神经病性疼痛和辅助镇痛剂意义完整版本.ppt

神经病性疼痛和辅助镇痛剂的意义 Neuropathic pain and the meaning of adjuvant analgesics Dr. Z. Zylicz Hospice in the Weald Pembury, Tunbridge Wells Kent. UK 自然”疼痛的两种类型 适应性疼痛-“正常”的疼痛, 疼痛有助于维护躯体的整合(自闭,总是准备,“急 性疼痛”大部分与A-δ纤维相关) 疼痛促进康复:“不要移动你断了的腿”,炎性疼痛 “慢性疼痛”大部分与C纤维有关 Two types ofnatural pain Adaptation pain-normal pain The pain helps to preserve body s integrity(withdrawal, always ready, fast pain mostly A delta fibres The pain promotes recovery: do not move your broken leg inflammatory pain, slow pain mostly C fibres 感受伤害性的疼痛 Nociceptive pain 疼痛自主反应 Noxious Peripheral Stimuli 退反射 热Heat Autonomic Response 冷cd Withdrawal reflex Intense Mechanica lodceptor Sensory Neuron 伤害感觉神经元 Brain 化学 Chemical 刺激物 Instants Spinal Cord 炎性疼痛 Inflammatory pain nflammation炎症 发性疼痛 巨嗜细胞 Spontaneous Pain 惶 降低:异常疼痛 Pain Hypersensitivity Mast Cell 反应增加:感觉过歆 Reduced Threshold: Allodynia Increased Response: Hyperalgesia 组织损伤 著密 Tissue Damage Nociceptor Sensory Neuron 伤害感觉神经元 Spinal Cord 装等除是2mm它基 酮舍林 etansenn 谷氨酸盐 M)( 谷氨酸盐 咪达唑仑 氯胺酮 可乐定0阿片类 AMPA Midazolam NMDA Morphine Clonidine 氨酪 氯芬 咪达唑仑 R-Pla Neca Baclofen postsynaptic element 突触后元件