decades, pain perception in the human brain has been studied with EEG/MEG brain topography and PET/ fMRI neuroimaging techniques. A host of cortical and subeortical loci can be activated by various nociceptive conditions. The activation in pain perception can be induced by physical (electrical, thermal, mechanical), chemical (capsacin, ascoric acid), psychological (anxiety, stress, nocebo) means, and pathological (e.g. migraine, neuropathic) diseases. This article deals mainly on the activation, but not modulation, of human pain in the brain. The brain areas identified are named pain representation, matrix, neuraxis, or signature. The sites are not uniformly isolated across various studies, but largely include a set of cores sites: thalamus and primary somatic area (SI), second somatic area (SII), insular cortex (IC), prefrontal cortex (PFC), cingnlate, and parietal cortices. Other areas less reported and considered important in pain perception include brainstem, hippocampus, amygdala and supplementary motor area (SMA). The issues of pain perception basically encompass both the site and the mode of brain function. Although the site issue is delineared to a large degree, the mode issue has been much less explored. From the temporal dynamics, IC can be considered as the initial stage in genesis of pain perception as conscious suffering, the unique aversion in the human brain.     

A role for uninjured afferents in neuropathic pain

Diseases and injuries to the nervous system can lead to a devastating chronic pain condition called neuropathic pain. We review changes that occur in the peripheral nervous system that may play a role in this disease. Common animal models for neuropathic pain involve an injury to one or more peripheral nerves. Following such an injury, the nerve fibers that have been injured exhibit many abnormal properties including the development of spontaneous neural activity as well as a change in the expression of certain genes in their cell body. Recent data indicate that adjacent, uninjured nerve fibers also exhibit significant changes. These changes are thought to be driven by injury-induced alterations in the milieu surrounding the uninjured nerve and nerve terminals. Thus, alteration in neural signaling in both injured and uninjured neurons play a role in the development of neuropathic pain after peripheral nerve injury.     

美国NIH公布最新口腔医学研究项目指南

2003年12月16日美国国立卫生研究院(National Institutes of Health,NIH)所属的牙颅颌研究所(National Institute of Dental and Craniofacial Research,NIDCR)公布了2004年口腔医学项目指南(program announcements,PAs),该指南涉及口腔医学基础、应用基础和临床研究。     

中枢神经系统D-氨基酸氧化酶的研究进展

新近研究证实,哺乳动物神经系统中存在内源性D-氨基酸氧化酶,参与脑内D-氨基酸的代谢.遗传学研究发现,D-氨基酸氧化酶基因与精神分裂症的发生密切相关.分子生物学研究表明,在D-氨基酸氧化酶基因启动子区域存在一些转录因子的结合位点.这些研究结果提示,中枢神经系统的D-氨基酸氧化酶除了参与D-氨基酸的代谢以外,可能还具有其它的生理功能.本文就中枢神经系统D-氨基酸氧化酶的研究进展作一综述.     

分娩球纠正枕后位的临床观察

目的:探讨产程中体位纠正枕后位的可行性和效果.方法:选择枕后位活跃期停滞的初产妇100例,随机分为A组(分娩球组)和B组(侧卧位组),每组各50例,观察两组阴道分娩率,产程时间和疼痛缓解率结果:(1)A组阴道分娩44例(88.0%),B组经阴道分娩为35例(70.0%),差异有显著性(P-0.048)(2)A组平均第1产程时间为10.51±4.19小时,B组第1产程时间为12.31±4.17小时,两组比较差异有显著性(P=0.049)(3)分娩球组疼痛缓解率为74.0%,同侧卧住组疼痛缓解率为42.0□,两组比较差异有极显著性(P=0.001).结论:产程中指导产妇坐分娩球能明显缓解分娩阵痛是提高阴道分娩,缩短产程的有效方法.