椎管内应用镇痛药物的问题和展望  

Problems and prospect of intrathecal analgesia

作　　者：曾维安[1] 

机构地区：[1]中山大学肿瘤防治中心麻醉科,广州市510060

出　　处：《实用疼痛学杂志》2005年第2期120-123,共4页Pain Clinic Journal

摘　　要：椎管内应用药物镇痛的机制涉及到几个方面,局麻药为非特异性阻断神经轴而产生镇痛效果。然而,抗伤害作用多数是通过药物直接作用于脊髓水平而发挥其作用,新斯的明作用机制不同于上述药物,它是通过抑制内源性乙酰胆碱的灭活。NMDA受体拮抗剂能阻滞外周神经伤害刺激导致的中枢敏感化。本文就椎管内应用阿片类药、局麻药、α2-肾上腺素能激动药、NMDA受体拮抗药、三环类抗抑郁药、Ca2+通道阻断药、NO合酶、钠钾泵抑制药及新斯的明镇痛近来的发展作一简介。Intrathecal administration drugs both in subarachnoid or epidural space are important methods for nociceptive pharmacology studies and clinical treatment. The mechanism of intrathecal analgesia concerns many factors. In addition to nonspecific axonal blockade by the local anesthetics, direct agonist such as opioids, amino butyric acid (GABA) receptor agonists, andα2-adrenergic agonists are important in intrathecal analgesia. Neostigamine relieve pain through inhibiting breakdown of accetylcholine in human and animal study. Recently studies suggest that N-methyl-D-aspartate (NMDA) receptor antagonists can prevent central sensitization caused by peripheral nociceptive stimulation and abolish the hypersensi-tiviry. However, intrathecal administration drugs have some side effects in clinic practice. This paper reviewed recent development in this method.

关 键 词：椎管内应用 镇痛药物 α2-肾上腺素能激动药 NMDA受体拮抗剂 NMDA受体拮抗药 三环类抗抑郁药 CA^2+通道 新斯的明 特异性阻断 抗伤害作用 中枢敏感化 药物镇痛 镇痛效果 脊髓水平 直接作用 作用机制 乙酰胆碱 神经伤害 

分 类 号：R614[医药卫生—麻醉学]