Tamsen Anders, Sakurada Tsukasa, Wahlström Agneta, Terenius Lars, Hartvig Per
Department of Anaesthesiology, University Hospital, S-750 14 Uppsala 14, Sweden Department of Pharmaceutical Pharmacology, Uppsala University, Sweden Hospital Pharmacy, University Hospital, Uppsala Sweden.
Pain. 1982 Jun;13(2):171-183. doi: 10.1016/0304-3959(82)90027-6.
Fourteen adult patients were allowed to self-administer small intravenous doses of pethidine to relieve postoperative pain. Thirteen of the patients obtained subjectively satisfactory analgesia while establishing steady-state levels of pethidine in plasma. The individual demand for pethidine was related to individual levels of fraction I endorphins and substance P-like immunoreactivity in the cerebrospinal fluid (CSF). There was a significant and inverse relationship between preoperative fraction I concentrations in CSF and the individual mean pethidine concentrations in plasma (P less than 0.05) and CSF (P less than 0.02) during self-administration. In the 24 h period encompassing surgery and postoperative self-administered analgesia, substance P decreased in 7 patients with calculated CSF pethidine great than 200 ng/ml, but remained virtually unchanged in 7 patients with calculated CSF pethidine less than 200 ng/ml. The results suggest a role for endorphins in the modulation of acute pain and are compatible with experimental evidence for an inhibitory effect of opiates on substance P release.
14名成年患者被允许自行静脉注射小剂量哌替啶以缓解术后疼痛。13名患者在血浆中建立了稳定水平的哌替啶时，主观上获得了满意的镇痛效果。个体对哌替啶的需求与脑脊液（CSF）中I组分内啡肽和P物质样免疫反应性的个体水平相关。术前脑脊液中I组分浓度与自我给药期间血浆（P<0.05）和脑脊液（P<0.02）中的个体平均哌替啶浓度之间存在显著的负相关。在包括手术和术后自我给药镇痛的24小时期间，7例计算脑脊液哌替啶大于200 ng/ml的患者中P物质减少，但7例计算脑脊液哌替啶小于200 ng/ml的患者中P物质几乎保持不变。结果表明内啡肽在急性疼痛调节中起作用，并且与阿片类药物对P物质释放的抑制作用的实验证据相符。
