氟比洛芬酯复合小剂量吗啡用于胸科术后静脉镇痛的临床观察

目的观察氟比洛芬酯复合小剂量吗啡用于开胸手术术后静脉镇痛的效果和安全性。方法60例开胸手术患者,随机分成两组（F、M组）,每组30例,术毕接电子泵行静脉自控镇痛（PCIA）。F组手术结束前15min静脉注射氟比洛芬酯50mg＋吗啡3mg为首量,维持配方为吗啡24mg＋氟比洛芬酯300mg＋生理盐水共150ml,背景流量2ml/hr,单次剂量3ml,锁定时间30min。M组在相同时间点给吗啡3mg为首量,维持配方为吗啡60mg＋生理盐水共150ml,参数同F组。分别记录和统计手术后12、48h各时间点两组患者的视觉模拟疼痛评分（VAS）、镇静评分（Ramsay评分）、泵按压次数、伤口引流量及恶心、呕吐、瘙痒、呼吸抑制、消化道出血等不良反应的发生率。结果两组镇痛效果相近,VAS评分和48h伤口引流量组间比较,差异无统计学意义（P〉0.05）,F组镇静评分、恶心、呕吐、瘙痒发生率低于M组,组间比较,差异有统计学意义（P〈0.05）。M组有1例呼吸抑制,F组无呼吸抑制。两组均未见消化道出血。结论氟比洛芬酯复合小剂量吗啡用于开胸手术术后静脉镇痛,疗效确切,不良反应少,安全性高。     

氟比洛芬复合芬太尼用于术后镇痛的疗效及安全性的研究

目的评价与芬太尼合用进行中等手术病人围术期镇痛的效果及安全性。方法192例病人随机分为4组，常规采用静吸复合麻醉，根据手术时间对术中芬太尼总量进行控制，术后采用静脉镇痛。氟比洛芬按照以下方案给予，除A组外，其余3组均于手术结束前给予氟比洛芬50mg。A组：术后芬太尼1mg＋生理盐水100ml；B组：术后芬太尼1mg＋生理盐水100ml；C组：术后100mg氟比洛芬＋芬太尼0．5mg＋生理盐水至100ml；D组；术后150mg氟比洛芬＋芬太尼0．5mg＋生理盐水至100ml。术后随访24h，记录生命体征、镇痛情况及其不良反应。结果整个研究共完成病例191例，4组手术病人一般情况无显著差别，术后24h内生命体征基本平稳。结果术后0h，VAS（视觉模拟疼痛评分）B、C、C〈VASA，术后4，8h，VASCD〈VASA，术后24h，VASC〈VAS10。D组病人呕吐的发生率显著高于其它3组。结论氟比洛芬复合芬太尼用于中等手术病人围术期镇痛具有确切的疗效，不良反应发生率较低，可以安全用于临床。     

氟比洛芬酯复合芬太尼用于乳癌根治术后镇痛的临床观察

目的观察氟比洛芬酯与芬太尼联合用于乳癌根治术后病人自控静脉镇痛（PCIA）的有效性和不良反应。方法30例30～70岁拟行乳癌根治手术病人随机分为两组：对照组（A组）及氟比洛芬酯与芬太尼联合用药组（B组），每组15例。术毕使用PCIA，并分别记录患者苏醒后2h（T1），5h（T2），和24h（T3）3个时间点的疼痛程度（PI）、疼痛缓解程度（PAR）、镇静评分（SS）、24h用药量及各种不良反应。结果在所有时间点，PI值A组与B组差异无显著意义（P〉0．05）；PAR值A组与B组差异无显著意义（P〉0、05）；对照组的镇静度和恶心呕吐不良反应的发生率与联合用药组差异有显著性（P〈0．05）。结论氟比洛芬酯与芬太尼联合用于乳癌根治术后病人自控静脉镇痛（PCIA）可减少用药量，减少不良反应的发生，提高镇痛质量。     

氟比洛芬酯对鼻内镜术术后镇痛效果的临床观察

目的：观察氟比洛芬酯注射液对鼻内镜术术后的镇痛效果及超前镇痛作用。方法：选择择期行鼻内镜术患者60例，采用随机方法分为术前给药组（A组）、术后给药组（B组）及对照组（C组），每组各20名。A组于术前15min缓慢静脉注射氟比洛芬酯50mg，B组于术毕缓慢静脉注射氟比洛芬酯50mg，C组不给药，分别观察术后6h和12h的视觉模拟量表（VAS）评分。结果：A组和B组术后6和12h VAS评分均显著低于C组。A组术后6h VAS评分低于B组，但术后12h无显著差异。结论：氟比洛芬酯注射液可有效缓解鼻内镜术术后疼痛，且术前给药优于术后给药。     

腹腔镜术终运用氟比洛芬酯和氯诺昔康术后镇痛的比较

目的观察腹腔镜术终时分别运用氟比洛芬酯和氯诺昔康进行术后镇痛效果的比较。方法123例行择期腹腔镜手术的患者,随机分为A组(40例)、B组(43例)和C组(40例),于手术结束前分别不予镇痛处理、静脉注射氯诺昔康8 mg、氟比洛芬酯50 mg。于术后6 h内用视觉模拟评分(VAS)分别对3组患者进行疼痛评估,比较镇痛效果,并记录不良反应的发生。结果B组和C组的疼痛均明显减轻,C组患者的不良反应略轻于B组。结论氟比洛芬酯静脉注射用于腹腔镜手术术后镇痛效果与氯诺昔康接近,但不良反应少。     

氟比洛芬酯超前镇痛对髋关节置换术后镇痛效果的影响

目的观察氟比洛芬酯超前镇痛用于髋关节置换术的临床效果。方法将40例52—73岁拟行髋关节置换术病人随机分为两组：A组术前15min静脉缓注氟比洛芬酯1．0mg／kg；B组术前15min静脉缓注等容量生理盐水，每组20例。术毕使用病人自控静脉镇痛（patient controlled intravenous analgesia，PCIA），并采用视觉模拟评分法（visual analogue scale，VAS）分别记录患者术后1h、2h、4h、8h、16h、24h共6个时间点的疼痛评分，记录24h用药量和各种不良反应。结果两组患者的性别、年龄、体重、手术时间、术中出血量等一般情况，无显著性差异（P〉0．05），两组术后的镇痛效果无显著性差异，而A组恶心、呕吐的发生率低于B组（P〈0．05），A组24h内舒芬太尼用药量明显少于B组（P〈0．05）。结论应用氟比洛芬酯超前镇痛能明显减少髋关节置换术患者PCIA期间舒芬太尼用药量及不良反应发生率，提高镇痛质量。     

Lipid nano/submicron emulsions as vehicles for topical flurbiprofen delivery

The application of lipid nano/submicron emulsions as topical drug carrier systems for the percutaneous absorption of flurbiprofen was investigated. The lipid emulsions were made up of isopropyl myristate (IPM), soybean oil, or coconut oil as the oil phase, egg lecithin as the predominant emulsifier, and double-distilled water as the external phase. Stearylamine (SA) and deoxycholic acid (DA) also were used to produce positively and negatively charged emulsions. To evaluate the physicochemical properties of the lipid emulsions, particle size by laser light scattering, the image of atomic force microscopy, and relaxation time values by Nuclear Magnetic Resonance (NMR) were determined. The in vitro permeation data showed that incorporation of SA significantly reduced the topical delivery of flurbiprofen. On the other hand, incorporation of DA exhibited no or a negligible effect on drug permeation. Enhancement of drug absorption was observed when adding oleic acid as part of the oil phase. The in vivo topical application of flurbiprofen from selected lipid emulsions showed a similar trend to the in vitro status. Furthermore, the intersubject variability was considerably reduced by lipid emulsions than by aqueous suspensions in both the in vitro and in vivo experiments. The irritant profiles of lipid emulsions showed that IPM elicited higher irritation than soybean oil. The incorporation of oleic acid also produced skin disruption. The results in the present study suggest the feasibility of lipid emulsions for the topical delivery of flurbiprofen.     

氟比洛芬酯复合酒石酸布托啡诺在腔镜甲状腺切除术后的镇痛效果研究

目的评价氟比洛芬酯复合酒石酸布托啡诺用于腔镜甲状腺切除术后多模式镇痛效果。方法选择60例拟行腔镜下甲状腺切除手术的成年女性患者,ASAⅠ-Ⅱ级,随机分为3组：对照组（C组）：注射用芬太尼0.1mg稀释至10ml,拔管后即刻静脉缓慢推注;氟比洛芬酯组（F组）：氟比洛芬酯100mg,拔管后即刻静脉缓慢推注;氟比洛芬酯复合酒石酸布托啡诺组（FB组）：氟比洛芬酯注射液50mg复合酒石酸布托啡诺1mg稀释至10ml,拔管后即刻静脉缓慢推注。观察静脉给药后0、2、4、8、12、24h的镇痛、镇静评分及不良反应发生率。结果与C组比较,F组在术后4h镇痛评分低;FB组在术后2、4及8h镇痛评分低,2及4h镇静评分高（P〈0.05）。与F组比较,FB组在术后2及4h镇痛评分低,在2h镇静评分高（P〈0.05）。术后恶心呕吐、呼吸抑制、皮肤瘙痒等不良反应发生率差异无统计学意义（P〉0.05）。结论氟比洛芬酯复合酒石酸布托啡诺静脉注射安全有效,能够更好的满足腔镜甲状腺切除术后早期镇痛,且镇静效果好。     

不同镇痛方式对腹腔镜胆囊切除术患者血浆皮质醇和血糖的影响

目的研究不同镇痛方式对腹腔镜胆囊切除术患者术后疼痛的影响。方法选择ASAⅠ或Ⅱ级行择期腹腔镜胆囊切除术老年患者60例,随机分为地佐辛组（D组,n=20）、氟比洛芬酯Ⅰ组（F组,n=20）和罗哌卡因组（R组,n=20）。D组于手术结束前5分钟静脉推注地佐辛0.1 mg/kg进行后处理;F于手术结束前5分钟静脉推注氟比洛芬酯1.0 mg/kg进行后处理;R组于手术结束前向切口内喷洒0.75%盐酸罗哌卡因4 mL,并在颈部切口两侧注入0.75%盐酸罗哌卡因6 mL封闭治疗。观察3组患者在麻醉前5分钟（T0）、术后6h（T1）、术后24 h（T2）、术后48h（T3）、术后72 h（T4）等各时点血浆皮质醇（Cor）,血糖（Glu）的水平。记录T2、T3、T4时使用镇痛药的患者比例和VAS（视觉模拟评分）。结果与T0比较：T1、T2时,D组、R组血浆Cor和GLU升高（P〈0.05）。与F组比较：T1、T2时,D组、R组血浆Cor和GLU降低（P〈0.05）;T2时R组需要使用镇痛药的患者比例显著下降（P〈0.01）;T4时D组、R组需要使用镇痛药的患者比例均下降（P〈0.05）;T2、T3、T4时VAS无差异。结论腹腔镜胆囊切除术患者使用罗哌卡因封闭治疗,能取得较好的镇痛效果,并能有效地抑制围术期应激反应。     

Reply to comments by Gonzalez et al. on the Concerta,Adderall XR Food Evaluation (CAFE) Study

Summary

A double-blind crossover trial of 200?mg flurbiprofen daily and 100?mg indomethacin daily, each given for 2 weeks separated by a 1-week placebo washout period, was carried out in 30 patients with rheumatoid arthritis. The results were analyzed for the 26 patients with complete records. No statistically significant differences were found between the two treatments with regard to subjective impression of pain severity, duration of morning stiffness, grip strength, joint size, haemoglobin and erythrocyte sedimentation rate. When the results for each treatment period were compared to baseline and both drugs considered individually, there was a statistically significant improvement from baseline. During the flurbiprofen treatment period the erythrocyte sedimentation rate showed a statistically significant fall, but not with indomethacin. During the placebo washout period between the active therapies, there was a statistically significant worsening in all parameters apart from the level of haemoglobin and erythrocyte sedimentation rate. These assessments showed little change. Five patients reported side-effects with indomethacin, and 1 with flurbiprofen. No side-effects were reported during the placebo period and although 4 patients were withdrawn, none was withdrawn because of side-effects. Patient preference was for flurbiprofen.