ICU患者镇痛与药物选择.ppt

此项回顾性研究表明,区域镇痛可使重症病人受益，但在临床上并未得到广泛使用。因为目前尚缺乏大规模的随机对照研究用于评估区域镇痛对重症病人镇痛的确切疗效。 Luísa GuedesI; Helena RebeloI;Rev. Bras. Anestesiol. vol.62 no.5 Campinas Sept./Oct. 2012 经皮神经电刺激 经皮的神经电刺激疗法 Transcuataneous electrical nerve stimulation（简称TENS） 经皮的神经电刺激疗法（周围神经粗纤维电刺激疗法）是通过皮肤将特定的低频脉冲电流输入人体以治疗疼痛的电疗方法。 镇痛机制 1.闸门控制假说 认为TENS是一种兴奋粗纤维的刺激，粗纤维的兴奋，关闭了疼痛传入的闸门，从而缓解了疼痛症状。 2.内源性吗啡样物质释放假说 激活了脑内的内源发吗啡多肽能神经元，引起内源性吗啡样多肽释放而产生镇痛效果。 Dorsal column stimulation for control of pain. Preliminary report on 30 patients J Neurosurg. 1972 May;36(5):590-7 Transcutaneous electrical nerve stimulationin the management of pancreatitis pain The application of transcutaneous electrical nerve stimulation (TENS) to the abdomen produced prompt and sustained relief of the pain associated with pancreatitis in five patients and in another patient with probable acute pancreatitis. The disorder was acute in two patients and recurrent in four. Multiple hospitalizations, including the need for analgesics and opiates, had been required during previous attacks in five patients. In view of the simple and noninvasive nature of such treatment, more extensive clinical trials appear to be warranted. Some of the possible mechanisms of action for TENS analgesia are reviewed. Roberts HJ. South Med J. 1978 Apr;71(4):396-8. 脊髓神经电刺激 脊髓刺激术（spinal cord stimulation scs） 是指将脊髓刺激器的电极安放于椎管的硬膜外腔后部，通过电流刺激脊髓后柱的传导束和后角感觉神经元，从而达到治疗疼痛或其它疾病目的的一种治疗方法。 Dual lead spinal cord stimulation using octad lead for central post-stroke pain Spinal cord stimulation (SCS) has become the preferred option for neurosurgical management of several intractable pains. To evaluate effects of dual lead SCS using two quad leads for central post-stroke pain (CPSP), we retrospectively reviewed eight consecutive patients with CPSP who underwent SCS. Six (75%) of eight patients obtained more than 50% pain relief during test stimulation, and the efficacies continued for