酮咯酸和强痛定对癌性疼痛的镇痛效果比较

目的：比较酮咯酸与强度对癌痛的镇痛效果及不良反应，方法：６２例癌痛病人（男性４４例，女性１８例，年龄５３±ｓ１４ａ），中度疼痛２５例，重度疼痛３７例，随机分为酮咯酸组（酮咯酸３０ｍｇ，ｉｍ，ｑ６ｈ）和强痛定组（强痛定１００ｍｇ，ｉｍ，ｑ６ｈ）２组各用药３ｄ再交换用药３ｄ。结果，两对癌痛的镇痛叫有效率及不良反应发生率无差异，前起效时间晚于后，无痛维持时间长于后，结论，酮咯酸与强痛定均为癌症疼     

酮咯酸氨丁三醇注射液用于癌性疼痛的临床研究

目的研究酮咯酸氨丁三醇(尼松)注射液用于癌性疼痛的超前镇痛及联合阿片类药物的安全性比较。方法以癌性疼痛患者,包括肺癌根治术和肝癌根治术等200例为研究对象,随机分为4组,A组:单用芬太尼1mg加用生理盐水至100mL进行经静脉自控镇痛(PCIA);B组:静注尼松30mg,PCIA用药:芬太尼1mg加用生理盐水至100mL;C组:静注尼松30mg.PCIA用药:尼松60mg加芬太尼0.05mg加用生理盐水至100mL;D组静注尼松30mg。PCIA用药:尼松90mg加芬太尼0.05mg加用生理盐水至100mL。经治疗后接PCIA,按0h,4h、8h、24h记录各项指标,PCA按压计数,芬太尼的用量,不良反应包括恶心、呕吐、尿潴留、嗜睡、头晕等。结果 0h,B、C、D组VAS评分明显低于A组(P<0.05)。4h后和8h,C、D组VAS评分明显低于A组(P<0.05),术后24h,B组VAS评分>C组(P<0.05),PCA按压计数相比不存在显著性差异,整个研究中,芬太尼的用量C、D组明显少于A组、B组(P<0.05)。结论酮咯酸氨丁三醇(尼松)注射液用于癌性疼痛具有超前镇痛,联合阿片类用药不但镇痛效果增加,而且阿片类药物副作用减少。     

酮咯酸,一种具有强力镇痛作用的非甾体类抗炎药

酮咯酸是一种新型非甾体类抗炎药,为一强效前列腺素合成酶抑制剂,其镇痛作用强度类似或强于吗啡、哌替啶,且不抑制呼吸也无成瘾的危险。口服和注射均有效,无局部刺激性。主要用途为减轻术后疼痛,可作为麻醉性镇痛药的代用品。     

酮咯酸口腔局部镇痛作用的实验和临床研究

目的　探讨酮咯酸的局部镇痛作用。方法　动物实验采用兔齿髓刺激法和小鼠福尔马林实验 ,临床疼痛评定采用视觉模拟评分法。结果　齿髓内注射酮咯酸氨丁三醇(KT) 15 0 μg/kg·只 -1能显著提高兔齿髓电刺激的痛阈而静注无效 ;小鼠左上唇scKT 1 6mg·kg-1能明显抑制该部位sc福尔马林的疼痛反应 ,但对对侧 (右上唇 )sc福尔马林所致的疼痛反应无效。临床小剂量KT口腔患处敷极显著降低患者的疼痛分值。结论　酮咯酸具有局部镇痛作用 ,可用于口腔疼痛的治疗     

酮咯酸氨丁三醇的超前镇痛效果

目的探讨酮咯酸氨丁三醇的超前镇痛效果。方法腰-硬联合麻醉下行骨科下肢手术患者50例均分为2组。A组在手术切皮前5min静注酮咯酸氨丁三醇30mg;B组静注同等剂量0.9%氯化钠注射液作为对照。采用视觉模拟评分(VAS)对评估术后4、8、12、24及48h的疼痛评分,记录术后自控镇痛(PCA)按压次数、VAS>5分时辅助使消炎痛栓应用及不良反应发生情况。结果 A组术后4、8、12、24及48hVAS疼痛评分均低于B组(P<0.05)。A组术后PCA泵按压次数要明显少于对照(P<0.05)。B组有5例使用消炎痛栓,A组无使用消炎痛栓病例。两组患者均未发生严重不良反应。结论术前应用酮咯酸氨丁三醇有良好超前镇痛作用,能减少辅助镇痛药用量,且不良反应少。     

丙氧氨酚与酮咯酸治疗癌痛的比较

晚期肿瘤疼痛病人３１例（男性１７例，女性１４例，年龄５０±ｓ１４ａ），用丙氧氨酚２片，ｐｏ，ｔｉｄ，共７ｄ。相似病人３０例（男性１６例，女性１４例。年龄５１±１３ａ），用酮咯酸１０ｍｇ，ｐｌ，ｑｉｄ，共７ｄ。结果：疼痛强度（标尺法）２组均有降低；显效时间前（丙氧氨酚）快于后组（酮咯酸）；药效维持时间后组长于前组；不良反应前组嗜睡多于后组，而胃肠道不适少于后组。     

酮咯酸合成路线图解

酮咯酸合成路线图解徐勤丰，盛成德（上海第六制药厂，上海２００３３３）ＧＲＡＰＨＩＣＡＬＳＹＮＴＨＥＴＩＣＲＯＵＴＥＳＯＦＫＥＴＯＲＯＬＡＣ￥ＸＵＱｉｎ－Ｆｅｎｇ；ＳＨＥＮＧＣｈｅｎｇ－Ｄｅ（ＳｈａｎｇｈａｉＮｏ．６ＰｈａｒｍａｃｅｕｔｉｃａｌＦａｃｔ...     

酮咯酸氨丁三醇治疗外科疾病疼痛118例

目的;探讨酮咯酸氨丁三醇对外科疾病疼痛的镇痛效果.方法;外科疾病疼痛患者118例,给予酮咯酸氨丁三醇注射液30 mg,im,口服剂10～20 mg,po,每天最大剂量不超过120 mg,对剧烈疼痛给药30 min后无效者,可再肌内注射30 mg.结果;起效时间5～60 min,平均35 min,止痛时间为0.5～24 h,平均8.2 h.总有效率97.5%.结论;酮咯酸氨丁三醇镇痛抗炎作用显著,并且起效迅速,可用于临床各种外科性疼痛.     

丙氧氨酚与酮咯酸治疗癌痛的比较

晚期肿瘤疼痛病人３１例（男性１７例，女性１４例，年龄５０±５１４ａ），用丙氧氨酚２片，ｐｏ，ｔｉｄ，共７ｄ。相似病人３０例（男性１６例，女性１４例，年龄５１±１３ａ），用酮咯酸１０ｍｇ，ｐｏ，ｑｉｄ，共７ｄ。结果：疼痛强度（标尺法）２组均有降低；显效时间前组（丙氧氨酚）快于后组（酮咯酸）；药效维持时间后组长于前组；不良反应前组嗜睡多于后组，而胃肠道不适少于后组。     

单剂量酮咯酸用于围术期超前镇痛的meta分析

目的 采用meta分析综合评价单剂量酮咯酸用于围术期超前镇痛的有效性及安全性。方法 遵循PRISMA声明指南,全面检索公开发表的随机对照试验,通过meta分析综合评价单剂量全身酮咯酸对术后疼痛、阿片样药物消耗及不良反应的影响。结果 共纳入11项研究,累计606人。Meta分析结果表明术后0,4,8 h的酮咯酸超前镇痛效果明显,术后24 h的酮咯酸超前镇痛效果无统计学差异。酮咯酸超前镇痛可以减少术后阿片类药物（吗啡）的使用[MD=-4.25,95%CI （-8.16,-0.35）,P=0.03],减少恶心、呕吐不良反应的发生[RR=0.68,95%CI （0.51,0.90）,P=0.006],且未增加严重不良反应。结论 现有的临床文献数据表明,酮咯酸用于围手术期超前镇痛效果明确,可减少术后阿片类药物（吗啡）的使用量,同时减少了恶心或呕吐的发生。     

酮咯酸氨丁三醇超前镇痛用于无痛胃镜的可行性观察简

目的观察酮咯酸氨丁三醇超前镇痛应用于无痛胃镜检查的效果。方法选择无痛胃镜检查患者120例,随机分为两组,各60例。A组为观察组,术前30rain肌肉注射酮咯酸氨丁三醇60mg;B组为对照组,术前未用任何镇痛药。记录两组患者术前、术中、术后的血压（SBP）、心率（HR）和血氧饱和度（SpOz）的变化,以及术毕清醒时间、丙泊酚总用量、术中不适等情况。结果SBP和HR的波动B组大于A组,B组丙泊酚总用量及术中不适发生例数均多于A组（P〈0．05）。结论酮咯酸氨丁三醇超前镇痛用于无痛胃镜检查效果满意,可降低术中不适,减少丙泊酚用量,缩短苏醒时间,值得临床推广。     

酮咯酸氨丁三醇在预防鼻窦手术术后疼痛中的应用

目的:探讨酮咯酸氨丁三醇对鼻内镜下鼻窦手术术后早期疼痛的预防效果及安全性。方法:取60例择期行鼻内镜下鼻窦手术成年患者,随机分为酮咯酸组和芬太尼组,均采取全凭静脉麻醉,于雷米芬太尼停止泵入前15min分别静脉予以酮咯酸氨丁三醇30mg或芬太尼50μg,观察术后疼痛及出血情况。结果:两组患者术后疼痛(30min 3.2±1.3vs 3.4±1.5,60min 2.0±1.1vs2.8±2)及出血情况(鼻出血VAS评分6.6±3.1VS 5.1±3.1,痰中带血VAS评分3.1±1.8vs 3.4±1.8,更换敷料VAS评分5.2±3.5vs 4.3±3.4)差异均无统计学意义。结论:手术结束前静脉给予酮咯酸氨丁三醇可以较好的替代麻醉性镇痛药用于预防鼻内镜下鼻窦手术的成年患者术后镇痛而不增加术后出血风险。     

吲哚美辛直肠给药治疗腹部手术后疼痛120例

目的：观察吲哚美辛直肠给药与曲马多肌内注射对腹部手术后疼痛的疗效比较。方法：１２０例腹部术后病人，男性８６例，女性３４例；年龄４１±ｓ８ａ，给予吲哚美辛混悬液５ｍＬ（７５ｍｇ）直肠给药。另有腹部手术后病人６０例，男性４１例，女性１９例；年龄４３±９ａ，用曲马多１００ｍｇ肌内注射。２组作随机单盲对照试验。结果：吲哚美辛组止痛作用优于曲马多组，总有效率分别为９２．５％和８２％（Ｐ＜０．０５）。吲哚美辛组平均镇痛有效持续时间９±５ｈ，优于曲马多组７±３ｈ（Ｐ＜０．０１）。结论：吲哚美辛直肠给药治疗腹部手术后疼痛疗效满意。     

Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain

AIMS: Previous research has reported on reduced paw withdrawal latencies to heat and mechanical stimuli after parenteral administration of opioids in animals and on increased pain sensitivity in humans subsequent to postoperative infusions of short-acting opioids or in drug addicts. The aim of the present study was to explore the possibility that oral opioid treated patients with cancer-related or chronic nonmalignant pain differ in their pain sensitivity from patients treated with non-opioid analgesics. METHODS: The study population consisted of 224 patients, including 142 in the opioid-treated group and 82 in the non-opioid-treated group. Pain thresholds for punctuate measured by von Frey filaments (g), mechanical pressure measured by pressure algometer (mmHg), heat stimuli measured by quantitative sensory testing (degrees C), as well as suprathreshold tonic heat pain intensity (46.5 degrees C for 1 min) measured by 0-10 numerical pain scale (NPS) were obtained at a nonpainful site (thenar eminence) in all patients. RESULTS: No differences between the groups were found for gender, age, duration of pain, or duration of treatment (independent variables). No significant differences between the groups were found in punctuate (difference = 17.0 g (95% CI -8.8, 42.8), P = 0.19), pressure (2.2 mmHg (-28.7, 33.2), P = 0.89) and heat (-0.3 degrees C (-1.5, 0.9), P = 0.70) pain thresholds, or in suprathreshold heat pain intensity (difference between maximal pain intensities -0.4 NPS units (95% CI -1.2, 0.4), P = 0.31). Pearson correlations within the opioid-treated group failed to show significant relationships between any of the independent variables and the outcome measures. A further comparison of the outcomes between the 'weak' opioid-treated subgroup and the 'strong' opioid-treated subgroup again revealed insignificant results. CONCLUSIONS: These results suggest that the administration of 'commonly used' dosages of oral opioids does not result in abnormal pain sensitivity beyond that of patients receiving non-opioid analgesia.     

Morphine-sparing effect of diclofenac in cancer pain

Summary The effectiveness of diclofenac 50 mg t.i.d. as additive treatment to parenteral patient-controlled administration therapy (PCAT) with morphine in cancer pain has been investigated in a double-blind study. In the fifteen patients who completed the study, morphine i.v. was titrated to optimal pain relief over 5 days.The mean total morphine consumption was significantly reduced during diclofenac administration (82.8 mg morphine per day) compared to placebo (95.0 mg morphine per day). The reduction in mean morphine consumption during active treatment with diclofenac was independent of the initial dose of self-titrated morphine.Pain, self-assessed according to VAS, tended to be lower during the diclofenac period, although the difference did not reach statistical significance. No adverse events were recorded among the 15 patients who completed the study.The present findings show that a non-steroidal anti-inflammatory agent, such as diclofenac, has a morphine-sparing effect in morphine-treated patients with cancer pain.J.E. Martinsson, MD, Department of Pulmonary Medicine, Renströmska Hospital, Gothenburg, M. Berndtsson, MD, Department of Pulmonary Medicine, Central Hospital, Bor»s, L. Grettve, MD, Department of Medicine, NÄL Hospital, Vänersborg, and L.G. Carlsson, MD, Department of Medicine, Uddevalla Hospital, Uddevalla, Sweden