文档介绍：疼痛药物治疗进展2011
Introduction
Pain: come as you be born
Introduction
Pain: accompany with you all your life
nal 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 2019;24(4):227-36. Piguet V et al. Eur J Clin Pharmacol 2019;53:321-4.
Pini LA et al. JPET 2019;280(2):934-40.
Chandrasekharan NV et al. PNAS 2019;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;49:198-203.
阿片类
NSAIDs
对乙酰氨基酚
神经阻滞
增强作用
及通安: 作用机制
曲马多
阿片类药物: 曲马多和 M1 代谢产物结合 阿片受体
辅助作用: 微弱抑制去甲肾上腺素 和5-羟色胺 再摄取
APAP
非鸦片类镇痛药: 中枢作用机制
可能的NO机制
Muth-Selbach US, et al. Anesthesiology. 2019;91:231-9.
Bjorkman R, et al. Pain. 1994;57:259-64.
及通安: 作用机制
多位点阻滞
疼痛传导阶段
疼痛调节阶段
疼痛感知阶段
良好的疼痛缓解
第三阶梯：强阿片类药物
常用吗啡、芬太尼——与阿片受体结合产生 镇痛