针刺麻醉与镇痛泵在肩关节术后镇痛领域中的应用及评价

以行肩关节手术的患者作为研究对象,比较和评价了针刺麻醉与肩峰下自控型镇痛泵对术后镇痛的疗效与安全性,指标包括疼痛视觉模拟评分（VAS）、肩关节活动度（ROM）、Lovett肌力分级等,结果显示镇痛泵组的胃肠道不良反应发生率（7/64）、基础病复发率（4/64）,及总体不良反应发生率（16/64）均显著高于针刺组（0/70）(0/70)(4/70),在轻度疼痛者中,2组的VAS未见差异,但针刺组的ROM更大,在中、重度疼痛者中,镇痛泵组的VAS低于针刺组,但2组的ROM及肩关节肌力未见差异,说明针刺麻醉的安全性极佳,可促进术后康复,适用于轻度疼痛者及合并相关内科基础病的中、重度疼痛者。     

红细胞作为吗啡载体延长吗啡镇痛时效的研究

探讨用高渗法制备红细胞包蔽吗啡溶液(RBG—M)的可行性。对RBC—M制备过程中红细胞(RBC)的体积和形态的变化、RBG—M溶液内外的吗啡(M)浓度及含量的变化以及择期上腹部手术患应用RBC—M溶液术后镇痛的时效和吗啡的血药浓度进行了研究。研究发现：(1)用高渗法制备红细胞包蔽吗啡溶液是可行的。(2)RBG—M溶液与单纯M溶液相比其术后镇痛作用显延长；其药代动力学指标消除半衰期(T1／2)延长3倍多。曲线下面积(AUC0→∞)增加约11倍。而清除率(CL)明显减小约9倍。(3)用RBGM溶液行术后镇痛的患其时效明显优于单纯用吗啡的患。     

曲马多超前镇痛用于小儿腭裂修补术的临床观察

目的观察小儿腭裂修补术中曲马多超前镇痛的有效性和安全性。方法选择46例美国麻醉医师协会分级法（ASA）Ⅰ—Ⅱ级腭裂修补术患儿，年龄1～3岁，随机分为曲马多组和对照组，全麻诱导气管插管后在术前分别静推曲马多2mg/kg和相同容量的生理盐水。记录患儿围麻醉期间血流动力学变化，并测定苏醒期的躁动评分，观察有无恶心呕吐、呼吸抑制、反流误吸等不良反应。结果两组患儿围麻醉期间术中血流动力学平稳，组间差异无显著性；但曲马多组在拔管时和苏醒期血流动力学明显较对照组平稳。苏醒期躁动评分曲马多组满意率明显高于对照组（P〈0．05）。两组患儿均未发生恶心呕吐、呼吸抑制、反流误吸等不良反应。结论小儿腭裂修补术术前静推曲马多2mg/kg可获得围麻醉期间较为平稳的血流动力学，减少拔管期的躁动，且不增加术后呼吸抑制、恶心呕吐等不良反应的发生率。     

力邦欣定减少吗啡术后硬膜外镇痛的恶心呕吐

选择 6 0例硬膜外麻下行腹部及下肢手术的患者 ,随机分为A、B 2组 ,A组为对照组 ,B组在A组镇痛液的基础上加入力邦欣定 ,观察患者术后镇痛VAS评分、嗜睡、恶心、呕吐的发生情况 .结果表明 :VAS评分 2组在各阶段比较无明显差异 (P >0 .0 5 ) ;恶心、呕吐 :B组与A组比较有显著性差异 (P <0 .0 5 ) .力邦欣定能有效地减少硬膜外吗啡镇痛治疗中恶心、呕吐的发生率 .     

Genetic determinants of individual differences in avoidance learning: Behavioral and endocrine characteristics

Bidirectional genetic selection for good and poor active avoidance learning in a shuttle box has been carried out in three independent laboratories using remarkably similar discrete-trial training procedures. The resulting strains are known as the Roman High and Low Avoidance (RHA and RLA), the Syracuse High and Low Avoidance (SHA and SLA) and the Australian High and Low Avoidance (AHA and ALA) strains, respectively. An additional unidirectionally selected strain, known as the Tokai High Avoider (THA) strain was developed in Japan using a free-operant Sidman avoidance procedure in a Skinner box. This paper reviews the selection of the Syracuse strains, enumerates the various behavioral and endocrine characteristics of the strains, and compares them to the other similarly selected strains. The behavioral work suggests that genetic selection from diverse breeding stocks has resulted in common characteristics that differentiate the strains in the emotional, not learning, domain. The endocrine data, however, are somewhat at odds. The Syracuse strains differentiate one way with respect to endocrine function, and the Roman strains differentiate in the opposite way. We suggest, therefore, that the endocrine correlates are not tightly linked to the avoidance genotype. Genetic analysis of all of the selected strains for both the avoidance phenotype and the endocrine correlates will be needed to test this hypothesis.Preparation of this paper was supported by research grant MH-39230-3 from the National Institute of Mental Health.     

罗哌卡因复合芬太尼蛛网膜下腔-硬膜外联合阻滞分娩镇痛的临床研究

通过对罗哌卡因复合芬太尼用于蛛网膜下腔-硬膜外联合阻滞和病人自控分娩镇痛(CSEA PCEA)的可行性探讨，结论表明：在CSEA PCEA分娩镇痛中，局麻药复合应用阿片类药物是一种较理想的配方，罗哌卡因3mg 芬太尼7．5μg用于蛛网膜下隙-硬膜外联合阻滞，镇痛效果最佳，副作用少，安全性高，产妇满意。     

Multitasking with neurotensin in the central nervous system

The 13-amino acid peptide neurotensin (NT) was discovered over 30 years ago and has been implicated in a wide variety of neurotransmitter and endocrine functions. This review focuses on four areas where there has been substantial recent progress in understanding NT signaling and several functions of the endogenous peptide. The first area concerns the functional activation of the high-affinity NT receptor, NTR-1, including the delineation of the NT binding pocket and receptor domains involved in functional coupling to intracellular signaling pathways. The development of NT receptor antagonists and the application of genetic and molecular genetic approaches have accelerated progress in understanding NT function in several areas, including the involvement of NT in antipsychotic drug actions, psychostimulant sensitization and the modulation of pain, and these are reviewed in that order. There is now substantial evidence indicating that NT is required for certain antipsychotic drug actions and that the peptide plays a key role in stress-induced analgesia.Received 18 March 2005; received after revision 9 May 2005; accepted 23 May 2005     

中华眼镜蛇心脏毒素对疼痛及记忆的影响

通过热板法及醋酸扭体法观察中华眼镜蛇心脏毒素(CTX)对成年昆明种小鼠疼痛的影响,通过Y一型电迷宫及穿梭箱法研究CTX对东蓖若碱诱发成年昆明种小鼠学习记忆障碍的影响,利用跳台法研究CTX对东蓑若碱诱发成年BABL/C小鼠学习记忆障碍的影响,利用Morris水迷宫法研究CTX对对东蓖若碱诱发成年C57BL/6J小鼠学习记忆障碍的影响。实验发现,CTX能明显增加热刺激引起的疼痛闭值,明显减少醋酸引起的扭体次数,并能显著增加小鼠在Y型迷宫实验中的正确反应次数,减少在穿梭箱实验中小鼠重新训练至学会标准的训练次数及小鼠的反应时间,能增加小鼠在跳台法中的潜伏期,减少错误反应次数,减少小鼠在Morris水迷宫实验中的寻台时间和游泳路程,以上效果均表现出明显的剂量依赖性。以上结果提示,CTX有良好的镇痛作用以及对东莫若碱诱发的小鼠学习记忆障碍的改善作用,这可能是由于CTX与眼镜蛇神经毒素(NT)三维结构相似而导致了相似的生物学效应。