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2009年西部麻醉学术论坛

作者： Katsushi Doi Tetsuro Nikai Kei Koshikawa yoji saito Anesthesiology Department Shimane University Faculty of Medicine

＜正＞Background Several studies have been reported that spinal anesthesia has sedative effect and there are also several reports about the relationship between the level of sensory block and sedative effect of spinal anesthesia in human study,there is little information available on this relationship in animal model.In this study,we established the animal model to evaluate the interaction of spinal anesthesia and intravenous propofol regarding as sedation.In addition we sought the correlation between degree of sedation with propofol and height of sensory blockade by intrathecal bupivacaine in rats.Methods With our institutional approval of animal research and use committee,experiments were performed using six male Sprague-Dawley rats.Under halothane anesthesia,an intrathecal catheter was implanted at the level of L3-4 to the caudal direction.After 3 days recovery,rats received intrathecal injection 15□l of saline（control group） followed by the intravenous infusion of propofol.After an interval of 3 days,rats were assigned randomly to two groups in a crossover design study,each rat to received either 0.75% bupivacaine 25□l（high dose group,HB group） or 10□l（low dose group,LB group） intrathecal injection and then infused propofol 10 minutes after intrathecal bupivacine.The propofol requirements to ablate the eyelid reflex were determined.The scale of each centimeter below the xiphoidal process was marked before intrathecal injection,and the level of sensory block was assessed with pinch stimulation from tail toward to xiphoidal process after intrathcal drug administration.The withdrawal,muscle contraction,vocalization or attempt to escape to the stimulation was designated as positive response.Mean artery blood pressure（MAP） and heart rate（HR） were measured.Propofol dose and hemodynamic data were compared using ANOVA followed by Scheffe’s and Dunnett’s tests,respectively.Mann whitney u test was used for comparison of sensory block level between HB group and LB group,and P＜0.05 was considered statistically significant.R

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大鼠静脉持续输注瑞芬太尼可诱发输注时长相关性一过性痛觉过敏

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麻醉与镇痛 2013年第2期9卷 10-16页

作者： Ryosuke Ishida Tetsuro Nikai Tatsuya Hashimoto Toshiko Tsumori yoji saito 李卉(译) 王焱林(校) Departments of Shimane University Faculty of Medicine Shimane Japan Departments of matomy and Morphological Neuroscience Shimane University Faculty of Medicine Shimane Japan 不详

背景最近研究表明，瑞芬太尼和其他仙型阿片受体激动剂一样可能会引起痛觉过敏。因此，我们拟通过动物实验（采用临床实践中应用的管理模型）研究静脉给予瑞芬太尼，观察瑞芬太尼是否可以日l起痛觉过敏以其Bj起痛觉过敏的条件。此外，... 详细信息

背景最近研究表明，瑞芬太尼和其他仙型阿片受体激动剂一样可能会引起痛觉过敏。因此，我们拟通过动物实验（采用临床实践中应用的管理模型）研究静脉给予瑞芬太尼，观察瑞芬太尼是否可以日l起痛觉过敏以其Bj起痛觉过敏的条件。此外，我们还研究输注瑞芬太尼引起的痛觉过敏是否与细胞外信号调节蛋白ERK1／2激酶磷酸化有关。方法雄性SD大鼠，经尾静脉置管，持续给予瑞芬太尼（30μg·kg^-1·min^-1）10分钟，或持续给予瑞芬太尼（0．1／1／10μg·kg^-1·min^-1）30分钟，或给予瑞芬太尼（0．1／1／3／10μg·kg^-1·min^-1）120分钟。随后行vonFrey测试及甩尾实验，并用免疫组化法测ERK1／2蛋白表达。在此基础上，观察鞘内预先给予MAPK抑制剂U0126是否可抑制瑞芬太尼引起痛觉过敏。结果瑞芬太尼的镇痛作用呈剂量依赖性，作用时间短恢复迅速。10分钟或30分钟的输注不会引起痛觉过敏。然而，各种剂量的瑞芬太尼120分钟组与对照组相比，甩尾潜伏期和终止输液后机械痛阈值均降低。但痛觉过敏持续时间不超过60分钟。与瑞芬太尼30分钟组（无痛觉过敏）相比，瑞芬太尼120分钟组（有痛觉过敏）脊髓背侧角神经元ERK1／2磷酸化明显增加，但U0126并不能抑制输注瑞芬太尼所导致的痛觉过敏。结论静脉输注瑞芬太尼可以引起短暂的药物撤退性痛觉过敏。这种痛觉过敏与瑞芬太尼持续输注的时间有关。与我们的假设相反，ERK1／2并不是51起痛觉过敏的一个必要因素。

关键词：静脉持续输注瑞芬太尼痛觉过敏 SD大鼠 ERK1 2 一过性相关性阿片受体激动剂

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静脉泵注瑞芬太尼对福尔马林致痛大鼠脊髓敏感化的影响

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中国疼痛医学杂志 2010年第5期16卷 280-284页

作者：邓立琴二階哲朗齐藤洋司桥本龍也滕部由贵子孟尽海宁夏医科大学附属医院麻醉科银川750004 日本岛根大学医学部麻醉科出云693-8501

目的：观察短期静脉泵注不同剂量瑞芬太尼后对福尔马林致痛大鼠行为学和脊髓后角c-Fos蛋白表达的影响。方法：选择体重250~300g,右侧颈内静脉置管后恢复良好的雄性SD大鼠18只,随机分为3组（n=6）：对照组（C组）、低剂量瑞芬太尼组（LR... 详细信息

目的：观察短期静脉泵注不同剂量瑞芬太尼后对福尔马林致痛大鼠行为学和脊髓后角c-Fos蛋白表达的影响。方法：选择体重250~300g,右侧颈内静脉置管后恢复良好的雄性SD大鼠18只,随机分为3组（n=6）：对照组（C组）、低剂量瑞芬太尼组（LR组）和高剂量瑞芬太尼组（HR组）。三组大鼠均在右侧跖底皮下注射5%福尔马林50μl,注射前5min LR组和HR组分别经右侧颈内静脉持续泵注瑞芬太尼5μg/kg/min、30μg/kg/min,对照组（C组）泵注生理盐水至注射后5min停止泵注。记录福尔马林注射后第一阶段（0~5min）和第二阶段（15~90min）内累计舔爪时间和注射后2h,L4~5脊髓后角Ⅰ-Ⅱ、Ⅲ-Ⅳ、Ⅴ-Ⅵ板层c-Fos蛋白表达阳性的神经细胞数量。结果：持续静脉泵注瑞芬太尼5μg/kg/min和30μg/kg/min均可完全抑制第一阶段疼痛行为,推迟第二阶段的疼痛行为开始和中止,HR组尤为显著（P〈0.01）,但第二阶段总的累计舔爪时间三组差异无统计学意义。三组脊髓c-Fos蛋白表达阳性的神经细胞数量差异也无统计学意义。结论：短期应用瑞芬太尼不加重福尔马林致痛大鼠的痛觉过敏。

关键词：瑞芬太尼福尔马林痛觉过敏 c-Fos

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Neoadjuvant Chemotherapy for Clinical Stage II and III Thoracic Esophageal Squamous Cell Carcinoma with Curative Esophagectomy

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Journal of Cancer Therapy 2015年第15期6卷 1207-1213页

作者： Masahide Ikeguchi Yusuke Kohno Kyoichi Kihara Kazunori Suzuki Kanenori Endo Seiichi Nakamura Takashi Sawada Tetsu Shimizu Tomoyuki Matsunaga yoji Fukumoto Hiroaki saito Tottori Prefectural Central Hospital Tottori Japan Department of Surgery Division of Surgical Oncology Faculty of Medicine Tottori University Tottori Japan

Esophageal squamous cell carcinoma (ESCC) is a gastrointestinal carcinoma with a poor prognosis. To improve the survival of patients with this disease, neoadjuvant chemotherapy (NAC) has been introduced. However, the survival benefits of NAC or the correlation between NAC and postoperative complications have not been well considered. In the present study, we retrospectively investigated the clinicopathological effectiveness of NAC in patients with clinical stage II and III thoracic ESCC. This retrospective study enrolled 63 patients with clinical stage II and III thoracic ESCC, who underwent resection of the thoracic esophagus and three-field lymph node dissection between January 2007 and December 2013. NAC with cisplatin plus 5-fluorouracil (5-FU) was introduced in 38 patients. NAC did not correlate with the occurrence of postoperative complications. The 5-year disease-free survival (DFS) rate of the 38 patients with NAC (41.6%) was similar to that for the 25 patients who did not receive NAC (38.1%;P = 0.784). However, we found that the DFS of 17 patients with histopathological Grade 2 and 3 tumors who received NAC (5-year DFS rate: 58.1%) was significantly higher than that of 21 patients with low histopathological grade tumors who received NAC (5-year DFS rate: 28.6%), or than that of the 25 patients who did not receive NAC (38.1%). Moreover, we found that the effectiveness of NAC assessed macroscopically did not correlate with the effectiveness of NAC assessed microscopically. These findings may indicate that preoperative estimation of NAC effectiveness is important in avoiding unnecessary adverse drug effects caused by NAC, and in prolonging the survival of patients with thoracic ESCC.

关键词： Esophageal Squamous Cell Carcinoma Histopathological Grade Neoadjuvant Chemotherapy Prognosis

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