超声引导下股神经阻滞联合纳布啡术前镇痛对髋部骨折患者椎管内穿刺前体位痛的镇痛效果

目的探讨超声引导下股神经阻滞联合纳布啡术前镇痛对髋部骨折患者椎管内麻醉前体位痛的镇痛效果。方法选择90例髋部骨折患者,采用随机数字表法将患者分为纳布啡组(N组)、股神经阻滞组(F组)和股神经阻滞联合纳布啡组(FN组),每组30例。所有患者入院后均静脉注射氟比洛芬酯50 mg,3次/d。入手术室后,N组给予静脉滴注纳布啡0.2 mg/kg;F组给予超声引导联合神经刺激仪行股神经阻滞,注入0.375%罗哌卡因15 mL;FN组同时给予F组和N组的镇痛方案。记录患者术前镇痛实施前(T0)、术前镇痛实施后(T1)、过床后5 min(T2)和摆侧卧位后5 min(T3)静态和动态VAS评分、平均动脉压(MAP)、心率(HR)、外周血氧饱和度(SpO 2);比较三组术前镇痛不良反应(恶心、呕吐、头晕、过度镇静及呼吸抑制)发生率、镇痛失败率及相关并发症情况。结果三组患者的静态和动态VAS评分差异有统计学意义,且静态和动态VAS评分均有随时间变化的趋势,分组与时间存在交互作用(均P<0.05);FN组的静息VAS评分在T3时明显低于N组、F组(P<0.05),而其余时点比较差异无统计学意义(均P>0.05)。FN组动态VAS评分在T1、T2、T3时明显低于N组、F组(均P<0.05)。三组的MAP、HR差异有统计学意义,且MAP、HR均有随时间变化的趋势,分组与时间存在交互作用(均P<0.05)。三组各时点SpO 2比较差异无统计学意义(均P>0.05)。三组患者均未出现恶心、呕吐、头晕、过度镇静及呼吸抑制等不良反应;F组、FN组未出现局麻药中毒反应、血肿等神经阻滞相关的并发症;三组患者术前镇痛的失败率比较差异无统计学意义(P>0.05)。结论超声引导下股神经阻滞联合纳布啡用于髋部骨折患者椎管内穿刺前体位痛,安全有效,是较为可靠的术前镇痛方法。

无痛结肠镜体位转换单的临床应用效果观察

[目的]探讨无痛结肠镜体位转换单的临床应用效果。[方法]将180例需要无痛结肠镜检查的病人随机分成观察组和对照组各90例,观察组使用无痛结肠镜体位转换单,对照组按传统方法人工搬动转换体位。比较两组病人对无痛结肠镜操作舒适感的满意度、内镜室医护人员满意度以及操作者对操作的满意度。[结果]观察组病人对舒适感的满意度、内镜室医护人员满意度以及操作者对操作的满意度均高于对照组(P<0.05)。[结论]无痛结肠镜体位转换单的应用解决了无痛结肠镜检查过程中病人体位转换的难题,提高了病人及医务人员的满意度。

Participation of local exosomes of acupoints in the initiation of acupuncture analgesic effect

Objective: To investigate the local initiation role of local exosomes of acupoints in acupuncture analgesic effect.Methods: Thirty-two rats with adjuvant arthritis were randomly divided into model group(Group CFA),model + electroacupuncture group(Group EA), model + antagonist + electroacupuncture group(Group GW4869 + EA), and model + dimethyl sulfoxide + electroacupuncture group(Group DMSO + EA), with 8 rats in each group. The model rat s of adjuvant arthritis were prepared by intradermal injection of 0.1 mL of Freund’s adjuvant complete into the metatarsal of the right posterior foot to induce inflammation.No intervention was given in Group CFA, while electroacupuncture was performed in the other three groups at 'Zúsānlǐ(足三里 ST 36, bilaterally)' and 'Huántiào(环跳 GB 30, bilaterally)' of the rats with the following electroacupuncture parameters: dilatational wave with a frequency of 2/10 Hz, an intensity of 5/10/15(0.76/1.53/2.3 mA), a duration of 30 min, and an intensity increasing every 10 min. In Group DMSO + EA, DMSO(with a concentration of 0.2%, 50μL/acupoint) was injected at bilateral 'ST 36' of the model rats one hour before electroacupuncture, while GW4869(with a concentration of 3 mg/mL,50μL/acupoint) was injected at bilateral ST 36 of the model rats one hour before electroacupuncture in Group GW4869 + EA. The paw withdrawal latency(PWL) was used as the therapeutic effect index.Results: The PWL of rats in each group at Hour 24 after modeling was significantly lower than that before modeling, indicating that the models were successfully established. After the electroacupuncture treatment, the PWL of rats showed an increasing trend in all groups. The PWL of Group GW4869 + EA(6.74 ±1.09)s was lower than that of Group EA(7.72 ±1.54)s on Day 1 after injection, but the difference was not statistically significant(P> 0.05). The PWL values of Group GW4869 + EA(7.72 ±0.70)s,(7.87 ± 0.58)s were significantly lower than those of Group EA(9.96 士 0.94)s,(9.66 ±0.96)s(both P< 0.05)on Days 2 and 3 after injection, and the differences were statistically significant.Conclusion: It was preliminarily found that acupuncture analgesic effect was significantly reduced after local exosomes of acupoints were blocked, indicating that local exosomes of acupoints may be involved in the initiation process of acupuncture effect.

Antinociceptive activity of transient receptor potential channel TRPV1, TRPA1, and TRPM8 antagonists in neurogenic and neuropathic pain models in mice

The aim of this research was to assess the antinociceptive activity of the transient receptor potential （TRP） channel TRPV1, TRPM8, and TRPA1 antagonists in neurogenic, tonic, and neuropathic pain models in mice. For this purpose, TRP channel antagonists were administered into the dorsal surface of a hind paw 15 min before capsaicin, allyl isothiocyanate （AITC）, or formalin. Their antiallodynic and antihyperalgesic efficacies after intraperitoneal ad- ministration were also assessed in a paclitaxel-induced neuropathic pain model. Motor coordination of paclitaxel- treated mice that received these TRP channel antagonists was investigated using the rotarod test. TRPV1 antagonists, capsazepine and SB-366791, attenuated capsaicin-induced nociceptive reaction in a concentration-dependent manner. At 8 pg/20 pl, this effect was 51% （P〈0.001） for capsazepine and 37% （P〈0.05） for SB-366791. A TRPA1 antagonist, A-967079, reduced pain reaction by 48% （P〈0.05） in the AITC test and by 54% （P〈0.001） in the early phase of the formalin test. The test compounds had no influence on the late phase of the formalin test. In paclitaxel-treated mice, they did not attenuate heat hyperalgesia but N-（3-aminopropyl）-2-{[（3-methylphenyl）methyl]oxy}-N-（2-thienylmethyl） benzamide hydrochloride salt （AMTB）, a TRPM8 antagonist, reduced cold hyperalgesia and tactile allodynia by 31% （P〈0.05） and 51% （P〈0.01）, respectively. HC-030031, a TRPA1 channel antagonist, attenuated tactile allodynia in the von Frey test （62%; P〈0.001）. In conclusion, distinct members of TRP channel family are involved in different pain models in mice. Antagonists of TRP channels attenuate nocifensive responses of neurogenic, tonic, and neuropathic pain, but their efficacies strongly depend on the pain model used.