神经阻滞镇痛术.pptxVIP

神经阻滞镇痛术第1页/共63页 paintwo componentssomatic sensationaffective (emotion)a. Acute pain (sharp pain)b. Chronic pain (dull pain)第2页/共63页 Pain transmission pathwayNoxious stimuliPGsK+、H+BK5-HTPrimary afferent fibresnociceptorSpinal cordLimbic systemSomato-sensory cortexmood effect, the affective aspect of painthe sensory aspect of painDorsal horn第3页/共63页 severe painOpioids (eg. Morphine) inflammatory pain NSAIDs (eg. Aspirin) local anaesthesia smooth muscle colic angina pectoris induced by coronary artery spasm trigeminal pain Drug treatment of paincholinoceptor-blocking drugs vasodilator drugs (eg. Nitroglycerin) CarbamazepineLocal anaesthetics第4页/共63页 Cortex Spinal cordDorsal hornPGsK+、H＋BK5-HTNSAIDsOpioidsSites of action of different drugs 第5页/共63页 opioid analgesics(narcotic analgesic, addictive analgesics) 第6页/共63页 Opium (阿片) is the dried exudate obtained from unripe seedpods of the poppy Papaver somniferum, containing morphine, codeine, and other alkaloid substances. Opiate (阿片剂) means that a substance is extracted from opium or is similar in structure to natural substances present in opium.Opioid (阿片样物质) is a term that designates substances that are not derived from opium. It refers particularly to opioid peptides, i.e. endogenous compounds that bind to opioid receptors and mimic the effect of morphine-like compounds.Widely use term第7页/共63页 Opium The flower of papaver Opium (阿片)第8页/共63页 Opiate (阿片剂)MorphineCodeinePapaverine (罂粟碱) … …第9页/共63页 structure-activity relationship海洛因吗啡纳洛酮OH第10页/共63页 Opioid (阿片样物质)Endogenous opioid peptides: Enkephalins Endorphins Dynorphins Orphanin第11页/共63页 1992~197319621975 analgesic site is laminae III of periventricular and periaqueductal gray areaput forward “receptors” for opiate analgesics in brainisolated the first “endogenous opioid peptide” and named enkephalinCloned opioid receptors: μ κ δ ?Research history第12页/共63页 ExtracellularCytoplasmicNH2HOOCOpioid receptor