常见镇痛药课件.pptVIP

第十九章 镇痛药 概 述 疼痛是一种因组织损伤或潜在的组织损伤而产生的痛苦感觉，常伴有不愉快的情绪甚或心血管和呼吸方面的变化。 既是机体的一种保护性机制，提醒机体避开或处理伤害，也是临床许多疾病的常见症状。 剧烈疼痛不仅给患者带来痛苦和紧张不安等情绪反应，还可引起机体生理功能紊乱，甚至诱发休克。 控制疼痛是临床药物治疗的主要目的之一。 躯体痛（Somatic pain)：快痛、慢痛,对机械性、化学性、炎症性、温度性刺激均敏感。 内脏痛（Visceral pain)：对牵张、炎症刺激敏感。 神经痛 (Neuropathic pain)：多由神经损伤或兴奋性增高引起，呈发作性或持续性，一般镇痛药无效。 Pain Pain is the unpleasant sensory and emotional experience an individual has when they perceive actual or potential tissue damage to their body. Pain is highly subjective to the individual experiencing it. Pain is a major symptom in many medical conditions Pain is part of the bodys defense system Analgesics A Drug that selectively relieves pain by acting in the CNS or on peripheral pain mechanism, without significantly altering consciousness. Nociception(Nociceptors, Pain Receptors) Opioid Receptors μ Receptors: Activation of the μ-opioid receptors is associated with analgesia, sedation, euphoria, physical dependence, and respiratory depression κReceptors δ Receptors Pain Receptors Pain Pathways疼痛的感觉传入 与疼痛传导有关的神经递质和调质 神经肽类: P物质（SP）、神经激肽（NKA、NKB) 经典递质类：Glu、GABA、5－HT、NA、腺嘌呤 阿片肽类（opioid peptides）：亮氨酸脑啡肽、甲硫氨酸脑啡肽、β－内啡肽、强啡肽、内吗啡肽等。 Pain Medication Anesthesia Reduction of all sensation Short-term Local, regional General: loss of consciousness Analgesia Specific reduction of pain Peripheral or central Anesthetics Local: Na+ channel blockers Alkaloids: Lidocaine, Novocaine, cocaine Nerve block Spinal / epidural anesthesia General anesthesia Gases or IV Mechanisms poorly understood Used in conjunction with paralytics, artificial ventilation Analgesics Peripheral Non-steroidal anti-inflammatory drugs (NSAIDS): aspirin, Tylenol, ibuprofen Block prostaglandin release by COX inhibition GI complications: ulcer, etc. Liver complications COX-2 inhibitors Central: opiates Opiate receptors are located in: PAG (stimulatory) Spinal cord (inhibitory) 镇痛药（Analgesics) 在不影响意识和其它感觉的情况下，能选择性地 缓解或消除疼痛及伴有的不愉快情绪（恐惧、紧张、不安等）。 按其作用机制、缓解疼痛的强度和临床用途可分为两大类。 主要作用于中枢神经系统、缓解疼痛的作