硫酸吗啡控释片口服与直肠给药控制癌痛疗效观察

目的 观察硫酸吗啡控释片口服给药和直肠给药对重度癌性疼痛的止痛效果.方法 采用交叉研究的方法,将100例重度癌性疼痛患者随机分为A、B两组.A组先口服给药后直肠给药,B组先直肠给药后口服给药,各用5天,剂量为30mg每12h.结果 口服给药患者的总有效率90%,直肠给药患者的总有效率87%,止痛效果明确,但两者之间无显著性差异(P＞0.05).两组给药方法的不良反应相同,主要为头昏、嗜睡、恶心呕吐、腹胀、便秘、排尿困难.口服给药总的不良反应发生率为74%,直肠给药总的不良反应发生率为45%,两者之间有显著性差异(P＜0.05).结论 硫酸吗啡控释片经直肠给药对重度癌性疼痛的止痛效果与口服相近,不良反应少,适用于口服不良反应多和不能口服的患者.     

硫酸吗啡控释片在控制癌性疼痛中的应用

目的:观察硫酸吗啡控释片对于晚期癌症患者癌性镇痛的作用。方法:给予患者口服硫酸吗啡控释片10～60mg,每12小时1次。结果:镇痛有效率达100％,其中,有效例数46例(占92.0％),好转例数4例(占8.0％)结论:患者口服硫酸吗啡控释片可使癌性疼痛得到有效控制,但需掌握正确的给药方法和药物剂量,密切观察镇痛效果,加强对副反应的预防,重视心理护理。     

吗啡控释剂口服和经直肠途径治疗癌痛的疗效分析

目的：比较口服、经直肠两种给药途径使用硫酸吗啡控释片治疗癌痛的疗效和不良反应。方法：将中重度癌痛患者81例随机分为A组41例口服给药,B组40例经直肠给药,比较两组的止痛效果和不良反应发生率。结果：A组和B组的疼痛缓解率分别为90.2%（37/41）和92.5%（37/40）,结果差异无统计学意义（P〉0.05）;不良反应发生率除呼吸抑制外,其余不良反应发生率均有差异,且差异有统计学意义（P〈0.05）。结论：口服硫酸吗啡控释片和直肠使用吗啡控释剂的止痛疗效相近;但后者的不良反应发生率明显低于前者。     

硫酸吗啡控释片直肠给药治疗癌性疼痛临床观察

目的:观察硫酸吗啡控释片(美施康定)直肠给药治疗癌性疼痛的疗效、生活质量与毒副反应。方法:对入选的41例恶心、呕吐、梗阻、吞咽困难的癌痛患者予美施康定直肠给药每12h一次,对照组32例予美施康定口服给药每12h一次。结果:直肠给药组止痛总有效率97.56％,毒副反应发生率19.52％,Karnofsky评分由(45.24±8.21)提高到(66.22±11.6);口服治疗组止痛总有效率96.87％,毒副反应发生率56.24％,Karnofsky评分由(47.81±12.11)提高到(66.72±10.36)。两组在疗效及生活质量上无明显差异(P>0.05),毒副反应发生率有明显差异(P<0.01)。结论:美施康定直肠给药治疗癌性疼痛疗效肯定,毒副反应较轻,适用于无法口服治疗的病人。     

硫酸吗啡控释片治疗癌性疼痛的研究

目的研究硫酸吗啡控释片治疗中重度癌性疼痛的疗效,探讨使用硫酸吗啡控释片的最佳途径。方法2002年9月～2003年8月住院及门诊的晚期癌症患者128例服用硫酸吗啡控释片(MST)初始剂量10mg～30mg．若疼痛无缓解即进行剂量滴定。临床观察指标为疼痛的缓解度,疼痛的缓解率,药物的成瘾性,不良反应等。结果疼痛缓解率为98．4％,对不同类型疼痛均有良好疗效。128例患者中有94例中止治疗。硫酸吗啡控释片的不良反应轻微,无患者出现成瘾现象。结论①硫酸吗啡控释片用于中重度癌痛止痛效果肯定,是治疗中重度癌痛的首选药物。②硫酸吗啡控释片用于中重度癌痛止痛的个体化剂量差异很大,用于治疗时无标准剂量,能够有效止痛的剂量即为合适荆量。③严格科学的剂量滴定是成功控制癌痛的关键。④硫酸吗啡控释片的安全性良好．长期应用来出现身体依赖或成瘾性。     

硫酸吗啡控释片治疗癌性疼痛30例

目的：寻求治疗中、重度癌性疼痛的有效药物和给药方法,达到最佳镇痛效果。方法;30例中晚期癌症患者,口服硫酸吗啡控释片,初始剂量60mg,分30mg,q12h,以后根据镇痛效果调整剂量,直至最适剂量。结果：30例具有中、重度疼痛的中晚期癌症患者口服硫酸吗啡控释片后,疼痛完全缓解率70．0％（21／30）,中度缓解率26．7％（8／30）,总有效率96．7％。结论：硫酸吗啡控释片治疗癌性疼痛疗效确切可靠,30mg每12小时给药一次是一种安全有效的镇痛方法。     

硫酸吗啡控释片治疗临终关怀病人癌性疼痛的合理应用分析

目的：分析硫酸吗啡控释片治疗临终关怀病人癌性疼痛的合理应用。方法选取我院2014年1月至2016年1月的60例中晚期癌痛患者分为两组,研究组使用硫酸吗啡控释片治疗,治疗前期应用剂量为1日20～60mg,之后根据患者的疼痛情况进行计量调整,对照组使用盐酸羟考酮,记录两组的疼痛缓释情况和不良反应发生率。结果研究组治疗后疼痛缓释率达到了93．33％,其中显效为26．67％、有效为66．67％,仅有2例（6．67％）无效,2例不良反应,分别为便秘、恶心,总发生率为6．67％;对照组的疼痛缓释率为80．00％,5例（16．67％）不良反应,两组差异具有统计学意义,P＜0．05。结论硫酸吗啡控释片用于临终关怀癌痛病人上可以更有效的缓解病人的疼痛,提高患者的生活质量,不良反应低,值得在临床上应用于中晚期癌痛患者的临终关怀上。     

硫酸吗啡控释片肛门用药治疗癌痛20例报告

目的：为了寻求有效的止痛方法,以控制一些不能口服硫酸吗啡控释片的癌症的癌痛。方法：肛门使用硫酸吗啡控释片治疗２０例重度以上癌痛且伴有不完全性肠梗阻的癌症崆春疗效。结果：镇痛显著有效率为７０％,生活质量有明显改善。结论：对不适于口服硫酸呈啡控释片且有重度以上疼痛的癌症患者可采用肛门用硫酸吗啡控释片。     

吗啡控释片治疗癌性疼痛的疗效和安全性评价

目的：通过Meta分析,评估吗啡控释片直肠给药在癌性疼痛治疗中的临床应用价值。方法：检索中国生物医学文献库（CBMdisc）、中国期刊全文数据库、维普数据库（VIP）等国内数据库已发表的相关文献,收集国内有关吗啡控释片直肠给药治疗癌性疼痛的临床随机、对照试验（randomized controlled trials,RCT）,由2位评价者分别按检索策略收集并纳入标准入选资料,分析指标为疼痛缓解率和不良反应发生率。结果：8个研究共598例患者纳入分析,吗啡控释片直肠给药和口服给药的疼痛缓解率分别是83.69%和87.97%（P=0.09）;在不良反应方面,吗啡控释片直肠给药导致便秘的发生率降低了15%（P〈0.000 1）,消化道反应的发生率降低了21%（P〈0.000 1）,嗜睡头晕的发生率降低了9%（P=0.001）。结论：吗啡控释片直肠给药和口服给药治疗中重度癌性疼痛的效果相近,但直肠给药不良反应的发生率可能较低,临床医生应根据患者个体情况合理选用。     

硫酸吗啡控释片直肠给药控制癌痛

目的：有效地控制中晚期癌痛患者的疼痛。方法：对临床25例因恶心、呕吐、吞咽困难、术后禁食无法口服给药的中晚期癌痛患者，采用硫酸玛啡控释片直肠给药方法用药。结果；有效地控制了癌痛。结论；硫酸吗啡控释片直肠给药安全、无创伤、便于操作、镇痛效果好。     

Absorption kinetics of rectally and orally administered ibuprofen

The bioavailability of rectally administered sodium ibuprofen solution and aluminum ibuprofen suspension was determined in eight normal subjects relative to the same treatments administered orally. The results indicate that the suspension was less bioavailable than the solution irrespective of the route of administration. Although not bioequivalent, rectally administered ibuprofen solution compared favourably with orally administered ibuprofen solution. The mean AUC and Cmax from rectal administration were 87 per cent and 62 per cent of the corresponding values achieved after oral administration. Mean residence times and peak times were 1-3 h longer with the rectal solution, indicating a slower rate of absorption. Absorption after rectal administration was zero order in some subjects while absorption after oral administration was first order. This may be due to the large differences in surface area between absorption sites. Since sodium ibuprofen solution is absorbed when given rectally, this route of administration could be used in patients unable to take oral ibuprofen.     

硫酸吗啡控释片直肠给药控制晚期癌症疼痛的疗效观察

目的观察硫酸吗啡控释片（MST）直肠给药对晚期癌症疼痛的镇痛疗效。方法果用MST直肠给药控制48例晚期癌症患者的中重度疼痛。结果MST直肠给药有效率（CR＋PR）为91．7％（44／48），轻度缓解（MR）为8．3％（4／48）。治疗后疼痛程度明显减轻，直肠给药前后疼痛级数相比有极显著性差异（P〈0．001），生活质量也明显提高。副作用与口服给药基本相同。结论MST直肠给药具有良好的镇痛效果，尤其适用于因各种原因导致的不能口服给药的晚期癌症患者。     

硫酸吗啡缓释片联合普瑞巴林治疗癌性神经病性疼痛的疗效及对患者疼痛缓解的影响

目的分析硫酸吗啡缓释片联合普瑞巴林治疗癌性神经病性疼痛的疗效及对患者疼痛缓解的影响。方法102例癌性神经病性疼痛患者,根据随机数字表法分为对照组及观察组,各51例。对照组采用硫酸吗啡缓释片治疗,观察组在对照组基础上联合普瑞巴林治疗。对比两组患者的治疗效果、疼痛程度、睡眠质量和不良反应发生情况。结果观察组治疗总有效率92.16%高于对照组的76.47%,差异具有统计学意义(P<0.05)。治疗后,两组患者的视觉模拟评分法(VAS)评分均较本组治疗前降低,且观察组降低程度优于对照组,差异均具有统计学意义(P<0.05)。两组患者的睡眠干扰(SLPD)、睡眠量(SLPQ)、睡眠充足度(SLPA)、综合睡眠障碍指数(9-items)评分均较本组治疗前改善,且观察组改善程度优于对照组,差异均具有统计学意义(P<0.05)。观察组不良反应发生率9.80%低于对照组的25.49%,差异具有统计学意义(P<0.05)。结论硫酸吗啡缓释片联合普瑞巴林治疗癌性神经病性疼痛的疗效显著,能有效缓解患者的疼痛情况,提高睡眠质量,降低不良反应发生率,安全性较高,值得应用。     

心理治疗联合吗啡缓释片对癌症患者疼痛的临床研究

目的探讨集体心理治疗结合个体心理治疗联合吗啡缓释片对癌症疼痛患者情绪及生活质量的影响。方法采用病例对照的研究方法,对干预组晚期癌症患者在吗啡缓释片治疗疼痛的同时,进行集体心理治疗结合个体心理治疗,对照组只进行吗啡缓释片治疗。应用抑郁自评量表（SDS）、焦虑自评量表（SAS）、癌症患者生存质量核心量表（QLQ-C30）对干预组和对照组在干预前后进行测试。结果干预组患者生活质量核心量表分值在干预前后有显著不同,主要表现为情感功能、认知功能、社会功能、整体健康状况等分值在干预前后差异有统计学意义（P〈0．05）,干预组焦虑、抑都等负性情绪减少。结论癌痛患者在进行躯体治疗的同时,实施有效的心理治疗可以纠正患者消极的应对方式,改善其不良情绪和减轻临床症状,有助于提高患者的生活质量。     

A controlled evaluation of orally administered aspirin,dipyrone and placebo in patients with post-operative pain

Summary

A double-blind controlled trial was carried out in 267 patients with inoderate to severe pain following episiotomy to compare the pain relief provided over a 6-hour period by a single oral close of 500?mg dipyrone, 500?mg aspirin or placebo. The results showed that dipyrone and aspirin were both significantly superior to placebo. Pain relief with dipyrone was already apparent at 30 minutes after drug intake, and was of significantly longer duration than that of aspirin. No side-effects were reported.     

Establishing the dosage equivalency of oxymorphone extended release and oxycodone controlled release in patients with cancer pain: a randomized controlled study

SUMMARY

Objective: To compare the analgesic efficacy and safety of oxymorphone extended release (ER) and oxycodone controlled release (CR) in patients with moderate to severe cancer pain.

Research design and methods: This randomized, multicenter, double-blind, 2-period crossover study included adult outpatients (≥ 18?years of age) with moderate or severe cancer pain who were first titrated for 3–10?days with open-label oxymorphone or oxycodone to achieve a stable dose that provided adequate analgesia with tolerable adverse events and no requirement for more than 2 doses of rescue medication per day. The subsequent double-blind treatment phase was a 7- to 10-day period of oxycodone CR or oxymorphone ER treatment followed by crossing over to the alternate medication for another 7–10?days. During the treatment phase, up to 2 doses per day of morphine sulfate 15-mg tablets were allowed as rescue.

Main outcomes and measures: Assessments included the Brief Pain Inventory, global evaluations, Karnofsky performance status, and clinical laboratory evaluations (serum chemistry profile, complete blood count, urinalysis). Efficacy variables were analyzed using a mixed-effects model with treatment, sequence, and period as fixed effects and subject as a random effect.

Results: Forty-seven patients entered the titration/stabilization phase, 44 received at least 1 dose of study drug, 42 completed the first double-blind phase, and 40 completed the second double-blind phase. Mean pain intensity scores and other efficacy parameters were comparable for the 2 groups. The mean daily dosage of oxycodone CR (91.9?mg) was twice that of oxymorphone ER (45.9?mg), an equianalgesic dose ratio of 2:1. Rescue medication use was low in both groups (approximately 1 tablet of morphine sulfate 15?mg/day). No significant differences in opioid adverse events were observed between the groups.

Conclusions: Adult patients with cancer who were taking oxycodone CR were readily converted to oxymorphone ER and required half the milligram dose to stabilize their pain. Within 72?h, most patients achieved a stable dose that provided adequate relief with similar opioid adverse events.     

放射治疗在直肠癌综合治疗中的应用

2011年美国癌症学会在著名学术刊物《CA:A Cancer Journal for Clinicians》上公布了最新的全球癌症发病及死亡调查报告,该报告指出:在发达国家每年新增直肠癌患者约42万名,而有约20万患者死于该疾病[1]。近年来,随着生活水平提高,饮食习惯改变等原因,我国     

Population pharmacokinetics of orally administered paclitaxel formulated in Cremophor EL

AIM: The vehicle Cremophor EL (CrEL) has been shown to impair the absorption of paclitaxel by micellar entrapment of the drug in the gastrointestinal tract. The goal of this study was to develop a semimechanistic population pharmacokinetic model to study the influence of CrEL on the oral absorption of paclitaxel. METHOD: Paclitaxel plasma-concentration time profiles were available from 55 patients (M:F, 17 : 38; total 67 courses; 797 samples), receiving paclitaxel orally once or twice daily (dose range 60-360 mg m(-2)) together with 12-15 mg kg(-1) cyclosporin A. A population pharmacokinetic model was developed using the nonlinear mixed effect modelling program NONMEM. RESULTS: After absorption, paclitaxel pharmacokinetics were best described using a two-compartment model with linear distribution from the central compartment into a peripheral compartment and first-order elimination. Paclitaxel in the gastrointestinal tract was modelled as free fraction or bound to CrEL, with only the free fraction available for absorption into the central compartment. The equilibrium between free and bound paclitaxel was influenced by the concentration of CrEL present in the gastrointestinal tract. The concentration of CrEL in the gastrointestinal tract decreased with time with a first order rate constant of 1.73 h(-1). The bioavailability of paclitaxel was independent of the dose and of CrEL. Estimated apparent paclitaxel clearance and volume of distribution were 127 l h(-1) and 409 l, respectively. Large interpatient variability was observed. Covariate analysis did not reveal significant relationships with any of the pharmacokinetic parameters. CONCLUSION: A pharmacokinetic model was developed that described the pharmacokinetics of orally administered paclitaxel. CrEL strongly influenced paclitaxel absorption from the gastrointestinal tract resulting in time-dependent but no significant dose-dependent absorption over the examined dose range studied.     

利用知信行模式对骨科手术患者实施疼痛教育的效果评价

目的 观察知信行疼痛教育模式对骨科手术患者疼痛信念与疼痛控制的影响.方法 将238例骨科择期手术患者随机分为观察组和对照组各119例.对照组采用骨科手术患者护理常规进行护理,观察组在常规护理的基础上对患者及家属采用知信行疼痛教育模式.通过问卷及疼痛评估记录比较2组患者疼痛信念、镇痛需求、术后不同时间疼痛程度情况.结果 观察组术后疼痛信念优于对照组,观察组镇痛需求高于对照组,观察组术后不同时间疼痛评分低于对照组,差异均有统计学意义（P〈0.01）.结论 采用知信行模式对骨科手术患者进行疼痛知识教育能优化患者疼痛信念,提高术后疼痛控制质量.