疼痛机理与临床学习班PPT.ppt

Glu SP nociceptors do not adapt 连续刺激continued stimulation ↓ 1.感受器反复放电→自发性疼痛 continuous or repetitive firing of the nociceptor 2.感受器反应域值下降 a decrease in the threshold ↓ 外周(感受器)敏化sensitization of nociceptors 传入纤维持续放电可引起投射神经元的反应发生改变 中枢敏化 “central sensitization” ↓ 痛觉过敏 hyperalgesia 痛觉倒错 allodynia. Mechanisms of peripheral and central sensitization in neuropathic pain. Primary Afferent pathways ←descending modulatory Systems（NE/5-HT） opioid noxiousstimulus, such as an injury or disease 持续伤害性刺激 手术 炎症 神经损伤 外周敏化Peripheral sensitization to pain: 1.感受器反复放电continuous or repetitive firing of the nociceptor 2.异位从动 背根神经节的电位震荡 →自发性疼痛 3.感受器反应域值下降a decrease in the threshold →对热 冷 静态机械刺激 交感神经释放的NE敏感 一炎症汤“inflammatory soup” nociceptor function is altered by the “inflammatory soup” that characterises a region of tissue injury. 从临床角度透视疼痛机理 贵阳医学院附院麻醉科 曾庆繁 疼痛机理离我们远吗? 麻醉: 抑制/对抗手术伤害性刺激 疼痛诊疗:针灸镇痛 脊髓电刺激 椎间盘突出的臭氧治疗 交感神经阻滞治疗疼痛 药物: TCA 加巴喷丁卡马西平辣椒素 什么是疼痛？ 分类(原因) 生理性(创伤性)疼痛 ↓ 病理性疼痛: 炎性痛 病理性神经痛 癌痛 心理性疼痛 ←急性疼痛:手术后疼痛 创伤 急性病 ←慢性疼痛months or years Acute pain is a normal and predictable physiologic response to an adverse chemical, thermal, or mechanical stimulus; it is associated with surgery, trauma, or acute illness and is usually experienced for a limited and defined period of time a few days or a few weeks 手术后慢性疼痛 截肢amputation 100%→慢性疼痛或不适 开胸手术thoracotomy 50-60% 疼痛持续6月 甚至 出现病理性神经痛-烧灼样 痛/麻刺感burning and tingling. 乳房切除术mastectomy 50-60%疼痛持续6月 开腹胆囊切除术open cholecystectomy 19% 腹腔镜胆囊切除术laparoscopic cholecystectomy 9% 病理性疼痛三大表现 定义 疼痛 ：组织损伤 ↓信息传递 脊髓 ↓ 脑 不愉快的感觉 情绪上的感受 疼痛信息传递 Transduction转导（换能transducer换能器） 不同的伤害性刺激→非电刺激 1.热thermal 2.机械mechanical 3.化学chemica