非甾体抗炎药在骨科手术超前镇痛中的临床应用研究

目的:研究非甾体抗炎药的超前镇痛在骨科手术中的效果。方法:按照入选标准和排除标准选取2014年1月至2014年6月收治入院行骨科手术的各类骨折患者。记录每名患者人口统计学资料,骨折类型和部位,手术和麻醉方式,镇痛治疗方案,术前和术后疼痛评分,心理评分,用药期间不良反应,患者满意度评分。结果:本研究共纳入241名行骨折手术患者,分为超前镇痛组(n=115)和对照组(n=126),超前镇痛组术前使用非甾体抗炎药(主要为帕瑞昔布、塞来昔布)进行镇痛,对照组术前不使用非甾体抗炎药镇痛,两组术前疼痛评分无显著性差异。超前镇痛组和对照组在术后6 h、12 h、48 h、72 h视觉疼痛评分(visual analogue scale,VAS)、不良反应发生率和满意度评分差别有统计学意义(P0.05)。超前镇痛组心理评分低于对照组,不良反应发生率少于对照组,满意度较高。结论:非甾体抗炎药超前镇痛运用于骨科手术中,能够有效缓解手术切口疼痛,减轻炎症反应,减少不良反应的发生,患者满意度高。     

Oxytocin and estrogen receptor alpha and beta knockout mice provide discriminably different odor cues in behavioral assays

Social behavior involves both the recognition and production of social cues. Mice with selective deletion (knockout) of either the gene for oxytocin (OT) or genes for the estrogen receptor (ER) -α or -β display impaired social recognition. In this study we demonstrate that these gene knockout mice also provide discriminably different social stimuli in behavioral assays. In an odor choice test, which is a measure of social interest and discrimination, outbred female Swiss-Webster mice discriminated the urine odors of male knockouts (KO: OTKO, αERKO, βERKO) from the odors of their wildtype littermates (WT: OTWT, αERWT, βERWT). Females showed marked initial choices of the urine odors of OTWT and βERWT males over those of OTKO and βERKO males, and αERKO males over αERWT males. The odors of OTKO and βERKO males also induced aversive, analgesic responses, with the odors of WTs having no significant effects. Odors of both the αERWT and αERKO males induced aversive, analgesic responses, with the odors of the WT inducing significantly greater analgesia. The odors of restraint stressed WT and KO males also elicited analgesia with, again, females displaying significantly greater responses to the odors of stressed OTKO and βERKO males than their WTs, and significantly lower analgesia to the odors of stressed αERKO than αERWT males. These findings show that the KO mice are discriminated from their WTs on the basis of odor and that the various KOs differ in the relative attractiveness/aversiveness of their odors. Therefore, in behavioral assays one causal route by which gene inactivation alters the social behavior of knockout mice may be mediated through the partners' modified responses to their odors.     

Prospects for Using Amiridine as an Analgesic with a Wide Pharmacological Spectrum of Action

The pharmacological activity of amiridine, a drug resynthesized at the Scientific Research Institute Khimtekhnologiya (Severodonetsk, Ukraine), was studied. It was found that amiridine is a moderately toxic compound and exerts marked analgesic effects on pain of different geneses.     

Opioidergic effects of nonopioid analgesics on the central nervous system

1. The analgesic effect of nonsteroidal anti-inflammatory drugs (NSAIDs) is partly due to the fact that they act upon the periaqueductal gray matter (PAG) and the rostral ventromedial medulla of the brain stem and thus activate the descending pain-control system, which inhibits nociceptive transmission at the spinal dorsal horn.2. The analgesic action of dipyrone (metamizol) and of lysine-acetylsalicylate (LASA), two well-known NSAIDs, whether microinjected into the PAG or given systemically, can be reverted by naloxone. Repeated administration of dipyrone or LASA induces tolerance to their antinociceptive effect, with cross-tolerance to morphine, and a withdrawal syndrome upon naloxone administration. Dipyrone tolerance can be reverted by proglumide, a cholecystokinin antagonist.3. These findings reveal a close association between the central action of NSAIDs and endogenous opioids.     

右美托咪定联合舒芬太尼术后镇痛对卵巢癌根治术患者细胞免疫功能和炎症应激反应的影响

摘要 目的：探讨右美托咪定联合舒芬太尼术后镇痛对卵巢癌根治术患者细胞免疫功能和炎症应激反应的影响。方法：根据随机数字表法将2020年2月至2023年2月期间陕西省肿瘤医院120例择期行卵巢癌根治术的患者分为对照组（n=60，术后镇痛药物选用舒芬太尼）和研究组（n=60，术后镇痛药物选用右美托咪定联合舒芬太尼）。对比两组镇静（Ramsay镇静评分）、细胞免疫功能[CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺]、镇痛情况[视觉模拟评分法（VAS）]、不良反应、炎症应激反应[白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、皮质醇（Cor）和去甲肾上腺素（NE）]变化情况。结果：与对照组术后6 h、12 h、24 h、48 h 相比，研究组同时间点VAS评分更低，Ramsay镇静评分更高（P<0.05）。与对照组术后24 h相比，研究组同时间点CD3⁺、CD4⁺、CD4⁺/CD8⁺更高，CD8⁺更低（P<0.05）。两组不良反应发生率组间对比未见差异（P>0.05）。与对照组术后24 h相比，研究组同时间点IL-6、TNF-α、Cor、NE更低（P<0.05）。结论：右美托咪定联合舒芬太尼用于卵巢癌根治术患者术后镇痛，镇静、镇痛效果显著，同时还可减轻机体炎症应激反应，缓解免疫抑制。     

硬膜外复合全麻对老年高血压患者腹部手术后并发症的影响

目的：探讨硬膜外复合全麻对老年高血压患者腹部手术后并发生的影响。方法：收集2013 年6 月-2015 年6 月在两家医院 接受腹部手术的老年高血压患者100 例,根据麻醉方法不同分为研究组和对照组。研究组患者给予硬膜外复合麻醉,对照组给予 全凭静脉麻醉。观察并比较两组患者的麻醉时间、药物用量以及术后并发症的发生率。结果：两组麻醉时间比较,差异无统计学意 义（P>0.05）;研究组麻醉药物用量低于对照组,差异具有统计学意义（P<0.05）;两组患者手术时间比较,差异无统计学意义（P>0. 05）;研究组患者术后苏醒时间、拔管时间以及住院时间均短于对照组,差异具有统计学意义（P<0.05）;研究组术后并发症的发生 率低于对照组,差异具有统计学意义（P<0.05）。结论：硬膜外复合全麻用于老年高血压患者腹部手术能够减少麻醉药物用量,降低 术后并发症的发生率,安全性较高。     

Column-switching HPLC–MS/MS analysis of ropivacaine in serum,ultrafiltrate and drainage blood for validating the safety of blood reinfusion

A high-performance liquid chromatography–tandem mass spectrometry (HPLC–MS–MS) method, using back-flush column-switching was developed for total drug concentrations of ropivacaine in serum and drainage blood in the measuring range 0.1–10 μg/mL. Samples were diluted with internal standard (²H₇-ropivacaine) and extraction buffer, centrifuged and injected directly onto a BioTrap 500 MS extraction column. Using a time programmed six-port valve switch, ropivacaine was back-flushed onto a Zorbax SB-Aq analytical column, gradient eluted and finally detected after electro spray ionisation and multiple reaction monitoring (MRM) of the transitions m/z 275 → m/z 126 and m/z 282 → m/z 133 for ropivacaine and ²H₇-ropivacaine, respectively. Accuracy (bias-%) was −1.5 to 5.8% and intermediate precision (C.V.) was 1.4–3.1%. The low sample amount required (10 μL), high specificity and short run time (6 min) makes it very suitable for determination of ropivacaine. Using the same methodology as described above and 200 μL ultrafiltrate, the free drug concentrations of ropivacaine in serum could be precisely determined with a C.V. below 3%. The method was used to investigate the safety of reinfusion of drainage blood after knee and hip arthroplasty when ropivacaine (Naropin^®) was used for local analgesia. Data for 30 patients are summarised.     

交感神经阻滞对糖尿病心腔扩张顽固心衰的疗效

目的:探讨交感神经阻滞对有糖尿病、心腔扩张的顽固心衰患者心脏收缩功能和心腔大小的影响。方法:经胸3～胸4棘突间隙穿刺至硬膜外腔,留置硬膜外导管,0.5%利多卡因3～5ml每2h推注一次,持续4w,适当辅以常规治疗。测定并比较TEB治疗前及后4w射血分数(EF)、左室内径(LVED)和左房内径(LAED)等指标的变化。结果:治疗后左室射血分数(EF)由治疗前的(31.53±9.29)%升为(44.75±8.32)%(P0.05);左室内径(LVED)由治疗前的(70.59±6.25)mm缩减到(63.59±7.05)mm(P0.05);左房内径(LAED)由治疗前的(46.16±7.19)mm缩减到(39.05±7.23)mm(P0.05)。结论:心区交感神经阻滞结合常规用药对有糖尿病、心腔扩张的顽固心衰患者的心脏功能有明显改善作用,并使其扩大的心脏明显缩小。     

Peripheral analgesia: Hitting pain where it hurts

Pain is a complex biological phenomenon that encompasses intricate neurophysiological, behavioural, psychosocial and affective components. Protracted or chronic pain alerts an individual to a possible pathological abnormality and is the main reason why patients visit a primary care physician. Despite the pervasiveness of chronic pain in the population, the effectiveness of current pharmacological therapies remains woefully inadequate and prolonged treatment often leads to the development of undesirable side-effects. Since the vast majority of chronic pain originates in a specific tissue or group of tissues, it may be advantageous to target pain control in the periphery and thereby circumvent the known risks associated with non-specific systemic treatments. This review spotlights a number of promising targets for peripheral pain control including the transient receptor potential (TRP) family of neuronal ion channels, the family of proteinase activated receptors (PARs), cannabinoids, and opioids. A critical appraisal of these targets in preclinical models of disease is given and their suitability as future peripheral analgesics is discussed.