CAJ | 학술논문

背景瘙痒是椎管内阿片类药物镇痛的常见并发症,其机制尚不完全清楚,阿片受体和非阿片受体都起到一定作用,中枢性μ阿片受体可能是其主要机制.椎管内阿片类药物所致的瘙痒常规抗组胺治疗无效,阿片受体拮抗药纳洛酮效果明确,但因逆转镇痛效果而限制了它的广泛应用.其他治疗药物如κ-阿片受体激动剂、5-羟色胺受体拮抗剂、多巴胺受体拮抗剂、丙泊酚及非甾体类抗炎药等可以不同程度地减轻阿片类药物引起的瘙痒,但其有效性存在争议. 目的探讨阿片类药物诱发瘙痒的可能机制,进一步研究和探索新的治疗方法. 内容就近年来阿片类药物诱发瘙痒的发生机制及目前存在的治疗方案进行综述. 趋向最近鉴别出的瘙痒特异性μ1D阿片受体(μ1D-opioid receptor,MOR1D)为椎管内阿片类物质所致瘙痒的治疗提供了新的思路.
배경 소양시추관내아편류약물진통적상견병발증,기궤제상불완전청초,아편수체화비아편수체도기도일정작용,중추성μ아편수체가능시기주요궤제.추관내아편류약물소치적소양상규항조알치료무효,아편수체길항약납락동효과명학,단인역전진통효과이한제료타적엄범응용.기타치료약물여κ-아편수체격동제、5-간색알수체길항제、다파알수체길항제、병박분급비치체류항염약등가이불동정도지감경아편류약물인기적소양,단기유효성존재쟁의. 목적 탐토아편류약물유발소양적가능궤제,진일보연구화탐색신적치료방법. 내용 취근년래아편류약물유발소양적발생궤제급목전존재적치료방안진행종술. 추향 최근감별출적소양특이성μ1D아편수체(μ1D-opioid receptor,MOR1D)위추관내아편류물질소치소양적치료제공료신적사로.
Background Pruritus is a common side-effect of intrathecal opiate analgesia and the pathogenesis of neuraxial opioid-induced pruritus is still unclear,which may be opioid receptor-induced or non-opioid receptor-induced,the central μ-opioid receptor may play the key role.The traditional antihistamines are ineffective for neuraxial opioid-induced pruritus.Opioid antagonists seem to be the most potent antipruritus drugs.Due to reversing analgesia,there are limitations for their wide use.Other drugs for itch such as κ-opioid receptor agonist,serotonin (5-HT3) receptor antagonist,dopamine (D2) receptor antagonist,propofol and nonsteroidal anti-inflammatory drugs have been tried.But their effectiveness is controversial.Objective To investigate the pathogenesis of neuraxial opioid-induced pruritus and to seek new treatments.Content This article reviewed literatures relating the mechanism and treatment of neuraxial opioid-induced pruritus.Trend Now the μ-opioid receptor isoform μ1D-opioid receptor (MOR1D) has been reported to be essential for morphine-induced itching,which offers the possibility to develop a novel therapeutic strategy to specifically attenuate itch without affecting the analgesic efficacy of opioids.