催产素在脊髓水平对电针镇痛的影响

采用玻璃微电极胞外记录和脊髓表面给药的方法观察了催产素（ＯＴ）、抗催产素血清（ＡＯＴＳ）以及电针穴位对背角神经元伤害性诱发放电的影响。结果表明：电针穴位或脊髓表面施加ＯＴ可部分抑制脊髓背角神经元的伤害性诱发放电;在电针的基础上施加ＯＴ则明显加强电针的抑制效应;相反,用ＡＯＴＳ预处理后,电针的抑制作用放取消。提示ＯＴ在脊髓水平参与了对痛觉信息的调制,并与一定频率的针刺镇痛有关。     

东莨菪碱镇痛作用的研究

腹腔(25或50mg/kg)或侧脑室注射东莨菪碱(1mg/kg),均使大鼠的痛阈升高42—80%,并持续32—36小时之久。当在恒温室内作昼夜连续观察时,对照组的大鼠在深夜20时至次日8时之前,痛刺激反应稍有增强,此时东莨菪碱组的镇痛作用也相应地减弱,而白天的镇痛作用较强,似有昼夜规律的表现。东莨菪碱的镇痛作用与脑内阿片能系统无关,DA 能暂时增强其镇痛作用,毒扁豆碱能拮抗其镇痛作用,所以,东莨菪碱的镇痛作用,主要是阻滞中枢 M-胆碱能系统的作用所致。     

中脑导水管周围灰质在侧脑室注入微量吗啡或纳洛酮所引起的镇痛或拮抗镇痛中的作用

本工作进一步探索中脑导水管周围灰质(PAG)在吗啡镇痛与纳洛酮拮抗吗啡镇痛中的作用。实验在清醒受限制的大鼠上进行,以电刺激鼠尾出现的甩尾和嘶叫为痛反应指标。结果表明:(1)侧脑室注射微量纳洛酮后,可使电刺激 PAG 或注射微量吗啡于 PAG 所引起的镇痛效应受到明显拮抗;(2)损毀 PAG 或注射微量纳洛酮于 PAG 后,可使由侧脑室注入微量吗啡所引起的镇痛效应显著减弱。由此可见 PAG 既是侧脑室注射吗啡镇痛作用的重要中枢部位,又是侧脑室注射纳洛酮拮抗吗啡镇痛的重要中枢部位。     

大鼠侧脑室注射精氨酸加压素对针刺镇痛的影响

以钾离子透入法引起大鼠甩尾反应为指标,测定动物的痛阈。由侧脑室注射精氮酸加压素(AVP)后,大鼠痛阈升高33.6％～68.5％,针刺镇痛效应明显加强,痛阈提高202.4％～302.7％。脑室注射抗精氨酸加压素血清,动物痛阈虽无明显变化,但针刺镇痛效应明显削弱,痛阈仅增加41.6％～71.0％。注射抗β-内啡肽血清和抗强啡肽A血清并不阻断AVP增强针刺镇痛效应。本工作的结果提示,脑内AVP参与针刺镇痛,这种作用与脑内内源性β-内啡肽和强啡肽的关系不甚密切。     

超声引导下QLB复合气管插管全麻对于老年患者TEP腹股沟疝无张力修补术影响因素分析

摘要 目的：探讨与分析超声引导下腰方肌阻滞(quadratus lumborum block,QLB)复合气管插管全麻对于老年患者腹腔镜下全腹膜外（totally extraperitoneal prosthetic,TEP）腹股沟疝无张力修补术的影响,以促进该方法的临床使用。方法：2014年9月到2020年6月选择在本院诊治的腹股沟疝老年患者180例,根据随机数字表法分为QLB组与对照组各90例。所有患者都给予腹腔镜下全腹膜外腹股沟疝无张力修补术,对照组给予气管插管全麻,QLB组在对照组麻醉的基础上给予超声引导下QLB,记录两组镇痛与麻醉效果。结果：两组的术中出血量、手术时间等对比差异无统计学意义(P>0.05),QLB组的术后住院时间、术后胃肠功能恢复时间、术后下床活动时间显著短于对照组(P<0.05)。与术后12 h对比,两组术后24 h与36 h的疼痛VAS评分均降低(P<0.05),且QLB组术后12 h、24 h与36 h的疼痛VAS评分都显著低于对照组(P<0.05)。QLB组术后7 d的血肿、呼吸抑制、脏器损伤、腹股沟区包块等并发症发生率为8.9 %,显著低于对照组的21.1 %(P<0.05)。QLB组的瑞芬太尼用量、术后48 h内有效按压自控静脉镇痛泵次数、自控静脉镇痛泵累计用量都显著少于对照组(P<0.05)。结论：超声引导下QLB复合气管插管全麻在老年患者腹腔镜下全腹膜外腹股沟疝无张力修补术中的应用能提高镇痛与麻醉效果,减少术后并发症的发生,有利于促进患者康复。     

吗啡皮下自控镇痛泵治疗难治性癌痛的前瞻性多中心随机对照研究

摘要 目的：观察吗啡皮下自控镇痛泵治疗难治性癌痛的临床疗效。方法：采用前瞻性多中心随机对照研究,应用治疗方法分为试验组和对照组,其中试验组使用皮下自控阵痛泵给药,对照组口服吗啡片剂,5 d为一疗程,共计观察3疗程。观察两组患者治疗后疼痛积分改善情况;每疗程吗啡日均用量;疼痛起效时间、最佳缓解时间;镇痛维持时间及剂量稳定天数、爆发痛情况;生活质量改善及不良反应发生率;疗程费用情况。结果：两组患者数字疼痛评分法(numerical rating scale,NRS)评分在治疗后均较镇痛前显著降低（P＜0.05）;在吗啡用量比较方面,试验组吗啡用量显著低于对照组同期用量;试验组在疼痛缓解时间、疼痛最佳缓解时间方面均显著优于对照组;治疗期间试验组平均镇痛维持时间明显长于对照组（P＜0.05）;两组患者治疗后体力状况分析标准(performance status,PS)评分较治疗前显著改善;试验组便秘、嗜睡不良反应发生率显著低于对照组（P＜0.05）。试验组每疗程费用明显低于对照组,具有明显经济优势。结论：吗啡皮下自控镇痛泵给药方式控制难治性癌痛临床疗效确切,止痛效果明显。与对照组比较,疼痛起效时间短,疗程较吗啡用量少,不良反应发生率低,改善了患者生活质量,且减轻了患者经济压力。     

Chinese plasma-derived products supply under the lot release management system in 2007–2011

In 2007, the Chinese State Food and Drug Administration (SFDA) implemented a management system for lot release of all plasma-derived products. Since then, there have been only a few systematic studies of the blood supply, which is a concern when considering the small amount of plasma collected per capita (approximately 3 L/1000 people). As a result, there may be a threat to the safety of the available blood supply. In this study, we examined the characteristics of the supply of Chinese plasma-derived products. We investigated the reports of lot-released biological products derived from all 8 national or regional regulatory authorities in China from 2007 to 2011. The market supply characteristics of Chinese plasma-derived products were analyzed by reviewing the changes in supply varieties, the batches of lot-released plasma-derived products and the actual supply. As a result, the national regulatory authorities can more accurately develop a specific understanding of the production and quality management information provided by Chinese plasma product manufacturers. The implementation of the lot release system further ensures the clinical validity of the plasma-derived products in China and improves the safety of using plasma-derived products. This work provides an assessment of the future Chinese market supply of plasma-derived products and can function as a theoretical basis for the establishment of hemovigilance.     

The Controversy on Fish Pain: A Veterinarian’s Perspective

Fish welfare is still a relatively new field. As such, regulations and protocols to ensure fish welfare are currently limited and vary considerably in different jurisdictions. This is in part because of the ongoing controversy as to whether or not fish feel pain. This controversy has persisted for several years, yet veterinarians have been mostly absent from the discussion so far. This essay aims to address this issue. Here, it is argued that while this controversy has its place, it is unlikely to be resolved in the near future. Fish welfare could instead be improved by pursuing more clinically applicable research to increase knowledge of fishes’ behavior and physiology. Such research would assist in learning the optimal environment for their specific needs, as well as compiling some verified indicators of pain in fish. This would then lead to improved studies that could help to determine if and when analgesic drugs can be beneficial in fish, as they are in many other species.     

不同剂量地佐辛用于腹腔镜妇科手术超前镇痛的效果观察

目的：观察不同剂量地佐辛用于腹腔镜妇科手术超前镇痛的效果。方法：将90例ASAI．II级、年龄18~60岁拟行腹腔镜妇科手术的患者随机分成3组,每组30例,A组给予地佐辛0．1mg／kg开皮前15rain静脉注射;B组给予地佐辛0．15mg／kg开皮前15min静脉注射;C组给予地佐辛0．2mg／kg开皮前15min静脉注射,采用VAS评分评估术后镇痛效果并观察术后辅助镇痛药物的使用和不良反应的发生情况。结果：B、c组术后2、4、6、8h的VAS评分明显低于A组（P〈0．05）;C组术后2、4h的Ramsay评分明显高于A、B组（P〈0.05）;A组术后辅助镇痛药的使用率明显高于B组和C组（P／0．05）;3组不良反应的发生率比较均无统计学差异（P〉0．05）。结论：开皮前15rain静注地佐辛0．15mg／kg用于腹腔镜妇科手术镇痛效果好,且不增加不良反应的发生率。     

不同胰岛素给药方式救治糖尿病酮症酸中毒临床研究

目的：比较不同胰岛素给药方式治疗糖尿病酮症酸中毒（DKA）的临床疗效。方法：82例DKA患者随机分为胰岛素泵持续皮下输液胰岛素（CSⅡ）组和微量泵持续静脉泵入胰岛素（CXqI）组各41例,分别给予胰岛素泵持续皮下输注胰岛素和小剂量胰岛素持续微量泵静脉泵入不同胰岛素给药方式,观察两组治疗后血糖变化、血糖达标时间、尿酮体变化、pH值变化、胰岛素平均日用量、平均低血糖次数及平均住院时间。结果：两组治疗后空腹血糖、餐后血糖显著下降及血糖达标时间显著缩短差异无统计学意义（P〉0．05）;CSII组尿酮体转阴时间（22．3±7．4）h短于CVII组（32．1±12．1）h（P〈0．01）;CSII组PH值恢复时间（9．4±2．5）h短于CVII组（15．7±3．5）h（P〈0．01）;CSII组平均胰岛素日用量为（47±5）U比CVII组（58＋7）U少（P〈0．01）;CSII组人均低血糖次数为（0．6±O．5）次／人。少于CVII组（1．5±0．8）次／人（P〈O．01）;CSII组住院时间（9．8±1．2）天明显比CVII组（12．5±2．0）天短（P〈0．01）。结论：CSII相较于CVII能更快更有效的纠正代谢紊乱,减少胰岛素日用量,缩短住院时间,从而提高临床疗效。具有较高的安全性及患者依从性。