神经阻滞镇痛术.pptx

Analgesics;;Pain transmission pathway;;Cortex; opioid analgesics(narcotic analgesic, addictive analgesics) ; ;Opium ;Opiate (阿片剂);;;;;Opioid receptors; Spinal cord;; Morphine + receptors;The cellular mechanisms;;Pharmacological actions ;1.CNS effects: principal effects Analgesia Sedation euphoria Respiratory depression Cough suppression Others: miosis, nausea, hormone ;(1) Analgesia insensitive: muscle spasms pain, deafferentation pain partially sensitive: nerve pain, CNS compression injury, bone cancer sensitive: myocardial infarction, other types of cancers relieve anxiety and distress, tolerance of pain; (2) Sedation and euphoria; respiratory rate ，tidal volume the most common cause of death from acute poisoning influenced by stimulus Mechanisms: ? the sensitivity of respiratory center to increased CO2 tension ; ;2. Smooth muscle system Gastrointestinal system Biliary tract Urinary system genital system ;; ;(3) Urinary tract; ;Clinical uses;Analgesia terminal cancer myocardial infarction renal and biliary colic (atropine) trauma, burn, operation;;;Opioid analgesic drugs;Morphine ;;美施康定（硫酸吗啡缓释片） 1. 强效，作用持续12 hr。主要用于晚期癌症患者第三阶梯止痛。 2. 抑制呼吸，可引起恶心、呕吐、便秘及排尿困难，长期应用可产生耐受性、身体依赖性和成瘾性。;Heroin (diamorphine);Codeine ;Pethidine (dolantin);Methadone;Fentanyl;口腔经粘膜芬太尼拘橼酸盐(Oral Transmucosal Fentanyl Citrate, OTFC);Pentazocine;Tramadol;延胡索乙素和罗通定;1. Tolerance;2. Dependence; 身体依赖性;药物滥用（drug abuse）: 非医疗目的反复使用具有依赖性潜能的精神活性物质。体验该物质产生的特殊精神效应。 ;;3. General adverse effects;The triad：;Naloxone;Contraindications;联合国禁毒机构估计全球约2亿人在滥用四类毒品，占全球15~64岁人口的5%。 阿片类 苯丙胺类 大麻 可卡因;Mode of administration of opioids;Patient Controlled Analgesia (病人自控镇痛，PCA);Non-opioid for mild pain;Thank you!;;;; Spinal cord;1.CNS effects: principal effects Analgesia Sedation euphoria Respiratory depression Cough suppression Others: miosis, nausea, hormone ;延胡索乙素和罗通定;The t