神经阻滞镇痛术.ppt
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1、 AnalgesicsZhang,Bin1-a.Acute pain(sharp pain)b.Chronic pain(dull pain)2-Pain transmission pathwayNoxious stimuliPGsK+、H+BK5-HTPrimary afferent fibresnociceptorSpinal cordLimbic systemSomato-sensory cortexmood effect,the affective aspect of painthe sensory aspect of painDorsal horn3-severe painOpioi
2、ds(eg.Morphine)inflammatory pain NSAIDs(eg.Aspirin)local anaesthesia smooth muscle colic angina pectoris induced by coronary artery spasm trigeminal pain Drug treatment of paincholinoceptor-blocking drugs vasodilator drugs (eg.Nitroglycerin)CarbamazepineLocal anaesthetics4-Cortex Spinal cordDorsal h
3、ornPGsK+、HBK5-HTNSAIDsOpioidsSites of action of different drugs 5-opioid analgesics(narcotic analgesic,addictive analgesics)6-Opium(阿片)is the dried exudate obtained from unripe seedpods of the poppy Papaver somniferum,containing morphine,codeine,and other alkaloid substances.Opiate(阿片剂)means that a
4、substance is extracted from opium or is similar in structure to natural substances present in opium.Opioid(阿片样物质)is a term that designates substances that are not derived from opium.It refers particularly to opioid peptides,i.e.endogenous compounds that bind to opioid receptors and mimic the effect
5、of morphine-like compounds.Widely use term7-Opium The flower of papaver Opium(阿片阿片)8-Opiate(阿片阿片剂)MorphineCodeinePapaverine(罂粟碱粟碱)9-structure-activity relationship海洛因海洛因吗啡啡纳洛洛酮OH10-Opioid(阿片阿片样物物质)Endogenous opioid peptides:Enkephalins Endorphins Dynorphins Orphanin11-1992197319621975 analgesic site
6、 is laminae III of periventricular and periaqueductal gray areaput forward“receptors”for opiate analgesics in brainisolated the first“endogenous opioid peptide”and named enkephalinCloned opioid receptors:Research history12-ExtracellularCytoplasmicNH2HOOCOpioid receptorsG protein-coupled receptors 13
7、-Opioid receptorssupraspinal analgesia,sedation,euphoria,dependence,respiratory depression,miosisspinal analgesia,sedationdysphoria(烦躁不安躁不安),hallucinationspinal analgesia,sedation,euphoria,dependence,respiratory depression :14-Spinal cordDorsal hornenkephalinsCa2+Ca2+Presynaptic terminalPostsynaptic
8、 neuronenkephalins The cellular mechanisms15-enkephalins Presynaptic terminalPostsynaptic neuronThe cellular mechanismsmorphine16-Morphine+receptorsOpen K+channelClose Ca2+channel 抑制冲抑制冲动传导Ach,NA,Glu,5-HT,P release presynapticpostsynapticExcitability The cellular mechanisms17-The cellular mechanisms
9、Presynaptic inhibition:activation of opioid receptors on presynaptic nerve terminals.Close Ca2+channel,decrease Ca2+input,and thereby reduce transmitter release(Ach,NA,Glu,5-HT,P).Postsynaptic inhibition:activation of postsynaptic opioid receptors.Open K+channels on postsynaptic neurons,increase K+o
10、utput,and thereby cause hyperpolarization and thus reduce postsynaptic neuronal excitability.18-Descending pain inhibitory pathwaysLocal inhibitory interneuron in spinal cordPainAscending pain transmission pathwaysEndogenous opioid peptides19-Pharmacological actions 1.CNS2.Smooth muscles3.Cardiovasc
11、ular system20-1.CNS effects:principal effects Analgesia Sedation&euphoria Respiratory depression Cough suppression Others:miosis,nausea,hormone 21-(1)Analgesia insensitive:muscle spasms pain,deafferentation pain partially sensitive:nerve pain,CNS compression injury,bone cancer sensitive:myocardial i
12、nfarction,other types of cancers relieve anxiety and distress,tolerance of pain1.CNS灼性神经痛(causalgia)系指在明确的神经损伤后,与损伤神经支配范围相一致的区域内出现的以剧烈灼样疼痛主要症状,表现为痛觉异常、痛觉过敏、交感神经机能障碍、血流障碍、出汗异常、骨、肌肉萎缩,有时表现出水肿性改变的慢性顽固性疼痛综合征。22-(2)Sedation and euphoria drowsiness and clouding of mentation sleep induced and aroused easil
13、y Euphoria a sense of contentment and well-being Sedation:the main reason for drug abuseSite:limbic system and locus ceruleus23-respiratory rate ,tidal volume the most common cause of death from acute poisoning influenced by stimulusMechanisms:the sensitivity of respiratory center to increased CO2 t
14、ension (3)Respiratory depression24-(4)Cough suppressionantitussive effect by inhibiting cough centercodeine(5)Other CNS effectsMiosis:pinpoint pupilsNausea and vomiting:CTZ muscular tension:限制限制 胸廓活胸廓活动,影响呼吸影响呼吸Hormone:LH,FSH,prolactin,GH,ADH25-2.Smooth muscle system Gastrointestinal system Biliary
15、tract Urinary system genital system 26-(1)Gastrointestinal tract delays passage secretion of digestive glandindigestioncentral inhibition a call of nature defecation reflex GIT tone GIT motility absorption of waterconstipation27-biliary colic constrict biliary smooth muscle constrict Oddis sphincter
16、 pressure in the biliary tract(2)Biliary tract28-(3)Urinary tractconstrict ureteral smooth muscle bladder sphincter tone urinary retention uterine tone prolong labor(4)Genital tract29-orthostatic hypotension Mechanisms:release of histamine vasomotor center3.Cardiovascular system(1)peripheral arteria
17、l and venous dilatation(2)intracranial pressuresecondary to respiratory depression30-Clinical usesAnalgesiaCardiac asthmaAntidiarrheaAntitussiveCombined anesthesia31-1.Analgesia terminal cancer myocardial infarction renal and biliary colic(atropine)trauma,burn,operationat regular time and quantity32
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- 关 键 词:
- 神经 阻滞 镇痛
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