奥施康定联合塞来昔布治疗妇科恶性肿瘤中重度疼痛的疗效观察

目的:观察奥施康定联合塞来昔布治疗妇科恶性肿瘤中重度疼痛的临床疗效。方法:选取我院收治的79例妇科中重度癌痛患者作为研究对象，随机分为两组，对照组患者（n=33）在一般治疗的基础上加用奥施康定进行镇痛，观察组患者（n=46）在此基础上加用塞来昔布进行镇痛。统计分析两组患者镇痛效果、5-羟色胺（5-HT）、去甲肾上腺素（NE）水平及不良反应。结果:经过治疗后，观察组患者NRS评分低于对照组患者，观察组患者治疗有效缓解率高于对照组患者，观察组患者5-HT、NE水平均低于对照组患者，差异具有统计学意义（P<0.05）；观察组患者便秘发生率低于对照组患者，差异具有统计学意义（P<0.05）。结论:奥施康定联合塞来昔布治疗妇科恶性肿瘤中重度疼痛具有确切的效果，可降低单纯应用奥施康定的不良反应，值得临床推广。     

IL-17A stimulates the expression of inflammatory cytokines via celecoxib-blocked prostaglandin in MC3T3-E1 cells

Objective

The prostaglandins (PGs) released from osteoblasts can alter the process of bone remodelling. Recently, we showed that compressive force induced the expression of pro-inflammatory cytokine interleukin (IL)-17s and their receptors in osteoblastic MC3T3-E1 cells and that IL-17A was expressed most highly. Consequently, in the current study we examined the effect of IL-17A and/or celecoxib on PGE₂ production and the expression of cyclooxygenases (COXs) and inflammatory cytokines in MC3T3-E1 cells. We also examined the effects of PGE₂ and cyclohexamide on the expression of inflammatory cytokines.

Methods

Cells were cultured with or without IL-17A (0.1, 1.0, or 10 ng/ml) in the presence or absence of 10 μM celecoxib, a specific inhibitor of COX-2, for up to 72 h. Cells were pretreated with or without 10 μg/ml cycloheximide, protein synthesis inhibitor, for 30 min, and then cultured with 10 ng/ml IL-17A for 24 h. Cells were also cultured with or without 1.5 ng/ml PGE₂ for 24 h. PGE₂ production was determined by ELISA. The expression of COX-1, COX-2, IL-1α, IL-6, IL-8, IL-11, and TNF-α mRNAs and proteins was determined by real-time PCR and ELISA, respectively.

Results

The expression of COX-2, IL-1α, IL-6, IL-8, IL-11, and TNF-α, as well as PGE₂ production increased in the presence of IL-17A, whereas COX-1 expression did not change. Celecoxib blocked the stimulatory effect of IL-17A on the expression of COX-2, IL-1α, IL-6, IL-8, and IL-11 as well as PGE₂ production, whereas it did not block TNF-α expression. Cycloheximide pretreatment suppressed the expression of IL-17-induced inflammatory cytokines. The expression of IL-1α, IL-6, IL-8, and IL-11 increased by the addition of PGE₂, whereas TNF-α expression was not affected.

Conclusion

These results suggest that IL-17A stimulates the expression of bone resorption-related inflammatory cytokines through an autocrine mechanism involving celecoxib-blocked PGs, mainly PGE₂, in osteoblasts.     

帕瑞昔布联合塞来昔布在妇科腹腔镜手术围手术期的应用

目的：观察帕瑞昔布联合塞来昔布在妇科腹腔镜手术的镇痛效果和安全性,为临床术后镇痛提供参考。方法选择全麻下妇科腹腔镜手术患者158例,随机分为观察组与对照组,每组79例。观察组术前24小时给塞来昔布200 mg口服,术前12小时塞来昔布200 mg口服,切皮前30分钟给予帕瑞昔布40 mg静脉注射,手术结束前30分钟给予帕瑞昔布40 mg静脉注射,术后12小时帕瑞昔布40 mg静脉注射。对照组手术结束前30分钟给予帕瑞昔布40 mg静脉注射,术后12小时生理盐水2 mL静脉注射。两组术后若VAS评分>4分,则追加曲马多。记录两组患者术后清醒拔管1、4、8、12、24、48与72小时的VAS 评分与追加曲马多药物剂量,统计分析术后不良反应发生情况、术前术后焦虑抑郁评分及术后慢性疼痛发生情况。结果观察组各个时点的VAS评分均低于对照组,差异有统计学意义(P<0．05);观察组患者术后并发症较对照组少,差异有统计学意义(P<0．05);观察组术前术后焦虑抑郁评分差值与对照组比较,差异有统计学意义(P<0．05)。结论帕瑞昔布联合塞来昔布在妇科腹腔镜手术术后镇痛有明显效果,减少了术后镇痛药物并发症发生,降低了术后疼痛评分,减少了其他类镇痛药使用量,缓解了术后焦虑抑郁情绪,预防了患者术后慢性疼痛的发生。     

COX-2抑制剂联合高频电凝电切治疗Peutz-Jeghers综合征胃息肉的临床研究

目的：观察塞来昔布结合胃镜下息肉切除术治疗Peutz-Jeghers综合征胃息肉的效果。方法将42例Peutz-Jeghers综合征胃息肉患者随机分为塞来昔布联合胃镜治疗组和胃镜治疗组,每组21例。塞来昔布联合胃镜治疗组于胃镜下高频电凝、电切治疗后口服塞来昔布800 mg/d,疗程为12个月;胃镜治疗组行胃镜下高频电凝、电切息肉切除术,疗程为12个月。两组均每4个月复查胃镜1次,观察息肉的数目、病理类型。结果塞来昔布联合胃镜治疗组于治疗后4、8、12个月胃息肉消退率分别为94.5%、91.8%和89.8%,而胃镜治疗组分别为83.0%、63.7%和49.3%,两组比较差异有统计学意义（P＜0.01）。息肉的异型增生较单纯的电凝电切治疗后明显减少,差异有统计学意义（P＜0.05）。结论塞来昔布联合胃镜下高频电凝电切治疗Peutz-Jeghers综合征胃息肉效果肯定,且优于单纯胃镜下息肉切除的治疗方法。     

多模式镇痛在髋关节置换术后疼痛患者中的应用

目的：探讨多模式镇痛在髋关节置换术后疼痛患者中的应用效果。方法选择全髋关节置换术患者108例,采用随机数字表法随机分为对照组和观察组各54例。对照组患者于术后48 h内给予镇痛泵（ PCA）镇痛,术后48 h停用PCA,改为口服塞来昔布,200 mg／次,bid,口服至术后第6天;观察组患者在给予PCA镇痛基础上,于术后第6小时开始口服塞来昔布,200 mg／次,bid,口服至术后第6天。记录两组患者手术日、术后第1,3,6天髋部切口疼痛,采用数字疼痛分级法（ NRS）评估,比较两组镇痛效果。结果观察组手术日、术后第1,3,6天NRS评分分别为（4．4±1．8）,（4．4±1．5）,（3．5±1．3）,（2．0±1．6）分,均低于对照组,两组比较差异有统计学意义（t值分别为74．131,106．335,223．316,217．195;P＜0．01）。结论采用PCA联合塞来昔布行多模式镇痛可提高髋关节置换术后患者的镇痛效果。     

Potentially inappropriate concomitant medicine use with the selective COX-2 inhibitor celecoxib: Analysis and comparison of spontaneous adverse event reports from Australia,Canada and the USA.

Background: To perform an international comparison and analysis of celecoxib spontaneous adverse event reports (AERs) from Canada, Australia and the United States, focusing on gastrointestinal, renal and cardiovascular events. This study also examined concomitant medicines use which may have potentiated the risk of the reported adverse events.

Research, design and methods: Three databases were searched for spontaneous AERs associated with celecoxib, submitted within the past 10 years: Australian Therapeutic Goods Administration Database of Adverse Event Notifications; Canada Vigilance Adverse Reaction Online Database; and the United States Food and Drug Administration Adverse Event Reporting System Database. Analysis of the AERs focussed on the identification of gastrointestinal, cardiovascular and renal adverse events and concomitant medications suspected of potentiating adverse event risks.

Results: A total of 24,232 celecoxib AERs were identified. Gastrointestinal disorders were the most frequently reported adverse events at the system organ class (SOC) level in the AERs. A large number of AERs documented the use of potentially inappropriate concomitant medicines which may have increased the risk of the reported adverse events.

Conclusions: The large number of reports that involved a concomitant medicine that was in contravention with prescribing guidelines indicates an increased need for efforts to support the safe prescribing of celecoxib.