Evaluation of ibuprofen versus aspirin and paracetamol on efficacy and comfort in children with fever

Objective: We compared efficacy and impact on the comfort of ibuprofen (7.5 mg/kg per dose), aspirin (10 mg/kg/dose) and paracetamol (10 mg/kg per dose) on children with fever aged 6–24 months in an open, randomised study with three parallel groups. Methods: The main criterion for efficacy was area under the curve (AUC) of percentage temperature reduction. Comfort was assessed on scores depending on general behaviour and degree of relief. General behaviour was assessed on a verbal scale and on a visual analogue scale (VAS) and the degree of relief was assessed in relation to baseline on a verbal scale. Results: The efficacy of ibuprofen was better than that of aspirin or paracetamol. In spite of more adverse events, the comfort scores were significantly in favour of ibuprofen 6 h after the first dose of treatment. Received: 29 March 1996 / Accepted in revised form: 2 August 1996     

布洛芬和对乙酰氨基酚治疗小儿感染性发热疗效比较

目的：了解布洛芬混悬液（美林）治疗儿童感染性发热的有效性和安全性,为临床选择1：1服退热药提供参考。方法：116例急性上呼吸道感染伴发热的患儿随机分为两组。治疗组72例,对照组44例,分别给予布洛芬（美林）和对乙酰氨基酚（泰诺林）治疗。结果：两组在服药后2h内退热的有效率分别为98．6％、95．5％,差异无统计学意义（P〉0．05）,但对照纽从服药自3～4h开始体温呈现回升趋势,而治疗组在服药后能雏持7～8h体温不回升,显效率分别为95．8％、70．5％,差异有统计学意义（P〈0．01）。结论：布洛芬混悬液退热作用强,维持时间久。     

粤西北地区上消化道出血的病因及相关因素分析

目的 探讨近5年来粤西北地区上消化道出(UGB)的病因及相关因素。方法 将近5年来264例上消化道出血住院病人的性别、年龄、发病季节、诱因、出血方式、出血病因进行对比。结果 本地区上消化道出血的首位病因为消化性溃疡，其次为急性胃粘膜病变，性别、年龄、季节等均为UGB相关因素。结论 上消化道出血病人应建议行内镜检查确诊，以指导治疗。如能重视卫生宣教工作，可降低UGB发病率。     

The influence of excipients on the diffusion of ibuprofen and paracetamol in gastric mucus

The aim of this study was to examine the diffusion of commonly administered analgesics, ibuprofen and paracetamol, through gastric mucus. As ibuprofen and paracetamol are often formulated with alkalising excipients, or are commonly co-administered with antacids that have been demonstrated to alter their absorption, diffusion was also studied in the presence of a range of soluble and insoluble antacids or buffering agents. The effect of pH, which has been demonstrated to modify the properties of mucus, was also studied. Mucus was a significant barrier to diffusion for both drugs, compared to an unstirred aqueous layer with diffusion rates significantly lower in the presence of a mucus barrier for both drugs; ibuprofen diffusion also demonstrated a significant increase in the lag time. Paracetamol diffusion was not significantly affected by addition of any antacid, whereas ibuprofen rates were affected and the diffusion lag time for ibuprofen was significantly reduced in all cases. Isolated increases in pH increased the rate and reduced the lag time for ibuprofen diffusion. It was shown that mucus acts as a passive barrier in the case of paracetamol diffusion, and an interactive barrier to ibuprofen diffusion. Changes in mucus viscosity at different pH values may be responsible for the observed changes in ibuprofen diffusion rate.     

对乙酰氨基酚和布洛芬均引起儿童急性荨麻疹不良反应1例

目的 探讨退热药物对乙酰氨基酚和布洛芬引起儿童急性荨麻疹的不良反应的发生及有效治疗方法。方法 临床药师全程开展药学服务,分析1例3岁患儿使用对乙酰氨基酚和布洛芬退热治疗后均出现急性荨麻疹的临床案例,并进行相关讨论。结果 患儿出现急性荨麻疹后,口服地氯雷他定干混悬剂抗过敏、地塞米松抗炎抗过敏和抗病毒药物治疗,最终患儿症状好转。结论 乙酰氨基酚和布洛芬同致急性荨麻疹的不良反应报道较为少见但仍存在,患儿用药后需密切观察,出现急性荨麻疹时可予抗过敏治疗。临床药师进行药物相关性不良反应的评分和分析,旨在为临床合理用药提供参考。     

胃镜下注射治疗消化性溃疡并急性上消化道出血的疗效分析

目的 探讨胃镜下注射治疗消化性溃疡并急性上消化道出血的疗效.方法 收集我院2013年4月至2015年4月入院的100例消化性溃疡并急性上消化道出血患者随机分为两组.对照组患者给予胃镜下病灶处药物喷洒治疗,实验组患者给予胃镜下病灶处药物注射治疗.比较两组患者治疗前后血红蛋白含量、总体治疗效果评价、相关临床指标与不良反应.结果 实验组患者治疗后Hb水平(108.56±19.77) g/L显著高于对照组(96.17±15.89) g/L,差异有统计学意义(P＜0.01).实验组患者治疗总有效率(96％)明显高于对照组(84％),差异有统计学意义(P＜0.05).实验组患者止血时间(4.58±1.22)d、住院时间(8.76±3.25)d与大便频繁发生率0％、血压紊乱发生率0％显著低于对照组(8.46±3.09)d、(13.34±5.11)d、22％、12％,差异有统计学意义(P＜0.05).结论 胃镜下注射治疗消化性溃疡并急性上消化道出血的疗效显著,具有借鉴性.     

Systematic review and meta-analysis of the clinical safety and tolerability of ibuprofen compared with paracetamol in paediatric pain and fever

ABSTRACT

Objective: The main aim of this review was to compare the tolerability and safety between ibuprofen and paracetamol when used as anti-pyretic and analgesic agents in children up to 18 years of age.

Methods: MEDLINE (1950 to November 2008), EMBASE (1980 to November 2008), The Cochrane Library (2007, Issue 3), ACP Journal Club (1991 to November 2007) and Pascal (1987 to November 2007) were searched for randomised controlled trails (RCTs) (comparing ibuprofen and/or paracetamol with placebo), controlled observational studies and large case series comprised more than 1000 participants.

Main outcome measures: Adverse events (AEs) requiring discontinuation of medication; systemic reactions related to ibuprofen or paracetamol; serious AEs that are fatal, life-threatening or require hospitalisation; and serious AEs not requiring hospitalisation.

Results: A total of 24 RCTs examined either ibuprofen and/or paracetamol versus placebo for AE data. Twelve other studies meeting our criteria were also included for AE data. Meta-analysis of systemic reactions demonstrated that tolerability and safety of ibuprofen was similar to placebo, as was paracetamol: ibuprofen versus placebo relative risk (RR) 1.39 (95% CI: 0.92, 2.10); paracetamol versus placebo RR 1.57 (95% CI 0.74, 3.33). A total of 2937 systemic AEs occurred in 21?305 patients taking ibuprofen compared with 1466 systemic AEs in 11?164 patients taking paracetamol: RR 1.03 (95% CI 0.98, 1.10). There was no significant difference between the two groups. Narrative analysis of AE data identified conflicting evidence regarding hepatic injury with paracetamol and group A streptococcal infections with ibuprofen or paracetamol treatment.

Conclusions: Ibuprofen, paracetamol and placebo have similar tolerability and safety profiles in terms of gastrointestinal symptoms, asthma and renal adverse effects. While the study data investigated here may not reflect over-the-counter use, these results are still relevant in the context of any safety concerns relating to general ibuprofen or paracetamol treatment in children.     

西咪替丁与兰索拉唑治疗消化性溃疡出血有效性和安全性分析

目的分析西咪替丁与兰索拉唑治疗消化性溃疡出血的有效性和安全性。方法所有患者均实施对症支持治疗,并选择40例患者使用西咪替丁治疗,与40例使用兰索拉唑治疗的患者比较两组胃液pH值、确定停止出血时间和疼痛消失时间,比较两组发生的并发症和统计两组的临床疗效。结果西咪替丁组治疗后胃内pH值显著低于兰索拉唑组(P<0.05);而凝血时间和疼痛消失时间均显著长于兰索拉唑组(P<0.05);西咪替丁组发生肝肾功能受损和皮疹的比率分别为22.5%和20.0%,均显著高于兰索拉唑组2.5%(P<0.05);西咪替丁组显效率高于兰索拉唑组(P<0.05)。结论兰索拉唑治疗消化性溃疡出血起效快,维持时间长,不良反应少,是一种值得临床推广的方法。     

雷贝拉唑联合奥美拉唑治疗消化性溃疡疗效和安全性评价

目的探讨分析了雷贝拉唑联合奥美拉唑在消化性溃疡治疗过程中的临床疗效以及不良反应。方法 2009年到2011年共收治消化性溃疡患者130例,130例患者随机分为两组,治疗组和对照组,每组患者65例,对照组患者采用口服奥美拉唑进行单独治疗,治疗组患者在对照组治疗的基础上给予雷贝拉唑联合治疗。两组患者在治疗期间均对患者的临床症状以及药物毒副作用进行记录,并分析两组患者治疗的临床有效率。结果治疗组疗效显著性高于对照组,差异具有统计学意义(P<0.05);对照组有4例患者出现头晕以及恶心症状,5例出现腹胀,治疗组3例出现恶心和呕吐以及头晕,4例出现了腹胀,均不影响治疗,均好转,对照组和治疗组患者的不良反应比较差异无统计学意义(P>0.05)。结论雷贝拉唑联合奥美拉唑在治疗消化道溃疡方面具有明显协同效应,其可显著性抑制患者胃酸分泌,清除患者幽门螺杆菌,是临床治疗消化道溃疡较好的药物配伍方案,值得临床推广使用。     

布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭对患儿血浆和尿前列腺素E_2水平的影响

目的分析布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭(sPDA)对患儿血浆和尿前列腺素E_2(PGE_2)水平的影响。方法纳入2014年7月至2016年12月我院出生的患有sPDA的84例早产儿作为观察对象。随机纳入42例给予布洛芬进行治疗(A组),另外42例给予对乙酰氨基酚治疗(B组)。对比两组治疗疗效,治疗前后血浆和尿PGE_2水平以及不良反应。结果两组患儿在各时段的关闭率以及总关闭率的组间差异均无统计学意义(P>0.05)。经治疗,两组患儿血浆PGE_2和尿PGE_2水平均较治疗前下降,与治疗前比较差异有统计学意义(P<0.05);A组下降程度稍大于B组,但组间差异均无统计学意义(P>0.05)。经治疗,两组患儿肝肾功能指标血肌酐(SCr)和丙氨酸氨基转移酶(ALT)水平均较治疗前略有上升(P>0.05),血小板(PLT)较治疗前有所下降,但差异无统计学意义(P>0.05);两组SCr、ALT及PLT水平比较差异无统计学意义(P>0.05)。B组高胆红素血症比例低于A组,组间差异有统计学意义(P<0.05),其他不良反应上,组间差异均无统计学意义(P>0.05)。结论布洛芬与对乙酰氨基酚的疗效相当,其对血浆PGE_2和尿PGE_2水平的影响略强于对乙酰氨基酚,但对乙酰氨基酚高胆红素血症的比例低于布洛芬。     

泮托拉唑与奥美拉唑治疗消化性溃疡出血的疗效比较

目的 观察比较泮托拉唑与奥美拉唑治疗消化性溃疡出血的临床效果.方法 选择78例确诊为消化性溃疡出血的患者,按入院顺序随机分为2组,39例患者在常规治疗基础上加用泮托拉唑治疗（泮托拉唑组）,39例患者在常规治疗基础上加用奥美拉唑治疗（奥美拉唑组）,均治疗3~6 d.其中常规治疗主要包括禁饮食、输液、维持水电解质平衡、输血及营养支持等治疗.仔细观察并记录两组患者每日呕血次数、黑便次数及出血量,仔细记录两组患者停止出血时间,并比较两组患者治疗效果,同时观察并记录用药期间不良反发生情况.结果 泮托拉唑组治疗第1天、第3天时出血量明显低于奥美拉唑组（P〈0.05）;泮托拉唑组平均停止出血时间为（1.5±0.4） d,奥美拉唑组为（2.4±0.6） d,两组比较差异有统计学意义（P〈0.05）.两组患者未出现明显不良反应.泮托拉唑组显效率高于奥美拉唑组,两组比较差异有统计学意义（74.36% vs.48.72%,P〈0.05）;泮托拉唑组、奥美拉唑组的总有效率比较差异无统计学意义（97.44% vs.94.87%,P〉0.05）.结论 泮托拉唑与奥美拉唑应用于消化道溃疡出血的治疗效果相当,且均无明显不良反应,但泮托拉唑显效快,可明显缩短出血时间,提高显效率.     

精氨洛芬治疗膝骨关节炎有效性和安全性观察

目的：观察精氨洛芬治疗膝骨关节炎（OA）的疗效和安全性。方法：采用开放试验,观察30例膝OA患者应用精氨洛芬（400mg,tid）的疗效和安全性,疗程为14d。主要疗效指标为靶部位患者的总体评价（视觉模拟评分法,VAS）,次要疗效指标包括休息痛指数、活动痛指数、关节压痛指数、关节肿胀指数、医生总体评价和药物起效时间,并对不良事件进行统计记录。结果：治疗前患者的总体VAS评分为（6.62±1.52）,治疗后降低至（3.57±2.36）（P〈0.001）,除关节肿胀指数外的各次要疗效指标在治疗后也有不同程度改善（P〈0.01或P〈0.001）,总有效率为70.0%。不良事件发生率为16.7%,而且均是轻度。结论：精氨洛芬治疗膝骨关节炎有良好的止痛效果,安全性好。     

奥曲肽联合泮托拉唑治疗老年患者消化性溃疡并出血疗效观察

【摘要】目的观察奥曲肽联合泮托拉唑对老年患者消化性溃疡并出血的治疗效果。方法选取符合诊断标准的消化性溃疡合并上消化道出血老年患者70例,随机分成观察组和对照组,每组各35例,治疗组应用奥曲肽联合泮托拉唑治疗,对照组单独用泮托拉唑进行治疗,观察及比较两组治疗效果、总有效率以及再出血情况。结果奥曲肽联合泮托拉唑治疗组总有效率为94．28％,对照组总有效率为82．86％,两组比较差异具有统计学意义（P〈0．05）。结论奥曲肽联合泮托拉唑治疗老年患者消化性溃疡并出血疗效优于单用泮托拉唑治疗。     

Warfarin-associated bleeding events and concomitant use of potentially interacting medicines reported to the Norwegian spontaneous reporting system

AIMS

To study warfarin associated bleeding events reported to the Norwegian spontaneous reporting system and evaluate the differences in assessment of potentially interacting medicines between reporters and evaluators.

METHODS

Data on bleeding events on warfarin were retrieved from the Norwegian spontaneous reporting system database. Key measurements were time to bleeding, use of concomitant medications and the evaluation done by reporters.

RESULTS

In 289 case reports a total of 1261 medicines (median 4.0 per patient, range 1–17) was used. The evaluators (authors of this article) identified 546 medicines including warfarin (median 2.0 per patient, range 1–7) that could possibly cause bleeding alone or in combination. Reporters assessed 349 medicines (median 1.0 per patient, range 1–4) as suspect. Evaluators identified 156 pharmacokinetic and 101 pharmacodynamic interactions, compared with 19 pharmacokinetic and 56 pharmacodynamic interactions reported as suspected by the reporters. Time to bleeding was stated in 224 reports. Among the early bleeding events, the reports on warfarin without interacting medicines showed the highest INR (international normalized ratio). Heparin was used in 17/21 reported bleeding events during the first week on warfarin. Among the late bleeding events, reports with pharmacokinetic interacting medicines had the highest INR.

CONCLUSIONS

Concomitant use of potentially interacting medicines was involved in the majority of the warfarin-associated bleeding events reported to the Norwegian spontaneous reporting system. Reporters assessed mostly warfarin as the only contributor to bleeding. In particular, pharmacokinetically interacting medicines were not suspected as contributing to bleeding.     

米卡芬净临床不良反应及合理用药

目的分析并探讨米卡芬净不良反应(ADR)发生的类型及特点,为临床安全、合理用药提供参考。方法检索国内外有关米卡芬净不良反应的病例报道,对其不良反应发生类型及特点进行分析和总结。结果米卡芬净的不良反应以皮疹、胃肠道反应及肝损害最为多见,另外可见心血管疾病、溶血及过敏反应等。结论鉴于米卡芬净可造成患者多个器官和系统的不良反应,医药人员在临床治疗过程中应加强不良反应的监测,减少和防止ADR的发生率,以确保患者的用药安全。     

伊立替康的用药风险与合理用药

目的分析伊立替康在临床使用中出现的不良反应(ADRs)及用药合理性,促进临床安全用药。方法检索近5年国外有关伊立替康ADRs的文献报道,进行分析整理。结果伊立替康的ADRs主要为胃肠道反应、血液系统、神经系统、皮肤及附件损害等,严重时可导致死亡。结论临床医务人员应及时处理伊立替康引起的ADRs,增加患者的依从性、耐受性,以保证临床用药安全。     

葛根素注射剂不良反应及其影响因素分析

目的：研究葛根素注射剂（GGS）引起的药物不良反应（ADR）发生率、ADR类型，探索GGS引起的溶血性贫血（Hemolytic Anemia，HA）的发生机制。方法：利用北京市ADR监测网络，选择32家医疗单位参加本课题研究。课题以使用GGS的l319例病例为暴露组，同期使用丹参／复方丹参注射液（DS）的541例病例为对照组．进行队列研究。并将暴露组中临床拟诊为HA的6例患者作为病例组，设立正常对照组进行血液免疫学临床试验研究，以探索GGS引起的HA的发生机制。结果：GGS的ADR发生率3．34％，与DS（3．14％）相比两组差异无统计学意义（P〉0．05）。暴露组ADR以转氨酶升高、药疹和HA最为多见；对照组ADR以药疹为主，两组ADR表现形式的构成差异呈高度显著（P〈0．001）：暴露组中、重度病例15．9％，死亡2例。GGS引起的HA属于Ⅱ型变态反应。结论：GGS与DS的ADR发生率差异无显著性，但对GGS引起的严重ADR应给予特别关注。对于使用GGS的患者应定期监测相关指标，特别是对于体内已存在抗葛根素药物性抗体（GGS-Ab）的患者应避免再次使用该药。