塞来昔布联合盐酸乙哌立松治疗急性腰扭伤40例

［摘要］目的观察塞来昔布联合盐酸乙哌立松治疗急性腰扭伤的临床疗效。方法急性腰扭伤患者72例,随机分为治疗组40例和对照组32例,对照组第1天给予塞来昔布400 mg,bid,从第2天开始每次200 mg,bid,饭后服用,6 d;治疗组同时联合应用盐酸乙哌立松50 mg,tid,饭后服用,7 d。比较两组治疗第7,14天的治疗效果。结果治疗组和对照组治疗第7天优良率分别为90.0%,75.0%(P＜0.05);第14天优良率分别为95.0%,93.8%(P＞0.05)。结论塞来昔布联合盐酸乙哌立松在早期可以迅速缓解急性腰扭伤患者症状,中远期两者疗效差异无统计学意义。     

塞来昔布联合盐酸乙哌立松治疗对神经根型颈椎病颈椎曲度及运动功能的影响

目的 探讨神经根型颈椎病患者采用盐酸乙哌立松片和塞来昔布胶囊联合治疗的效果及对颈椎曲度及运动功能的影响.方法 将2018年1月～2019年10月诊治的124例神经根型颈椎病患者作为研究对象,根据治疗方式分组.对照组62例给予盐酸乙哌立松片口服治疗,联合组62例同时联合塞来昔布胶囊口服治疗.比较治疗后的临床疗效及治疗前后...     

盐酸乙哌立松的合成

盐酸乙哌立松的合成李科（第二军医大学药学院，上海２００４３３）ＳＹＮＴＨＥＳＩＳＯＦＥＰＥＲＩＳＯＮＥＨＹＤＲＯＣＨＬＯＲＩＤＥ￥ＬＩＫｅ（ＣｏｌｌｅｇｅｏｆＰｈａｒｍａｃｙ，ＳｅｃｏｎｄＭｉｌｉｔａｒｙＭｅｄｉｃａｌＵｎｉｖｅｒｓｉｔｙ，Ｓｈａｎｇ...     

乙哌立松治疗紧张性头痛的疗效观察

紧张性头痛 ( TTH)与头颈部肌肉的持续痉挛或造成肌肉中的缺血诱发头痛有关 ,临床无明显特效药物 ,作者自1999～ 2 0 0 1年对 43例 TTH 病人用盐酸乙哌立松( eperisoene hydrochloride,商品名妙纳 )治疗取得了较满意的疗效 ,结果报告如下。1　资料和方法1.1　一般资料　根据 1997年 ICD-ID国际疾病分类委员会标准诊断 TTH。本组 43例中男性 14例 ,女性 2 9例 ,年龄18～ 5 5岁 ,平均 3 4.9岁 ,病程 3个月到 18年 ,平均 5 .6年 ,急性 TTH19例 ,慢性 TTH2 4例 ,排除其他疾病和神经系统病变所致的头痛。1.2　治疗方法　于头痛发作即日起…     

塞来昔布治疗类风湿关节炎疗效观察

目的：观察塞来昔布治疗类风湿关节炎的临床疗效。方法90例类风湿关节炎患者按数字表法随机分为观察组和对照组,每组45例。两组患者均给予常规治疗,对照组加用布洛芬治疗,观察组加用塞来昔布治疗,比较两组临床疗效。结果观察组总有效率为77．78％,对照组为68．88％,两组差异无统计学意义（χ^2＝1．79,P＞0．05）。两组治疗后症状指标（晨僵持续时间、压痛关节数、关节疼痛指数、关节肿胀指数、握力）、实验室指标（RF、ESR及CRP）差异均无统计学意义（t＝2．23、1．69、1．50、2．10、1．52、2．02、1．44、2．04,均P＞0．05）。观察组不良反应发生率为17．78％,对照组为37．78％,两组差异有统计学意义（χ2＝4．76,P＜0．05）。结论塞来昔布治疗类风湿关节炎疗效与布洛芬相当,但不良反应少。     

双氯芬酸钠联合盐酸乙哌立松治疗腰腿痛40例

目的观察双氯芬酸钠联合盐酸乙哌立松治疗腰腿痛的疗效。方法将2010年12月至2012年12月诊治的腰腿痛患者80例随机分为对照组(单用双氯芬酸钠)和观察组(双氯芬酸钠联合盐酸乙哌立松),对两组临床疗效、不良反应,以及治疗后疼痛视觉模拟评分(VAS评分)进行比较。结果与对照组相比,观察组的总有效率明显升高,不良反应发生率显著降低,治疗后VAS评分明显降低(P<0.05)。结论双氯芬酸钠联合盐酸乙哌立松治疗腰腿痛的疗效显著,能明显改善患者的预后质量,值得临床推广。     

塞来昔布与盐酸氨基葡萄糖联合治疗膝骨关节炎临床观察

目的 评价塞来昔布与盐酸氨基葡萄糖胶囊联合治疗膝骨关节炎的疗效.方法 收集膝骨关节炎患者88例,按就诊顺序随机分为塞来昔布联合盐酸氨基葡萄糖治疗组45例,塞来昔布治疗对照组43例;治疗组给予口服塞来昔布200mg、1次/天,盐酸氨基葡萄糖0.75g/次、2次/天;对照组给予口服塞来昔布200 mg、1次/天;两组患者连续给药4周后评价疗效.结果 两组患者有效率组间比较差异有统计学意义（P＜0.05）;给药停药两周后,两组治疗前后比较差异有统计学意义（P＜0.05）;在休息痛、运动痛、关节压痛、关节晨僵和行走能力等方面治疗后组间比较差异有统计学意义（P＜ 0.05）.结论 塞来昔布联合盐酸氨基葡萄糖治疗膝骨关节炎具有确定疗效.     

乙哌立松治疗紧张型头痛75例

目的：验证乙哌立松对伴有颅周肌肉收缩的急性或慢性紧张型头痛的临床疗效。方法：按国际头痛学会诊断标准，符合要求病人７５ 例，其中急性紧张型头痛组２１ 例，慢性紧张型头痛组５４ 例。以多中心开放研究，给予乙哌立松５０ ｍｇ ， ｐｏ，ｔｉｄ ×４ｗｋ ，观察头痛严重程度、颈肩部肌肉压痛阈值和压痛总评分等，记录服药前， 服药ｗｋ １ ，２ ，４ 末指标的变化。结果：乙哌立松对伴有颅周肌肉收缩的紧张型头痛总有效率为９１ ％ 。治疗１ｗｋ ５３ 例病人肌肉压痛阈值和（ 或） 压痛总评分与治疗前相比差别有显著意义（ Ｐ＜ ０ ．０１ 和Ｐ＜ ０ ．０５） ，急性紧张型头痛与慢性紧张型头痛病人同期疗效比较差别有显著意义（ Ｐ＜ ０ ．０５） ；无效７ 例；不良反应３ 例。结论：乙哌立松治疗紧张型头痛安全有效，对急性紧张型头痛疗效优于慢性紧张型头痛。     

塞来昔布致急性胰腺炎

1例43岁女性患者因肩周炎服用塞来昔布胶囊0．2g,2次／d,共服用2周。末次服药后2h上腹出现持续性钝痛,伴腹胀、恶心、呕吐。实验室检查示血清淀粉酶1822U／L,胰淀粉酶1529U／L,脂肪酶1410U／L,白细胞计数12．7×10^9／L,中性粒细胞0．74,淋巴细胞0．16。腹部超声检查和磁共振胰胆管造影示胰腺弥漫性增大、胰腺周围有液性渗出,诊断为急性胰腺炎。停用塞来昔布,禁食,给予营养支持和抑酶、抑酸、抗感染治疗13d,患者腹痛、腹胀消失,实验室检查示淀粉酶86U／L,胰淀粉酶48U／L,脂肪酶55U／L,白细胞计数7．2×10^9／L,中性粒细胞0．65,淋巴细胞0．32。胰腺CT示胰头、胰体和胰尾位于同一层面,形态及大小基本正常。     

硫酸氨基葡萄糖联合塞来昔布治疗骨关节炎疗效分析

目的：评价硫酸氨基葡萄糖联合塞来昔布治疗骨关节炎疗效与安全性。方法以2014年4月～2015年12月,医院收治的140例膝关节骨关节炎患者作为研究对象,观察组与对照组各纳入患者70例,分别以硫酸氨基葡萄糖联合塞来昔布治疗、单独应用塞来昔布治疗,对比治疗前后、停药4周后HSS评分以及不良反应发生情况。结果停药后观察组与对照组膝关节评分高于治疗前,停药4周后高于停药时,停药4周后观察组高于对照组,差异具有统计学意义（ P ＜0.05）;观察组不良反应发生率12.86％高于对照组1.67％,差异具有统计学意义（ P ＜0.05）。结论硫酸氨基葡萄糖联合塞来昔布治疗骨关节炎疗效较好,但可能增加不良反应发生风险。     

系统评价塞来昔布联用阿片类药物治疗中重度癌性疼痛的有效性和安全性

目的 系统评价塞来昔布联用阿片类药物（吗啡、羟考酮）治疗中重度癌性疼痛的临床疗效和安全性。方法 检索Cochrane Library、PubMed、中国生物医学文献数据库（CBM）、中国学术期刊全文数据库（CNKI）、维普中文期刊全文数据库（VIP）和万方数据库关于塞来昔布联用阿片药物对比单用阿片类药物治疗中重度癌性疼痛的随机对照试验（RCTs）,检索时间为2000年1月—2019年7月。由2名研究者独立提取数据、评价质量,并交叉核对。采用RevMan 5.3软件进行Meta-分析。结果 共纳入12项RCTs,1 292例患者。Meta-分析结果显示相对于单用阿片,塞来昔布联用阿片药物能显著提高疼痛缓解率（OR=1.94,95%CI=1.64～2.59）、减少日均阿片药物用量（MD=-10.64,95%CI=-15.03～-6.26）和提高生活质量（MD=3.53,95%CI=1.34～5.72）,差异均有统计学意义（P<0.01）,按照阿片药物类别进行亚组分析结果与上述Meta-分析结果一致。在安全性方面,塞来昔布能显著降低吗啡便秘、恶心呕吐、嗜睡、头痛头晕发生率和羟考酮便秘发生率（P<0.01）,对阿片药物致排尿困难发生率无影响。结论 塞来昔布联用阿片药物用于中重度癌痛患者镇痛疗效确切,同时可显著降低便秘和恶心呕吐等发生率。     

雷公藤多苷联合塞来昔布治疗类风湿关节炎的临床效果研究

目的 研究雷公藤多苷联合塞来昔布治疗类风湿关节炎的临床效果。方法 选择2014年1月-2015年12月在西安市第五医院进行诊治的类风湿关节炎患者60例,随机分为两组,每组各30例。对照组口服塞来昔布治疗,每次200 mg,每天2次;观察组联合口服雷公藤多苷片治疗,每次20 mg,每天3次。两组均治疗3个月。比较两组的临床治疗效果,观察治疗前后的血清C反应蛋白、类风湿因子和红细胞沉降率,血清白介素-6、肿瘤坏死因子-α以及白介素-23水平。结果 观察组的有效率为93.33%（28/30）,明显高于对照组的73.33%（22/30）,差异有统计学意义（P<0.05）。治疗后两组的血清C反应蛋白、类风湿因子和红细胞沉降率均明显降低,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组明显低于对照组,差异有统计学意义（P<0.05）。治疗后两组的白介素-6、肿瘤坏死因子-α以及白介素-23均明显降低,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组明显低于对照组,差异有统计学意义（P<0.05）。两组的不良反应率相比无明显差异。结论 雷公藤多苷联合塞来昔布治疗类风湿关节炎的临床效果明显优于单纯使用西药塞来昔布治疗,是一种安全有效的治疗方法。     

Intestinal First-Pass Metabolism of Eperisone in the Rat

Purpose. The purpose of this study was to clarify quantitatively the contribution of the intestine to the first-pass metabolism of eperisone in rats. Methods. The systemic availabilities of eperisone were estimated by administering the drug into the duodenum, portal vein, and femoral vein in rats in vivo. The first-pass metabolism of eperisone was confirmed in the perfused rat small intestine in situ. Metabolism of eperisone to an -1-hydroxylated metabolite (HMO), the first step of eperisone metabolism, was studied using rat intestinal microsomes in vitro. Results. The bioavailabilities in the intestine were 0.176 and 0.0879 at administration rates of 100 and 25 mg/h/kg, respectively, whereas those in the liver were 0.532 and 0.486, respectively. In the intestinal perfusion experiment, the appearance clearance to the portal vein from the intestinal lumen was much lower than the elimination clearance from the intestinal lumen, resulting in high metabolic clearance of eperisone in the small intestine. Eperisone was biotransformed to HMO by rat intestinal microsomes, and this was inhibited by -naphthoflavone and an anti-rat CYP1A antibody. Conclusions. Those data strongly suggest that eperisone may be metabolized to HMO by CYP1A in rat intestinal microsomes during the first-pass through the epithelium of the small intestine.     

度洛西汀联合硫辛酸治疗糖尿病周围神经病变性疼痛的疗效观察

目的:探讨度洛西汀联合硫辛酸治疗糖尿病周围神经病变性疼痛的有效性及安全性。方法:将78例糖尿病周围神经病变性疼痛患者随机分为两组,西汀组口服度洛西汀,联合组口服度洛西汀和静脉滴注硫辛酸,比较两组疗效。结果:两组治疗后正中神经感觉传导速度(median nerve conduction velocity,MNCV)、腓总神经感觉传导速度(phil nerve conduction velocity,PNCV)、尺神经感觉传导速度(ulnar nerve conduction velocity,UNCV)均显著提高(P<0.05);联合组治疗4周、8周后MNCV、PNCV、UNCV均显著高于治疗前及同期西汀组(P<0.05);两组治疗后疼痛强度简易评述量表(VRS)、数字疼痛强度量表(NRS)评分显著下降(P<0.05);联合组治疗4周、8周后VRS、NRS评分显著低于治疗前及同期西汀组(P<0.05);两组不良反应发生率(30.77%和23.08%)差异无统计学意义(P>0.05);两组治疗前、治疗8周后胆固醇(TC)、甘油三酯(TG)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、血肌酐(SCr)指标水平均无显著性变化(P>0.05)。结论:度洛西汀联合硫辛酸治疗糖尿病周围神经病变性疼痛,能有效改善患者神经功能,减轻疼痛症状,且安全可靠。     

Low-dose cyclobenzaprine versus combination therapy with ibuprofen for acute neck or back pain with muscle spasm: a randomized trial

ABSTRACT

Objective: This prospective, randomized, open-label, multicenter, community-based study was conducted to compare cyclobenzaprine 5?mg three times daily (TID) orally (CYC5) given for 7 days as monotherapy or in combination with ibuprofen 400?mg TID (CYC5/IBU400) or 800?mg TID (CYC5/IBU800) in adults with acute neck or back pain with muscle spasm.

Study design: Eligible patients were 18–65 years old, had cervical or thoracolumbar pain and spasm for ≤ 14 days, and, aside from the prescribed study medications, discontinued treatment with all analgesics, anti-inflammatory agents, and skeletal muscle relaxants during the study period. Randomization was 1:1:1 to the three treatment groups. Treatment outcome was assessed after 3 and 7 days of therapy using five patient-rated scales: spasm, pain, patient global impression of change (PGIC), medication helpfulness, and Oswestry Disability Index (ODI).

Results: A total of 867 patients provided postbaseline data and were included in the intent-to-treat population (CYC5, n = 288; CYC5/IBU400, n = 286; CYC5/IBU800, n = 293). All three treatment groups demonstrated significant improvements from baseline in PGIC, spasm, pain, ODI, and medication helpfulness (?p < 0.001 for all comparisons) after 3 and 7 days of therapy. There were no significant differences in mean PGIC among groups after 3 days of therapy (?p = 0.65 for treatment effect) or after 7 days of therapy (primary endpoint; p = 0.41). A PGIC responder analysis of changes from baseline showed that 88% and 93% of patients reported at least mild improvement after 3 and 7 days of therapy, respectively. All three treatments were well tolerated, with no significant differences between treatments regarding the number of adverse events (AEs) reported or number of patients reporting AEs. The most common AEs in all groups were fatigue, somnolence, dizziness, sedation, and nausea. Limitations of this study include an unblinded design and possible introduction of bias into efficacy and safety results by use of a voluntary telephone reporting system.

Conclusions: This randomized, community-based clinical trial demonstrated that combination therapy with cyclobenzaprine 5?mg TID plus ibuprofen was not superior to cyclobenzaprine 5?mg TID alone in adult patients with acute neck and back pain with muscle spasm. All treatments were well tolerated.     

对贵刊《乙哌立松治疗肩周炎》一文的验证

笔者阅读了贵刊2003年第2期刊登的《乙哌立松治疗肩周炎》一文后深受启发，并采用此法于2003年3月～2005年3月对门诊肩周炎病人进行临床验证，报道如下。     

塞来考昔在脊柱内固定术后镇痛中的应用

目的：研究塞来考昔在脊柱内固定术后镇痛中应用的疗效及安全性。方法：脊柱内固定手术后的病人150例,随机分为2组,每组75例,均于术后自觉疼痛开始给药。塞来考昔组予塞来考昔200 mg,po,q12h；美洛昔康组予美洛昔康7．5mg,po,qd；均治疗7d。按视觉类比量表（VAS）评价病人用药过程中的疼痛情况,并观察血压变化、监测不良反应。结果：2组病人术后,在用药后30min,VAS评分开始下降,用药2h后VAS评分下降明显（P＜0．01）,且镇痛作用均平稳维持12h以上。用药前后2组病人的血压无显著变化（P＞0．05）。塞来考昔组和美洛昔康组不良反应发生率分别为11%和13%,主要表现为胃肠道反应,与美洛昔康相比塞来考昔的胃肠道反应相对轻微,但无显著差异,无严重不良反应发生。结论：塞来考昔可安全、有效地缓解脊柱内固定术后病人的疼痛。     

针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征的可行性及安全性

目的：探讨针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征的可行性及安全性。方法选取本院2012年10月~2013年11月收入院的慢性腰腿疼痛综合征患者605例,随机分为观察组305例和对照组300例,观察组采用针灸联合腰腿痛丸治疗,对照组采用腰腿痛丸治疗,比较两组的临床疗效、关节疼痛评分及疼痛综合评分。结果观察组总有效率明显高于对照组,差异有统计学意义（P〈0.05）。观察组治疗后的关节疼痛评分明显低于对照组,疼痛综合评分明显高于对照组,差异有统计学意义（P〈0.05）。两组治疗后的关节疼痛评分低于治疗前,差异有统计学意义（P〈0.05）。结论采用针灸联合腰腿痛丸治疗慢性腰腿疼痛综合征,可明显缓解患者疼痛,疗效显著,安全可靠,值得推广应用。     

painDETECT: a new screening questionnaire to identify neuropathic components in patients with back pain

ABSTRACT

Objective: Nociceptive and neuropathic components both contribute to pain. Since these components require different pain management strategies, correct pain diagnosis before and during treatment is highly desirable. As low back pain (LBP) patients constitute an important subgroup of chronic pain patients, we addressed the following issues: (i) to establish a simple, validated screening tool to detect neuropathic pain (NeP) components in chronic LBP patients, (ii) to determine the prevalence of neuropathic pain components in LBP in a large-scale survey, and (iii) to determine whether LBP patients with an NeP component suffer from worse, or different, co-morbidities.

Methods: In co-operation with the German Research Network on Neuropathic Pain we developed and validated the painDETECT questionnaire (PD‐Q) in a prospective, multicentre study and subsequently applied it to approximately 8000 LBP patients.

Results: The PD‐Q is a reliable screening tool with high sensitivity, specificity and positive predictive accuracy; these were 84% in a palm-top computerised version and 85%, 80% and 83%, respectively, in a corresponding pencil-and-paper questionnaire. In an unselected cohort of chronic LBP patients, 37% were found to have predominantly neuropathic pain. Patients with NeP showed higher ratings of pain intensity, with more (and more severe) co‐morbidities such as depression, panic/anxiety and sleep disorders. This also affected functionality and use of health-care resources. On the basis of given prevalence of LBP in the general population, we calculated that 14.5% of all female and 11.4% of all male Germans suffer from LBP with a predominant neuropathic pain component.

Conclusion: Simple, patient-based, easy-to-use screening questionnaires can determine the prevalence of neuropathic pain components both in individual LBP patients and in heterogeneous cohorts of such patients. Since NeP correlates with more intense pain, more severe co‐morbidity and poorer quality of life, accurate diagnosis is a milestone in choosing appropriate therapy.     

盐酸羟考酮与硫酸吗啡治疗晚期癌痛的疗效观察

目的：探讨盐酸羟考酮与硫酸吗啡对晚期癌痛的疗效及安全性。方法：将120例晚期癌痛患者随机分为A、B两组,A组62例采用盐酸羟考酮进行治疗,B组58例采用硫酸吗啡进行治疗,两组均进行4周以上的疗效对比观察。结果：A组总有效率为93.5%,B组总有效率为91.4%,两组差异无统计学意义（P〉0.05）。两组治疗后生活质量均较治疗前明显改善（P〈0.05）。两组不良反应相似,但A组便秘较B组明显减少（P〈0.05）。结论：在治疗各种不同程度的癌痛时,盐酸羟考酮的镇痛效果比硫酸吗啡更有效,毒性反应更低,可作为吗啡的替代品,值得临床上进一步推广使用。