右美托咪定联合经皮穴位电刺激对混合痔剥扎术后患者肠胃功能及术后疼痛的影响

摘要 目的：探讨右美托咪定联合经皮穴位电刺激对混合痔剥扎术后患者肠胃功能及术后疼痛的影响。方法：选择2022年3月-2022年7月我院行混合痔剥扎术的患者60例,将60例患者随机分为对照组（30例）与观察组（30例）,对照组患者给予右美托咪定镇痛,观察组给予术前经皮穴位电刺激,时间为手术开始前2 min至手术结束,右美托咪定使用方法、剂量同对照组。对比两组患者术前、术后0.5 h、1 h、2 h、3 h的疼痛评分,对比两组患者的术后疼痛疗效,对比两组创面愈合时间、腐肉完全脱落时间、住院时间及胃肠功能恢复情况,对比两组术前、术后的血管活性肠肽、胃动素及胃泌素水平。结果：术前及术后3 h时,两组的疼痛评分对比无统计学意义（P>0.05）;术后0.5 h、1 h、2 h时,观察组的疼痛评分明显较对照组低（P<0.05）。观察组的术后疼痛有效率明显较对照组高,P<0.05。观察组的创面愈合时间、腐肉完全脱落时间及住院时间明显较对照组低（P<0.05）。观察组的肠鸣音恢复时间、术后恶心呕吐发生率及排气时间明显较对照组短（P<0.05）。术前,两组的血管活性肠肽、胃动素及胃泌素水平对比无统计学意义（P>0.05）;术后,两组血管活性肠肽、胃泌素水平升高,胃动素水平降低,且观察组变化幅度明显较对照组低（P<0.05）。结论：右美托咪定联合经皮穴位电刺激可改善混合痔剥扎术后患者肠胃功能及术后疼痛情况。     

不同容量胸段经椎间孔硬膜外注射阻滞范围的CT影像研究及诊断性阻滞的可行性分析

摘要 目的：探讨不同容量对胸段经椎间孔硬膜外注射（TFEI）药液扩散范围和镇痛效果的影响以及胸段TFEI用于诊断性阻滞的可行性。方法：选择2021年1月至2022年12月南京大学医学院附属鼓楼医院收治的胸段带状疱疹相关疼痛患者140例,随机分为4组,实施单次TFEI并分别注入不同容量含造影剂局麻药（A组：0.2 mL;B组：0.5 mL;C组：1.0 mL;D组：2 mL）,CT扫描并观察造影剂在硬膜外向头侧、尾侧及总扩散节段,造影剂在椎间孔、同侧椎旁间隙、同侧及对侧硬膜外间隙扩散情况,判断是否为选择性神经根阻滞。评估注射前、注射后30分钟及24小时视觉模拟评分（VAS）。结果：头侧和尾侧扩散节段以及总扩散节段数,D组最多,A组最少（P<0.05）;C组、D组造影剂扩散≥3个节段发生率明显高于B组（P<0.05）;C组、D组病例造影剂扩散至同侧椎旁间隙和对侧硬膜外间隙的发生率明显高于A组、B组（P<0.05）,仅A组37.1%的病例实现选择性神经根阻滞,其余各组均无选择性阻滞病例。注射后30分钟,C、D组VAS评分显著低于A、B组（P<0.05）;注射后24小时,D组VAS评分显著低于A、B组（P<0.05）。结论：胸段带状疱疹相关疼痛患者TFEI药液扩散范围随注射容量的增加而扩大,且在硬膜外倾向于头侧扩散,2 mL容量单次TFEI可阻滞3个以上的神经节段,获得良好的镇痛效果。胸段TFEI行诊断性阻滞的可行性较差。     

损毁和刺激垂体对大鼠痛阈的影响

采用局限性损毁和刺激垂体的方法,以行为测痛为指标,观察大鼠垂体在痛觉调节中的作用以及地塞米松（Ｄｅｘ）对其影响。实验结果显示,损毁垂体中间叶（ＩＬ）及邻近的前叶（ＡＬ）,大鼠痛阈明显低于手术前的痛阈（Ｐ＜０．０１）。电刺激垂体的上述同样部位,大鼠痛阈明显高于手术基础值及自身假刺激值（Ｐ＜０．００１）。经Ｄｅｘ处理的动物,电刺激垂体不再引起痛阈升高。结果表明,大鼠垂体ＩＬ及靠近ＡＬ与痛调节有关,这种     

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。     

Influence of surface anesthesia on the pressure pain threshold measured with different-sized probes

Transcutaneous pressure with pressure probes of arbitrary diameters have been commonly used for measuring the threshold and magnitude of muscle pain, yet this procedure lacks scientific validation. To examine the valid probe dimensions, we conducted physiological experiments using 34 human subjects. Pin-prick pain, pressure pain threshold (PPT) to pressure probes of various diameters, heat pain threshold, and electrical pain threshold of deep tissues were measured before and after application of surface lidocaine anesthesia to the skin surface over the brachioradial muscle in a double-blinded manner. The anesthesia neither affected PPT with larger probes (diameters: 1.6 and 15?mm) nor increased electric pain threshold of deep structures, whereas it diminished pain count in pin-prick test and PPT with a 1.0?mm diameter probe, suggesting that mechanical pain thresholds measured with 1.6 and 15?mm probes reflect the pain threshold of deep tissues, possibly muscle. Pain thresholds to heat did not change after application of the anesthesia. These results suggest that larger pressure probes can give a better estimation of muscular pain threshold.     

The spinal cord in vitro: What can it tell us about nociception?

The use of amphibian and mammalian in vitro spinal cord preparations, e.g., hemisected cord and transverse slices, has gained in popularity over the years due to the flexibility and ease of use of such preparations compared to classical in vivo approaches. When combined with modern experimental methodologies, such as patch clamping of visualized single cells or post-experimental neuroanatomy, this approach provides a powerful addition to the armamentarium available to study nociceptive processing in the dorsal horn. Some of these novel experimental approaches and the insight into nociception that they have provided are described below. Neirofiziologiya/Neurophysiology, Vol. 38, Nos. 5/6, pp. 481–491, September–December, 2006.     

Preparation and evaluation of soluble epoxide hydrolase inhibitors with improved physical properties and potencies for treating diabetic neuropathic pain

Soluble epoxide hydrolase (sEH), a novel therapeutic target for neuropathic pain, is a largely cytosolic enzyme that degrades epoxy-fatty acids (EpFAs), an important class of lipid signaling molecules. Many inhibitors of sEH have been reported, and to date, the 1,3-disubstituted urea has the highest affinity reported for the sEH among the central pharmacophores evaluated. An earlier somewhat water soluble sEH inhibitor taken to the clinic for blood pressure control had mediocre potency (both affinity and kinetics) and a short in vivo half-life. We undertook a study to overcome these difficulties, but the sEH inhibitors carrying a 1,3-disubstituted urea often suffer poor physical properties that hinder their formulation. In this report, we described new strategies to improve the physical properties of sEH inhibitors with a 1,3-disubstituted urea while maintaining their potency and drug-target residence time (a complementary in vitro parameter) against sEH. To our surprise, we identified two structural modifications that substantially improve the potency and physical properties of sEH inhibitors carrying a 1,3-disubstituted urea pharmacophore. Such improvements will greatly facilitate the movement of sEH inhibitors to the clinic.     

Íleo biliar como causa de dolor abdominal en el paciente anciano

Gallstone ileus is a rare and potentially serious complication of cholelithiasis. It is defined as a mechanical intestinal obstruction secondary to the presence of a gallstone in the intestinal luz. The most frequent cause is impaction of the calculus in the ileum after passing through a bilioenteric fístula. It has a high morbidity and mortality rate, mainly due to the difficulty and delay in its diagnosis. A retrospective study is presented of 4 cases of gallstone ileus treated between 2013 and 2017 in the Hospital Nuestra Señora del Prado. An analysis was performed on the clinical characteristics, diagnostic tests, and surgical treatment.     

OPRM1(A118G)基因多态性与肺癌癌痛患者镇痛效果的相关性

目的:探讨阿片样物质受体(μ1 opioid receptor,OPRM1)(A118G)基因多态性与肺癌癌痛患者镇痛效果的相关性。方法:选取本院2017年3月至2019年10月收治的360例肺癌患者作为研究对象,判断患者阿片耐受与不良反应发生情况。收集患者血液指标,检测OPRM1(A118G)基因多态性情况并进行相关性分析。结果:在360例患者中,阿片耐受78例(耐受组),耐受率为21.7%;耐受组的性别、年龄、体重指数、肿瘤最大直径等与非耐受组对比差异无统计学意义(P0.05),两组临床分期与淋巴结转移等对比差异有统计学意义(P0.05)。OPRM1(A118G)基因共有AA、AG、GG三种基因型,两组人群的OPRM1(A118G)基因型分布均符合Hardy-Weinberg平衡定律;两组OPRM1(A118G)基因型分布差异具有统计学意义,耐受组的OPRM1(A118G)基因GG基因型比例显著高于非耐受组(P0.05),等位基因G频率显著高于非耐受组(P0.05);耐受组的呼吸抑制、恶心呕吐、头晕、皮肤瘙痒等不良反应发生率为35.9%,显著高于非耐受组的2.8%(P0.05)。直线相关性分析显示OPRM1(A118G)基因GG基因型与阿片耐受、淋巴结转移、临床分期都呈现相关性(P0.05);二分类变量Logistic回归分析显示OPRM1(A118G)基因GG基因型、临床分期、淋巴结转移为影响阿片耐受的主要因素(P0.05)。结论:肺癌癌痛患者在镇痛中存在阿片耐受情况,与患者的OPRM1(A118G)基因多态性与治疗不良反应显著相关,OPRM1(A118G)基因GG基因型、临床分期、淋巴结转移为影响阿片耐受的主要因素。     

Reliability of surface electromyography for the gluteus medius muscle during gait in people with and without chronic nonspecific low back pain

The purpose of this study was to determine the intratester reliability of surface electromyography (EMG) assessment of the gluteus medius muscle in healthy people and people with chronic nonspecific low back pain (CNLBP) during barefoot walking. Gluteus medius muscle activity was measured twice in 40 people without and 30 people with CNLBP approximately 7 days apart. Walking gluteus medius muscle activity was normalised to maximal voluntary isometric contractions during side-lying hip abduction with manual resistance. Good intratester reliability (ICC > 0.75) was found for mean, peak, and peak to peak amplitude for healthy people. Only mean amplitude demonstrated good intratester reliability in those with CNLBP. Peak amplitude and peak to peak amplitude of the gluteus medius muscle of those with CNLBP, and the time of peak amplitude in both groups, demonstrated moderate reliability (ICC ranged from 0.50 to 0.58). Moderate to large standard error of measurement and minimal detectable change values were reported for outcome measurements. These results suggest that potentially large levels of random error can occur between sessions. Future research can build on this study for those with pathology and attempt to establish change values for EMG that are clinically meaningful.