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71.
Linton-Dahlöf P Linde M Dahlöf C 《Cephalalgia : an international journal of headache》2000,20(7):658-662
Chronic daily headache (CDH) associated with long-term misuse of headache medication is a common clinical problem which is refractory to most treatments. The present study is a retrospective analysis of the effect of drug withdrawal therapy in patients with CDH and frequent long-term use of headache symptomatic medication. One hundred and one adult patients (74 women and 27 men, aged between 16 and 72 years, mean age 43 years) were evaluated 1-3 months after drug withdrawal therapy had been initiated. The mean headache frequency at baseline was 26.9+/-4.0 days per month. Fifty-seven (56%) patients were significantly improved (defined as at least 50% reduction in number of headache days) after a period of drug withdrawal therapy. Based on the outcome of the drug withdrawal therapy, the patients were divided into three categories: group I, those who had between 0 and 10 headache days per month (n = 41), group II, those who had 11-20 days (n = 37), and group III, those who had 21-30 days (n = 23). The mean headache frequencies in groups I, II and III were 5.6+/-2.8 days, 15.7+/-2.5 days and 28.7+/-2.4 days, respectively. Treatment with amitriptyline was offered to patients in whom no improvement had been achieved. Ten of those 22 patients (36%) experienced a significant (> or = 50%) reduction of headache days. It is concluded that out-patient drug withdrawal therapy is the treatment of choice in patients with CDH and frequent long-term use of headache symptomatic medication, and that about one quarter of these CDH patients do not respond to drug withdrawal therapy only. 相似文献
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Grosset AB Roberts MS Woodson ME Shi M Swanton RE Reder RF Buckley BJ 《Journal of pain and symptom management》2005,29(6):584-594
Two multicenter, randomized, double-blind, crossover studies with identical designs evaluated the efficacy of oral extended-release hydromorphone (HHER) administered q24h compared with immediate-release hydromorphone (HHIR) dosed four times daily in patients with persistent moderate to severe pain. Patients titrated to a stable HHER dose were randomized to individualized doses of HHER or HHIR for 3 to 7 days before crossover to the second treatment. Primary efficacy end point was the mean of average pain intensity (API) scores, rated on a 0- to 10-point numeric scale, over the last 2 days before the pharmacokinetics/pharmacodynamics day of each double-blind period. Difference between treatments (HHER − HHIR) in study 1 was 0.17 with a 90% confidence interval (CI) (−0.01, 0.34); in study 2, difference was 0.07 with a 90% CI (−0.12, 0.26). There were no significant differences between treatments in API scores or amount of rescue medication used at any time interval within the 24-hour dosing period. No reduction in pain control occurred in patients administered HHER at the end of the 24-hour dosing period. Most treatment-emergent adverse events were opioid-related. In these studies, HHER administered q24h and HHIR dosed four times daily provided comparable analgesia at an equivalent total daily dose. 相似文献
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目的 探讨帕瑞昔布钠不同给药时机对瑞芬太尼复合麻醉患者术后急性阿片类药物耐受的影响.方法 择期拟行胆囊切除术患者54例,ASA Ⅰ或Ⅱ级,年龄30~64岁,随机分为3组(n=18):均靶控输注异丙酚(血浆靶浓度3μg/ml)和瑞芬太尼(血浆靶浓度4 ng/m1)行麻醉诱导和维持,Ⅰ 组和Ⅱ组分别于麻醉前30 min、术毕前30 min静脉注射帕瑞昔布钠40 mg,C组为对照组.术后在麻醉复苏室30 min内每隔5 min询问患者的疼痛情况,疼痛评分>0分时,静脉注射吗啡2 rag,30 min后连接病人自控静脉镇痛泵(按压1次吗啡剂量1-1lg,锁定时间5 min)返回病房,记录术后30 min内、30 min~24 h及24~48 h的吗啡用量,观察不良反应的发生情况.结果 与C组比较,Ⅰ组术后48 h内各时段、Ⅱ组术后30 min~24 h及24~48 h的吗啡用量降低(P<0.05),Ⅱ组术后30 min内差异无统计学意义(P>0.05);与Ⅰ组比较,Ⅱ组术后30 min内吗啡用量升高(P<0.05).各组均未见不良反应发生.结论 麻醉前30 rain静脉注射帕瑞昔布钠40 mg可有效减轻瑞芬太尼复合麻醉患者术后早期的急性阿片类药物耐受. 相似文献
76.
目的分析研究南京中医药大学泰州附属医院2008年癌症患者麻醉性镇痛药的应用情况,为临床用药合理性提供指导。方法根据世界卫生组织的建议,对我院麻醉镇痛药以药物利用指数(DUI)为指标对处方进行分析,评价该类药物应用的合理性。结果1年中我院癌症患者使用美施康定、度冷丁、可待因片止痛,分别占各自消耗量的100%。39.5%,3.5%.结论我院麻醉药品品种相对比较齐全,能给患者提供良好的治疗。在应用上较为合理,能够把握WHO癌症三阶梯止痛方案的规定,安全、合理、有效地使用麻醉药品。 相似文献
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Dong-Yun Shin Jae-Sang Ryu Soon-Sil Hyun Hyun-Ju Park Ra-Ok Jeon Young-Ger Suh 《Archives of pharmacal research》1999,22(4):398-400
Sufentanil, a potent anilidopiperidine analgesic, was synthesized from a simple thiophenylethylamine via six step sequence. The key parts of this synthesis involved an efficient construction of thiophenylethylpiperidone by aminomethano desilylation-cyclization followed by Swern oxidation and a direct regioselective N-nucleophilic spiral epoxide cleavage with aniline promoted by Lewis acids. 相似文献