疼痛药物治疗进展2011.ppt

文档介绍：疼痛药物治疗进展2011
【通用模板】【教育说课】【述职报告】【工作汇报】
医护相互学习
定义（IASP）
疼痛是一种机体实际存在或潜在的组织损伤所引起的或相关联的不愉快感觉和情感体验。机体在受到伤害性刺激时不仅感觉疼痛，同genase; coxibs = COX-2 inhibitors; PG = prostaglandin; TxA2 = thromboxane A2;
NSAID = nonsteroidal anti-inflammatory drug; ASA = aspirin.
NSAIDs
Tissue-specific isomerases
第一阶梯：NSAID药物作用机制
Dose-dependent toxicity
Intolerability, dyspepsia
GI bleeding
Ulcers – bleeds / perforations
Upper-GI
Renal
Fluid retention, oedema, hypertension
Renal dysfunction / failure – acute / chronic
Heart failure
Anti-platelet effects
Angioedema, bronchospasm
Contributes to blood loss
Hypersensitivity
NSAIDs - Safety Concerns
第二阶梯用药：Tramodol
a synthetic analogue of codeine.
a central analgesic with a low affinity for opioid receptors.
a selective agonist of mu receptors and preferentially inhibits serotonin reuptake, whereas tramadol mainly inhibits noradrenaline reuptake.
a central acting analgesic
shown to be effective and well tolerated,
be of value for treating several pain conditions (step II of the World Health Organization ladder) where treatment with strong opioids is not required.
treat moderate to severe pain.
Tramodol
Tramodol: Side effects
dizziness weakness
headache nervousness or anxiety
agitation
shaking hands that you cannot control
increased muscle tightness
changes in mood drowsiness
blurred vision heartburn or indigestion
upset stomach vomiting diarrhea
constipation itching sweating flushing
dry mouth
疼痛治疗中主张多模式镇痛
D’Amours RH et al. JOSPT 1996;24(4):227-36. Piguet V et al. Eur J Clin Pharmacol 1998;53:321-4.
Pini LA et al. JPET 1997;280(2):934-40.
Chandrasekharan NV et al. PNAS 2002;99(21):13926-31.
阿片类

激活阿片受体
对乙酰氨基酚

与
血清素下行抑制途径相互作用
NSAIDs

抑制外周和中枢 Cox-1 / Cox-2(抑制 PG合成）)
对乙酰氨基酚

抑制中枢 Cox-2 / Cox-3 (?)
(抑制 PG 合成)
镇痛药的多种作用机制
多模式镇痛举例
减少每种镇痛剂的剂量
由于协同作用改善抗损害作用
可能减轻每种药物的副反应
Kehlet H, Dahl JB. Anesth Analg. 1993;77:1048-1056.
Playford RJ, et al. Digestion. 1991;4