骨科创伤患者超前镇痛对术后睡眠状况的效果观察与护理

目的：研究骨科创伤患者术前使用洛索洛芬钠对术后睡眠的影响。方法将86例骨科创伤患者随机分成观察组（45例）和对照组（41例）,观察组术前采用在常规护理干预的基础上使用洛索洛芬钠止痛,对照组术前采用常规护理干预方法止痛,分别观察两组术后睡眠的状况。结果观察组术后疼痛值明显低于对照组,两组比较差异有统计学意义（ P＜0．05）。观察组术后3 d平均睡眠状况明显好于对照组,两组比较差异有统计学意义（ P＜0．05）。结论术前使用洛索洛芬钠的患者术后疼痛值降低,术后睡眠状况良好。     

曲马多缓释片联合洛索洛芬对腰椎间盘突出症患者术后疼痛及凝血功能的影响

目的：探讨洛索洛芬与曲马多缓释片配合治疗对腰椎间盘突出症患者术后疼痛及凝血功能的影响。方法：回顾性分析2017年6月~2019年6月收治的100例腰椎间盘突出症患者的临床资料,根据治疗方式的不同分为对照组和观察组,各50例。对照组给予洛索洛芬治疗,观察组给予曲马多缓释片联合洛索洛芬治疗,对比两组患者术后疼痛程度、凝血功能及不良反应发生情况。结果：观察组术后2 h、4 h、6 h及12 h时疼痛评分分别为（1.49±0.12）分、（2.11±0.41）分、（2.24±0.36）分、（2.52±0.15）分,均低于对照组的（2.22±0.50）分、（3.51±0.82）分、（4.46±0.77）分、（4.69±0.38）分,差异有统计学意义（P＜0.05）;观察组术后纤维化蛋白原（3.07±0.52） g/L、凝血酶原时间（11.89±0.63） s、活化部分凝血活酶时间（31.56±7.13） s,均低于对照组的（3.39±0.77） g/L、（13.13±0.87） s、（36.12±8.66） s,差异有统计学意义（P＜0.05）;观察组不良反应发生率12.00%（6/50）略高于对照组的8.00%（4/50）,但差异无统计学意义（P＞0.05）。结论：曲马多缓释片与洛索洛芬联合治疗腰椎间盘突出症患者,可促进患者疼痛程度与凝血功能的改善,且不增加不良反应的发生,具有较高的安全性。     

洛索洛芬钠片辅助治疗骨关节炎的疗效及不良反应

目的探讨洛索洛芬钠片辅助治疗骨关节炎的效果及不良反应。方法选择2018年1月至2020年1月郑州市骨科医院收治的150例确诊为骨关节炎的患者作为观察对象,根据治疗方式不同分为观察组和对照组,每组75例。对照组基于玻璃酸钠注射液治疗,每周行关节腔内注射25 mg,5次为1疗程,共治疗2个疗程。观察组在此基础上联合洛索洛芬钠片,每次60 mg,每天3次,持续治疗10周。比较治疗前后两组患者关节滑液肿瘤坏死因子、细胞白介素水平;患者疼痛程度、膝关节功能以及不良反应情况。结果观察组治疗有效率为97.33%(73/75),对照组为84.00%(63/75),差异有统计学意义(P<0.05)。治疗前,两组之间的VAS和WOMAC评分比较差异未见统计学意义(P>0.05)。治疗后观察组膝关节疼痛和疼痛的改善优于对照组(P<0.05)。治疗前两组患者的白细胞介素-1β(IL-1β),白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平比较差异未见统计学意义(P>0.05),治疗后观察组上述炎性因子水平低于对照组(P<0.05)。观察组不良反应发生率为2.67%(2/75),低于对照组(12%,9/75),差异有统计学意义(P<0.05)。结论洛索洛芬钠片能有效患者患者疼痛和膝关节症状,提高患者治疗效果且疗效确切,值得借鉴。     

洛索洛芬与罗非昔布对照治疗膝骨关节炎57例

57例膝骨关节炎患者分为洛索洛芬组26例与罗非昔布组31例。洛索洛芬组男6例,女20例;年龄20～74岁,平均55岁;病程2个月～20年,平均2年。罗非昔布组男5例,女26例;年龄32～76岁,平均55岁;病程2个月～20年,平均3年。两组的年龄、病程有可比性。正在使用其他非甾体消炎药或肾上腺皮质激素类药的患者,停药1周后才进入实验。治疗方法:洛索洛芬组予洛索洛芬60mg,餐后口服,每日3次;罗非昔布组予罗非昔布25mg,餐后口服,每日1次。疗程均为4周。期间不使用其他非甾体消炎药。疗效评定:对治疗前、后患者的症状和体征进行评分,指标包括休息时疼痛、活动时…     

盐酸氨基葡萄糖治疗腰椎关节突关节骨性关节炎的临床观察

目的观察盐酸氨基葡萄糖治疗腰椎关节突关节骨性关节炎（lumbar zygapophyseal jointosteoarthritis,LZOA）的临床疗效及安全性。方法 2009年1月2010年1月,对90例LZOA患者随机分成治疗组和对照组,各45例。治疗组口服盐酸氨基葡萄糖,6周为1个疗程,治疗3个疗程,前2周均加用洛索洛芬钠;对照组患者仅给予洛索洛芬钠口服12周。比较两组治疗后2、6周及3、6、12个月的疗效及安全性。结果治疗后6周、3个月,治疗组与对照组症状均明显改善,对照组改善更明显。治疗6个月后,治疗组评分持续下降,到12个月时与治疗前比较差异有统计学意义（P〈0.01）;而对照组评分则逐渐增高,到12个月时与其治疗前比较差异无统计学意义（P〉0.05）。两组的不良反应率分别为6.67%、15.56%,差异有统计学意义（P〈0.01）。结论盐酸氨基葡萄糖治疗LZOA疗效确切,且安全性良好。     

牛痘疫苗接种家兔炎症皮肤提取物治疗急性腰椎间盘突出症的临床观察

<正>2010年3月至2011年3月,我们分别对包头市第四医院骨科诊治68例急性腰椎间盘突出症的患者进行了临床治疗观察。其中36例采用了牛痘疫苗接种家兔炎症皮肤提取物(神经妥乐平),同时腰部微波+干扰电治疗,另32例采用了甘露醇+地塞米松后给洛索洛芬钠口服,同时腰部微波+干扰电治疗,现将观察结果报告如下。     

帕瑞昔布序贯洛索洛芬钠治疗截肢术后疼痛的临床研究

截肢术后疼痛是残端术后常见的并发症之一,如果不在初始阶段对疼痛进行有效控制,可引起中枢神经系统发生病理性重构,急性疼痛极有可能发展为难以控制的慢性疼痛,不仅给患者带来痛苦,还带来严重的心理及生理创伤,增加并发症的发生率。目前处理截肢术后疼痛的治疗方案很多,2009年6月至2011年1月,我们采用瑞帕昔布和洛索洛芬钠治疗残端疼痛62例,效果满意,报道如下。     

帕瑞昔布钠对老年骨科手术患者术后早期认知功能的影响

目的：探讨帕瑞昔布钠对老年骨科手术患者术后早期认知功能的影响。方法：将60例择期行骨科手术的老年患者,随机分为帕瑞昔布钠组（P组,n=30）和对照组（C组,n=30）。分别于麻醉诱导前30 min及术后6 h,P组静脉注射帕瑞昔布钠40 mg,C组静脉注射等容量0.9%氯化钠液。术后均采用患者静脉自控镇痛（patient controlled intravenous analgesia,PCIA）,镇痛泵内药物为0.001%芬太尼和托烷司琼5 mg,背景剂量为2 mL/h,按压给药量为2 mL/次,锁定时间为15 min,术后48 h停用PCIA泵。记录患者年龄、性别、体质量、受教育年限、手术时间、失血量和认知功能障碍的发生率。于术后24 h、48 h采用视觉模拟评分法（visual analogue scale,VAS）评估疼痛程度;测定患者术前、术后1 d、3 d、7 d的简易精神状态量表（minimental state examination,MMSE）评分。结果：P组和C组分别有6例、7例出现术后认知功能障碍（postoperative cognitive dysfunction,POCD）,发生率分别为20%和23.3%（P〉0.05）。两组患者术前MMSE评分差异无统计学意义,术后1 d、3 d、7d MMSE评分差异无统计学意义。结论：帕瑞昔布钠未能降低老年骨科手术患者术后早期POCD的发生率。     

当归四逆汤联合甲氨蝶呤 洛索洛芬钠治疗类风湿关节炎疗效分析

目的探讨当归四逆汤联合甲氨蝶呤、洛索洛芬钠治疗类风湿关节炎患者的临床效果.方法将243例娄风湿关节炎患者按简单随机化分组法分为3组,每组81例,西药组口服甲氨蝶呤、洛索洛芬钠治疗,中药组口服当归四逆汤治疗,联合组予以当归四逆汤联合甲氨蝶呤及洛索洛芬钠治疗,观察1个月.比较3组治疗1个月后总有效率,曼彻斯特大学骨性关节炎指数评分、中医症候积分、实验室指标(血沉、C反应蛋白、娄风湿因子、抗环瓜氨酸肽抗体)、Wnt/β-catenin信号通路(Wnt3α、β-catenin)表达水平及不良反应发生率.结果(1)联合组治疗1个月后总有效率(90.1%)显著高于西药组(75.3%)、中药组(72.8%)(P<0.05),西药组与中药组比较差异无统计学意义(P>0.05);(2)联合组治疗1个月后曼彻斯特大学骨性关节炎指数评分、中医症候积分显著低于西药组、中药组(P<0.01),西药组与中药组比较差异均无统计学意义(P>0.05)(3);联合组治疗1个月后血沉、C反应蛋白、类风湿因子、抗环瓜氨酸肽抗体水平及Wnt3α、β-catenin表达水平均显著低于西药组、中药组(P<0.01),西药组与中药组各项指标比较差异均无统计学意义(P>0.05);(4)联合组、中药组不良反应发生率(2.5%、1.2%)显著低于西药组(13.6%)(P<0.01),中药组、联合组不良反应发生率比较差异无统计学意义(P>0.05).结论当归四逆汤联合甲氨蝶呤及洛索洛芬钠治疗类风湿关节炎患者具有协同增效作用,能有效改善患者疼痛、晨僵等临床症状,缓解炎症反应,控制患者病情,且安全性高.     

独活寄生汤结合康复训练治疗腰椎间盘突出症患者的效果观察

目的探讨独活寄生汤结合康复训练对腰椎间盘突出症患者的治疗效果。方法选取90例腰椎间盘突出症患者,随机分为对照组(采用洛索洛芬钠分散片联合常规干预治疗)与观察组(采用独活寄生汤结合康复训练治疗),每组45例。比较2组患者治疗前后疼痛程度、腰椎功能。结果 2组治疗后中医症候评分、视觉模拟评分量表(VAS)评分均较治疗前降低,日本骨科协会评估治疗(JOA评分)较治疗前升高,且观察组上述评分结果均优于对照组,差异有统计学意义(P 0. 05)。2组未出现肝肾异常、出血事件,对照组不良反应发生率为15. 56%,显著高于观察组的2. 22%(P 0. 05)。结论独活寄生汤结合康复训练可提高腰椎间盘突出症患者的腰椎功能,减轻腰腿疼痛程度。     

Potential cardiovascular effects of COX-2 selective nonsteroidal antiinflammatory drugs

The newly developed nonsteroidal antiinflammatory drugs (NSAIDs) that selectively inhibit cyclooxygenase-2 (COX-2), are effective against pain and inflammation and appear to have less gastrointestinal toxicity than conventional NSAIDs. Their COX-2 selectivity, however, has raised concerns regarding their cardiovascular safety, since they do not inhibit COX-1, the isoform of the enzyme that is active in thrombosis and vasoconstriction. At this point there is no conclusive evidence that COX-2 inhibitors cause ischemic vascular events, because retrospective post hoc analyses conflict one another, and no specific randomized trials have yet been done. Renal effects, edema and hypertension appear to be similar between conventional NSAIDs and COX-2-selective inhibitors. Aspirin is still required for patients with cardiovascular risk who are prescribed a COX-2-selective inhibitor.     

Potential Cardiovascular Effects of COX-2 Selective Nonsteroidal Antiinflammatory Drugs

The newly developed nonsteroidal antiinflammatory drugs (NSAIDs) that selectively inhibit cyclooxygenase-2 (COX-2), are effective against pain and inflammation and appear to have less gastrointestinal toxicity than conventional NSAIDs. Their COX-2 selectivity, however, has raised concerns regarding their cardiovascular safety, since they do not inhibit COX-1, the isoform of the enzyme that is active in thrombosis and vasoconstriction. At this point there is no conclusive evidence that COX-2 inhibitors cause ischemic vascular events, because retrospective post hoc analyses conflict one another, and no specific randomized trials have yet been done. Renal effects, edema and hypertension appear to be similar between conventional NSAIDs and COX-2-selective inhibitors. Aspirin is still required for patients with cardiovascular risk who are prescribed a COX-2-selective inhibitor.     

Cyclooxygenase-2-selective inhibitors in the management of acute and perioperative pain

Postsurgical pain is often undertreated. Opioids are frequently used in perioperative analgesia, but concern about side effects can result in administration of an inadequate dose for pain relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used increasingly for postoperative analgesia. The use of balanced analgesia-a combination of opioids, NSAIDs, and local anesthesia utilizing agents from other classes (eg, ketamine, clonidine)-improves the efficacy of pain relief and decreases risk of side effects. While lacking some of the troublesome side effects of opioids, nonselective NSAIDs may cause bleeding as a result of their inhibitory effects on COX-1. For this reason, COX-2-selective inhibitors (coxibs) are attractive opioid-sparing analgesic options in the perioperative setting. Factors in addition to side effects such as time to onset of action, duration of action, maximum pain relief, use of rescue medication, and other factors relevant to a given pain model are important in determining overall analgesic efficacy. Clinical studies show that COX-2-selective inhibitors are effective for the treatment of preoperative and postoperative pain and reduce postsurgical requirements for opioids. This evidence supports a role for COX-2-derived prostaglandins as key mediators of nociceptive pain and peripheral sensitization (hyperalgesia). Pain management in the perioperative setting and the role of COX-2-selective inhibitors in acute and postoperative pain are reviewed here.     

Incremental cost-effectiveness of cyclooxygenase 2-selective versus nonselective nonsteroidal anti-inflammatory drugs in a cohort of coumarin users: a pharmacoeconomic analysis linked to a case-control study

BACKGROUND: A previous case-control study involving concomitant users of coumarin and nonsteroidal anti-inflammatory drugs (NSAIDs) found that cyclooxygenase 2 (COX-2)-selective NSAIDs were associated with fewer bleeding complications than nonselective NSAIDs. OBJECTIVE: The goal of this study was to determine the incremental cost-effectiveness of COX-2-selective versus nonselective NSAIDs in relation to the occurrence of bleeding complications in a cohort of concomitant coumarin users. METHODS: The pharmacoeconomic evaluation was linked to a case-control analysis (patients with and without bleeding complications) based on data from the earlier study in users of concomitant coumarin and NSAIDs. Medical costs associated with NSAID use and bleeding complications were estimated according to Dutch guidelines for pharmacoeconomic analyses, based on Dutch drug prices and national averages for health care costs. Rofecoxib, meloxicam, and nabumetone were considered COX-2 selective. Total costs were calculated and compared for 2 hypothetical scenarios in which patients used either COX-2-selective or nonselective NSAIDs. Sensitivity analyses were performed in which both the odds ratios (ORs) and the costs of NSAIDs and bleeding episodes were varied. RESULTS: A total of 1,491 bleeding complications occurred in 4400 coumarin users: among the 221 (15%) NSAID users with a bleeding episode, 96% used a nonselective NSAID and 4% used a COX-2-selective NSAID. The adjusted OR of a bleeding episode for nonselective compared with COX-2-selective NSAIDs was 3.07 (95% CI, 1.18-8.03). The estimated mean cost of a bleeding episode was 478 per patient. Factoring in the excess cost of a COX-2-selective NSAID compared with a nonselective NSAID, as well as the cost savings in averted bleeding episodes, it was determined that there would be net medical cost savings of 53,800 and 162 averted bleeding episodes if the entire patient group received COX-2-selective NSAIDs rather than nonselective NSAIDs. The sensitivity analysis showed these results to be robust. CONCLUSION: In this study population of concomitant coumarin and NSAID users, the reduction in bleeding complications with the use of more expensive COX-2-selective inhibitors was associated with net medical cost savings compared with nonselective NSAIDs.     

Cyclooxygenase-2 enzyme inhibitors: place in therapy

Nonsteroidal anti-inflammatory drugs (NSAIDs) play a major role in the management of inflammation and pain caused by arthritis. A new class of NSAIDs that selectively inhibit the cyclooxygenase-2 (COX-2) enzyme has been developed. The first COX-2 inhibitors, celecoxib and rofecoxib, are said to provide therapeutic benefit with less toxicity than traditional NSAIDs. A third COX-2-selective inhibitor, meloxicam, has recently been introduced. COX-2 inhibitors and traditional NSAIDs do not appear to differ significantly in their effectiveness in alleviating pain or inflammation. They have similar gastrointestinal side effects, including abdominal pain, dyspepsia and diarrhea. However, short-term studies show fewer gastrointestinal ulcers in patients treated with COX-2 inhibitors compared with traditional NSAIDs.     

Rofecoxib: clinical pharmacology and clinical experience

BACKGROUND: Rofecoxib is a member of a subgroup of nonsteroidal anti-inflammatory drugs (NSAIDs) known as cyclooxygenase-2 (COX-2)-selective inhibitors. It has been studied in adult and elderly patients in a number of painful conditions (primary dysmenorrhea, acute pain after dental and orthopedic surgery, osteoarthritis [OA], and rheumatoid arthritis). OBJECTIVE: This review discusses the clinical pharmacology of and clinical experience with rofecoxib, and the role of COX-2-selective inhibitors in clinical practice. METHODS: Pertinent studies were identified through searches of MEDLINE and EMBASE, as well as the Web sites and proceedings of relevant scientific meetings. RESULTS: Although the published literature is limited, the data indicate that rofecoxib is an effective analgesic agent for the painful conditions in which it has been studied. As a COX-2-selective inhibitor, rofecoxib offers safety advantages over traditional NSAIDs. In clinical trials, gastrointestinal (GI) toxicity, including mucosal damage, perforation, ulcers, and bleeding, occurred significantly less often in healthy volunteers and patients treated with rofecoxib than in those who received NSAIDs such as ibuprofen, naproxen, or diclofenac (all comparisons, P < 0.001). In terms of renal toxicity, rofecoxib does not appear to offer a safety advantage over traditional NSAIDs. Rofecoxib has not been shown to affect platelets (bleeding time and platelet aggregation), unlike traditional NSAIDs. CONCLUSIONS: Rofecoxib is an appropriate choice for patients who do not obtain adequate analgesia with acetaminophen and those who have not obtained adequate analgesia from, cannot tolerate, or are at risk for GI toxicity with traditional NSAIDs. Patients who require chronic analgesic medication (ie, those with OA), including those who take other medications daily for comorbid conditions, may also benefit from the once-daily dosing regimen of rofecoxib.     

Development and clinical application of COX-2-selective inhibitors for the treatment of osteoarthritis and rheumatoid arthritis

Osteoarthritis (OA) and rheumatoid arthritis (RA) are among the most prevalent chronic illnesses and leading causes of disability in the United States. The clinical symptoms of OA and RA, pain and inflammation, are biologic processes mediated in part by prostanoids-prostaglandins, prostacyclin, and thromboxanes. The intermediate enzymes responsible for prostaglandin biosynthesis, cyclooxygenase (COX)-1 and COX-2, have been the target of arthritis therapy using nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). An understanding of the biochemistry and molecular pharmacology of COX enzymes has allowed for the development of agents that specifically inhibit COX-2. COX-2-selective inhibitors have efficacy in OA and RA that is similar to that of NSAIDs but with a lower potential for upper gastrointestinal injury, a serious side effect of nonselective NSAIDs. COX-2-selective inhibitors have been increasingly used in the treatment of OA and RA as well as other inflammatory arthropathies including ankylosing spondylitis and gout. Clinical trials with two currently available drugs, rofecoxib and celecoxib, have demonstrated efficacy comparable to nonselective NSAIDs but with a lower risk of gastrointestinal side effects. In general, these drugs are well tolerated in patients with aspirin-sensitive asthma. Rofecoxib is well tolerated in patients with sulfonamide sensitivities; further studies are needed to fully characterize the utility of celecoxib in these patients. Clinical experience shows that because of their improved GI safety, rofecoxib and celecoxib, and newer COX-2-selective inhibitors (valdecoxib, etoricoxib, parecoxib), represent a significant advance in the treatment of arthritis and other related inflammatory conditions.     

The prevalence of cardiorenal risk factors in patients prescribed nonsteroidal anti-inflammatory drugs: data from managed care

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to cause abnormalities in renal function. This is an important concern in patients with cardiorenal risk factors, including hypertension, congestive heart failure, edema, renal impairment, and advanced age. OBJECTIVES: The goals of this study were to determine the prevalence of cardiorenal risk factors in patients with rheumatoid arthritis (RA) or osteoarthritis and ascertain whether these risk factors are associated with prescribing patterns of cyclooxygenase (COX)-2-selective inhibitors and other NSAIDs. METHODS: This was a retrospective, longitudinal claims analysis using data from 19 large independent-practice-model managed care health plans in the United Stated. Three cohorts were identified based on claims for celecoxib, rofecoxib, or other NSAIDs from October 1, 1999, through September 30, 2000. Logistic regression models were used to explore whether baseline cardiorenal risk factors were related to choice of therapy. RESULTS: A total of 77,552 patients received celecoxib (n = 6779 [8.74%]), rofecoxib (n = 7189 [9.27%]), or other NSAIDs (n = 63,584 [81.99%]). Patients prescribed COX-2-selective inhibitors were older than those receiving other NSAIDs and had a diagnosis of RA more often. Overall, 42% of patients had >or=1 cardiorenal risk factor, and approximately one third had hypertension. Cardiorenal risk factors were not related to physicians' prescribing of celecoxib or rofecoxib, but the presence of any cardiorenal risk factor was associated with an increase in the use of COX-2-selective inhibitors compared with other NSAIDs, from 12% for cerebrovascular disease (point estimate, 1.124; P<0.001) to 74% for chronic renal failure/nephritis (point estimate, 1.738; P=0.025). RA and advanced age were associated with the use of celecoxib rather than rofecoxib. CONCLUSIONS: The prevalence of cardiorenal risk factors was found to be similar in patients prescribed celecoxib or rofecoxib for arthritis. Patients with these risk factors were more likely to receive a COX-2-selective inhibitor than other NSAIDs.