超音波刺激藥物經皮的滲透研究

Abstract

所謂藥物經皮吸收系統（trandermal therapeutic systems，TTS）是指在皮膚表面給藥，使藥物以恒定速度（或接近恒定速度）通過皮膚各層，進入體循環產生全身或局部治療作用的新方法。經皮給藥是除了口服給藥外最為大家所接受的給藥方式，到目前為止人體in vivo經皮超音波導入法的實驗並無法得到確切的數據，驗證有滲透效果。 局部麻醉藥具止痛效果，疼痛是一種個體的主觀體驗，它受文化水準，生活背景、注意力和其他心理學變量的影響。每一個人對於『疼痛』的感受皆不相同。現行疼痛的評估最常使用的為等級法、問卷及疼痛圖形，這些方式都屬於主觀體驗。本研究採取pretreatment超音波導入法，針對如何讓藥物透過皮膚角質層做各種研究，藉由各種儀器（如壓痛計、痛覺測試儀、神經傳導檢查及肌電圖量測儀NCV/EMG）量測各種訊號，希望能藉由超音波導入法降低EMLA的給藥時間，得到量化數據，在不傷害人體皮膚前提下，並探討影響超音波導入的因素及取得超音波導入藥物的人體模式，做一分析並得到不經傳統量測疼痛方式而取得相關神經電位振幅及latency變化來驗證是否有超音波增進導入的效果。 尤其是我們利用神經傳導檢查及肌電圖量測儀NCV/EMG，感覺神經傳導檢查主要用於周邊神經病變鑑別診斷，利用感覺神經傳導檢查，完全由機器觸發電流，減少人為因素干擾，用電位訊號振幅變化大小或神經傳導速度的快慢變化，來驗證神經是否有麻醉藥物導入，去證明超音波是否能加速麻醉藥物導入，可避免疼痛量測時主觀意識所造成的誤差，並取得客觀科學數據，提供感覺神經傳導檢查在疼痛的評估另一個思考方向，也可以驗證超音波增進導入的效果。

There are numerous passive and active methods of administering drugs to the body. Active methods include the use of penetration enhancers and assisted drug delivery and One of them is sonophoresis (phonophoresis). Topical anesthetics can be used to reduce the local pain and the distress caused by venipuncture, injections, lumbar punctures, arterial blood gases, and other cutaneous procedures. About this treatment, Not only adults but also children dislike it. However, these agents（EMLA） require at least ¬60 minutes to achieve acceptable anesthesia. Application of brief 1 M Hz frequency ultrasound (Ultrasonic Skin Firmer KUM-2000 pulse wave Duty cycle 5：5 Intensity 1.5 W/cm2 90％ 5 minute) has been shown to de¬crease the time to onset of EMLA analgesia in healthy controls from 60 minutes to 20-30 minutes. （EMLA , Eutectic Mixture of Local Anesthetics , Lidocaine 2.5% & Prilocaine 2.5%） Traditionally , the measurement of the pain has been subjective, Hence we are trying to find more efficient ways,so we use NCV（Nerve Conduction Velocity）in sonophoresis to achieve the goal. One of the NCV, sensory nerve conduction studies, could record the surface electrodes are used to record action potentials whose amplitude is only a few tens of microvolts and nerve conduction velocity variability.（Comparison of the latencies of responses evoked by stimuli at different places along the nerve allows the conduction velocity of the fastest sensory fibres to be determined.） The objective of this study was to demonstrate that ultrasound treatment followed by brief application of topical anesthetic decreases the perception of the patients’ pain caused by the treatment of IV cannulation. We utilize the method of NCV to measure variability of the latency. We get a real biological signal which is not a pain score.It can avoid getting as subjective data as possible.To use pretreatment with ultrasound to the skin increases permeation rates of hydrophobic topical medications, including topical EMLA.