急腹症疼痛管理新观念——早期止痛

从早期止痛的意义,早期止痛的依据以及传统止痛观念的成因等三个方面论述急腹症早期止痛的必要性和合理性,并探讨早期止痛的策略。提醒医务人员要更新观念,对急腹症患者应尽早实施止痛干预。     

舒芬太尼与芬太尼复合罗哌卡因用于小儿术后镇痛效果比较研究

为了观察舒芬太尼或芬太尼复合罗哌卡因用于小儿术后镇痛的效果及其不良反应,选择ASAⅠ-Ⅱ级行择期下腹部手术的小儿50例,随机分为两组,各25例,术后分别使用0．5μg·m^-1舒芬太尼或2μg·ml^-1芬太尼复合0．1％罗哌卡因行硬膜外病人自控镇痛,观察术后24h镇痛效果及其不反应。结果显示,舒芬太尼组术后24h静态和活动时镇痛效果优于芬太尼组（P〈0．05）,恶心、呕吐发生率低,程度轻（P〈0．05）。因此,舒芬太尼复合罗哌卡因可安全用于小儿下腹部术后镇痛,效果优于芬太尼复合罗哌卡因。     

不同浓度罗哌卡因的硬膜外镇痛效应对自然分娩的影响

观察不同浓度的罗哌卡因与固定浓度的芬太尼配伍行硬膜外自控分娩镇痛的临床效果。随机选择80例ASAI级～Ⅱ级、头位、单胎足月妊娠要求分娩镇痛的初产妇,按双盲原则分为四组。观察产妇的生命体征、疼痛程度、运动能力、感觉变化、宫缩情况、产程及分娩情况,以及产妇满意度等。不同浓度的镇痛药其镇痛效果无显著性差异。0．15％罗哌卡因与2μg／ml芬太尼混合液用于硬膜外分娩镇痛效果良好,药量适中,基本无运动及感觉阻滞,对产程及新生儿无明显影响,是较为适合用于分娩镇痛的浓度。     

多模式镇痛在幻肢痛预防中的临床研究

为探讨多模式镇痛预防截肢后幻肢痛的临床效果。选择50例下肢截肢患者,随机分为2组,试验组（Ⅰ组）和对照组（Ⅱ组）,观察患者疼痛评分,患者自控镇痛按压次数,使用其他镇痛药物的情况,记录所有的不良反应及幻肢痛发生率。结果显示,镇痛评分,Ⅱ组高于Ⅰ组（P〈0．01）;PCA按压次数,Ⅱ组多于Ⅰ组（P〈0．01）;不良反应发生率Ⅱ组高于Ⅰ组（P〈0．01）;Ⅱ组幻肢痛发生率明显高于Ⅰ组（P〈0．01）。采取多模式镇痛预防幻肢痛是安全有效的。     

Neuropharmacological aspects of adaptive pain inhibition in murine “victims” of aggression

This review outlines recent research on a subset of physiological responses in murine “victims” or aggression. In a typical resident-intruder paradigm, the detailed study of intruders has revealed that exposure to conspecific attack (and related stimuli) is associated with two forms of analgesia which appear to be integral components of the murine defensive repertoire. In response to intense/enduring attack, intruder mice display a profound, long-lasting and opioid-mediated analgesia. This reaction is highly correlated with defensive immobility and may function to reduce involuntary cues to further attack. In contrast, the inhibition of pain reactivity in mice tested immediately upon the display of defeat is less intense, shorter-lasting, non-opioid in nature and may function to facilitate active defenses such as escape. As this form of pain inhibition is also evident in intruders exposed to the scent of an aggressive male conspecific, a possible anticipatory defensive function linked to mechanisms of anxiety has been proposed. This hypothesis is supported by 1) the prevention of defeat analgesia by a range of antianxiety drugs (benzodiazepines, 5-hydroxytryptamine_1A [5-HT_1A] receptor agonists, and 5-HT₃ receptor antagonists) and 2) the effects of social defeat on behavior in the elevated plusmaze model of anxiety. These findings are discussed in relation to coping mechanisms in murine “victims” of aggression. © 1995 Wiley-Liss, Inc.     

Physostigmine''s Impact on Brief Shock-Induced Hypoalgesia Parallels Its Effect on Memory

Past research indicates that the anticholinergic drug scopolamine disrupts memory and environmentally induced hypoalgesia in rats. The present study examined the impact of the centrally active cholinesterase inhibitor physostigmine, which enhances memory and central cholinergic activity, on brief shock-induced hypoalgesia on the tail-flick test using Sprague–Dawley rats. It is reported that physostigmine (0.1 mg/kg) potentiates the magnitude of this hypoalgesia. Contrary to past research, our results showed that omission of baseline testing did not eliminate hypoalgesia or its potentiation by physostigmine. Similar to its effects on memory, physostigmine (0.04, 0.1, and 0.25 mg/kg) has a nonmonotonic impact on brief shock-induced hypoalgesia; low doses potentiated hypoalgesia (0.1 mg/kg), whereas a high dose (0.25 mg/kg) disrupted it. These results provide further evidence that the cholinergic system indirectly affects pain reactivity by modulating the memory of the aversive event.     

随机对照试验与伦理学的冲突——椎管内阻滞分娩镇痛效果分析

以随机对照试验（RCT）的方法验证椎管内阻滞分娩镇痛的效果有违试验设计的伦理学要求,现有关于椎管内阻滞分娩镇痛的文献都存在着试验设计的死角,导致了医学科学试验与伦理学的水火不容。循证医学（EBM）方法为科学地解决这一问题带来了曙光。     

The Effect of Rehabilitation on Positive Interpretations of Illness

Postoperative patients received one of the three, alternative pain-management treatments: patient-controlled analgesia (PCA); perceived PCA (PPCA without actual control) and continuous intravenous infusion of analgesics (CII). Pain reports, morphine consumption and satisfaction of the groups were compared, and influences of individual differences in preferences for control and trait anxiety were tested. The main findings were: (1) PCA patients consumed less morphine and reported more pain and somewhat higher satisfaction; (2) PPCA patients were intermediate between the other two groups in pain reports and morphine consumption and lowest in satisfaction and (3) individual differences did not moderate the effects of PCA. The findings were interpreted as indicating that the main effect of PCA is increased pain tolerance, and that a bio-psycho-social framework is most appropriate to explain these effects.     

浅谈产科镇痛与人文关怀

实施无痛分娩是对每位产妇最贴切的人文关怀,每位产妇都有享受这种关怀的权利,而在我国分娩镇痛仍未普遍采用.通过实际案例及产科镇痛发展史,论证了当今实施产科镇痛的必要性及技术条件的成熟性,剖析了当今实施此技术的人为及社会障碍,并提出了解决这一问题的方法和途径.     

镇静与镇痛在ICU机械通气患者中的应用变化

探讨ICU内机械通气患者应用镇痛剂、镇静剂及肌松剂的情况及其对机械通气和预后的影响。回顾性分析我院中心ICU2006年、2007年收治的244例行有创机械通气治疗超过48h患者的临床资料,并将患者分为2006年组和2007年纽,用统计软件分析患者在年龄、性别、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、基础疾病,气管插管时间、机械通气时间、ICU住院天数、镇痛与镇静剂应用的时间、机械通气时是否使用肌松剂、Ramsay评分及病死率方面是否存在差别。统计分析显示2006年组和2007年组在年龄、性剐、入ICU时APACHEⅡ评分、血糖、血浆白蛋白、是否使用肌松剂及基础疾病方面无差别;与2006年组相比2007年组患者气管插管时间、机械通气时间及ICU住院天数均缩短,镇痛与镇静剂应用时间均缩短,Ramsay评分降低,病死率下降。提示对机械通气的危重症患者应合理使用镇痛剂与镇静剂。