抗坏血酸在多种类型疼痛管理中的临床应用 进展

Progress on Clinical Applications of Ascorbic Acid in the Management of Various Types of Pain

摘要: 疼痛是围手术期及多种疾病患者常见且显著影响生活质量的重要症状。尽管非甾体抗炎药和阿片类药物在临床镇痛中应用广泛，但其不良反应及长期使用风险限制了疼痛管理的进一步优化。抗坏血酸(维生素C，VC)作为人体必需的水溶性维生素，除抗氧化作用外，近年来研究显示其在炎症调控、神经保护及疼痛调节方面具有潜在价值。本文综述了VC在疼痛管理中的镇痛机制及临床应用进展。现有研究表明，VC可通过清除活性氧、调节炎症反应、参与神经递质及肽类激素合成的酶促调控，以及影响神经传递和内源性阿片系统等多种途径发挥镇痛作用。在临床方面，VC在术后疼痛、复杂性区域疼痛综合征、神经病理性疼痛、炎性疼痛及癌性疼痛中显示出一定的镇痛或辅助镇痛效果。总体而言，VC安全性高、耐受性好，作为多模式镇痛的辅助措施具有一定应用前景，但其最佳给药方案仍需进一步研究明确。

Abstract: Pain is a common symptom during the perioperative period and in various clinical conditions, significantly affecting patients’ quality of life. Although nonsteroidal anti-inflammatory drugs and opioids are widely used for analgesia, their adverse effects and long-term safety concerns limit further optimization of pain management. Ascorbic acid (vitamin C, VC), an essential water-soluble vitamin, has traditionally been recognized for its antioxidant properties, while recent studies suggest potential roles in inflammation regulation, neuroprotection, and pain modulation. This review summarizes the analgesic mechanisms of VC and recent progress in its clinical application for pain management. Available evidence indicates that VC may exert analgesic effects through multiple pathways, including reduction of oxidative stress, modulation of inflammatory responses, enzymatic regulation of neurotransmitter and peptide hormone synthesis, and modulation of neurotransmission and endogenous opioid systems. Clinically, VC has shown analgesic or adjunctive analgesic effects in postoperative pain, complex regional pain syndrome, neuropathic pain, inflammatory pain, and cancer-related pain. Overall, VC appears to be a safe and well-tolerated adjunct in multimodal analgesia, although optimal dosing strategies require further investigation.