氯诺昔康用于功能性鼻窦内窥镜手术后患者自控镇痛的临床观察

目的:评价非甾体抗炎药氯诺昔康用于功能性内窥镜鼻窦手术(Fess)后患者自控镇痛(PClA)的效应及安全性.方法:45例手术患者,随机分为对照组(C)、氯诺昔康组(K)和氯诺昔康复合芬太尼组(KF),K组和KF组接受PCIA治疗,使用力美泵,观察术后各时间点患者的疼痛程度分布情况,术后睡眠情况,不良反应及完成术后镇痛48h内患者对镇痛治疗总体印象评分.结果:K组和KF组都能提供Fess术后满意的镇痛效果,与C组术后不同时间点疼痛分布情况差异明显(P＜0.05),KF组患者术后睡眠质量好(P＜0.05),但肛门排气时间延长(P＜0.05).结论:氯诺昔康用于Fess术后PCIA具有安全可行性.     

氟比洛芬酯超前镇痛在妇科腹腔镜手术中的应用

目的:研究非甾体类抗炎药物对妇科腹腔镜术后超前镇痛的效果。方法:66例择期行妇科腹腔镜手术的患者,随机分为三组,各22例。麻醉诱导前A组(静注氟比洛芬酯50 mg),B组(氯诺昔康8 mg);C组静注等量生理盐水。每组患者于完全清醒时,清醒后0.5 h、1 h、2 h、8 h、24 h进行VAS评分及不良反应观察。结果:A组完全清醒后8 h内和B组完全清醒后2 h内各时点的VAS评分,均明显低于C组相应时点(P<0.05),且完全清醒后8 h内各观察点VAS,氟比洛芬酯组明显低于氯诺昔康组;与C组比较,A、B两组未见明显不良反应。结论:麻醉诱导前预注氟比洛芬酯或氯诺昔康,均能减轻妇科腹腔镜手术后疼痛,以氟比洛芬酯效果较好。     

Effects of the intraperitoneal lornoxicam on the formation of intraperitoneal adhesions in rat peritonitis model

BACKGROUND: To investigate the effects of intraperitoneally administered lornoxicam on adhesion formation, bursting pressure, tissue antioxidant levels, morbidity and mortality after ileocolic anastomosis in a rat bacterial peritonitis model. METHODS: Thirty-six rats were divided into three random groups. Bacterial peritonitis was induced by performing a cecal ligation and puncture, then the cecal was resected and ileocolic anastomosis was performed. Rats of groups 1, 2 and 3 were given 2 mL normal saline, 2 mL lornoxicam, and nothing, respectively. All groups were killed at day 14. Adhesions were scored, and the presence of intra-abdominal abscesses and fistulas were noted. Anastomotic healing was assessed by bursting pressure. Tissue antioxidant levels were tested from left abdominal walls. RESULTS: One day after cecal ligation and puncture, microbiological examination showed polymicrobial bacterial peritonitis. The rats treated with lornoxicam had significantly lower adhesion scores than did the saline and nothing treated rats (P = 0.007). Bursting pressures of groups were unaffected by the treatment. Tissue antioxidant levels of groups were affected by the treatment. Morbidity and mortality were similar in all groups. CONCLUSIONS: The present study demonstrated that a single intraperitoneal instillation of lornoxicam in buffer solution at the end of the surgery reduces adhesion formation in rats bacterial peritonitis model. It was also determined that lornoxicam had no negative effect on the healing of intestinal anastomosis, abscess and anastomotic leakage. Use of lornoxicam in peritonitis was effective in decreasing the oxidative stress of tissue during peritonitis.     

Lornoxicam pharmacokinetics in relation to cytochrome P450 2C9 genotype

AIMS: To investigate the pharmacokinetics of lornoxicam and the relationship with CYP2C9 polymorphism in healthy Chinese subjects. METHODS: A single oral dose of 8 mg lornoxicam was administered to 18 healthy Chinese male subjects. Plasma was sampled for 24 h post dose, and plasma concentrations of lornoxicam were measured using a validated LC/MS/MS method. CYP2C9 genotype was determined by polymerase chain reaction-based restriction fragment length polymorphism or by direct sequencing of the coding region of the CYP2C9 gene. RESULTS: Of the 18 subjects, one subject was found to be a very poor metabolizer of lornoxicam with a long t(1/2) of 106 h, a low CL/F of 0.71 ml min(-1), and a high AUC(0-infinity) of 187.6 microg ml(-1) h. Genotyping studies revealed that this subject was heterozygous for CYP2C9*3 and a new variant CYP2C9 allele. Of the other 17 subjects, 13 were *1/*1 carriers, three were *1/*3 carriers, and one was a *1/*2 carrier. Mean AUC(0-infinity) values (95% confidence intervals) of lornoxicam were 9.25 (6.55, 11.95) vs. 4.75 (3.55, 5.95) microg ml(-1) h in *1 heterozygotes vs.*1 homozygotes, and mean CL/F values were 14.8 (10.2, 19.4) vs. 32.9 (24.5, 41.3) ml min(-1), respectively (P < 0.05 for both AUC and CL/F). CONCLUSIONS: The results show that the pharmacokinetics of lornoxicam are dependent on CYP2C9 polymorphism. In particular, the presence of the CYP2C9*3 allele impairs the oral clearance of lornoxicam.     

关节腔内注射氯诺昔康复合布比卡因、吗啡或丁丙诺啡用于膝关节镜术后镇痛的效应

目的:评价关节腔内单独使用氯诺昔康及其配伍布比卡因、吗啡、丁丙诺啡用于膝关节镜术后镇痛的效果。方法:病例选自于摩洛哥王国塔塔医院和塞达特医院,共120例慢性膝关节炎行膝关节镜手术患者,随机分为6组,每组20例。A组:氯诺昔康8 mg;B组:吗啡2 mg;C组:氯诺昔康8 mg+0.5%布比卡因20 ml;D组:吗啡2 mg+0.5%布比卡因20 ml;E组:氯诺昔康8 mg+丁丙诺啡0.1 mg;F组:氯诺昔康8 mg+吗啡2 mg。A、B、E、F组均用生理盐水稀释至20 ml。于手术结束时关节腔内注射药物行术后镇痛。分别记录术后各组0.25、0.5、1、4、8、16、20、24 h在膝关节屈曲90°状态下疼痛程度(PI)、疼痛程度差值(PID)、疼痛缓解程度值(PAR)、镇痛治疗总体印象评分及药物相关副作用。结果:术后0.25、0.5、16、20、24 h,A、B组PID值低于C、D、E、F组(P<0.01),PAR值高于C、D、E、F组(P<0.01)。术后8、16 h A组PID值高于B组(P<0.01),PAR值低于B组(P<0.01)。镇痛治疗总体印象评分在C、D、E、F四组之间无不同,但明显优于A组与B组(P<0.01)。E组有7例、F组有9例出现腹胀、恶心。结论:氯诺昔康复合布比卡因或阿片类药物关节腔内注射用于膝关节镜术后镇痛的效果明显优于其单独用药,但合用阿片类药物可引起轻度胃肠道症状。     

氯诺昔康复合芬太尼和曲马多病人自控镇痛的比较

目的：评价氯诺昔康复合小剂量芬太尼与曲马多比较病人术后静脉自控镇痛（PCIA）中的疗效与不良反应。方法：80例ASAⅠ-Ⅱ级择期行乳腺癌根治术患者,随机分为实验组和对照组。实验组以氯诺昔康48mg和芬太尼0．3mg用生理盐水稀释至100ml。对照组以曲马多1000mg和氟哌利多5mg用生理盐水稀释至100ml。拔除气管导管后开通PCIA,预注泵内液4ml。PCIA设计2ml／h,PCA每次0．5ml,锁定时间15分钟。记录PCA次数和术后4,8,12,24,48小时视觉模拟镇痛评分（VAS）及不良反应发生。结果：两组镇痛效果VAS评分无统计学差异（P〉0．05）,但实验组患者PCA次数明显少于对照组（P〈0．05）,实验组不良反应恶心、呕吐、眩晕、嗜睡等发生率低于对照组（P〈0．05）。结论：氯诺昔康复合小剂量芬太尼可获得良好的镇痛效果和较少的不良反应,司作为多模式镇痛药物选择。     

氯诺昔康和吗啡在自控镇痛中的作用比较

目的　比较氯诺昔康和吗啡在患者静脉自控镇痛中的效果和副作用。方法　选择 6 0例要求使用镇痛泵的患者 ,随机分为氯诺昔康组 (L组 ,n =31)和吗啡组 (M组 ,n =2 9) ,接受静脉自控镇痛治疗 ,L组使用氯诺昔康 (4 8mg/ 4 8h) ,M组使用吗啡 (6 0mg/ 4 8h)。观察 2组患者术后镇痛效果 (疼痛缓解评分总和及疼痛程度差值总和 )、副作用 (瘙痒、恶心和呕吐、尿潴留 )。结果　L组和M组的疼痛缓解评分总和分别为 13 8± 2 8、14 1± 2 6 (P >0 0 5 ) ,疼痛程度差值总和分别为 9 4± 2 1、8 3± 2 9(P >0 0 5 )。L组的瘙痒、恶心和呕吐发生率低于M组 (P <0 0 5 ) ,尿潴留也低于M组 (P <0 0 1)。结论　氯诺昔康在患者静脉自控镇痛的镇痛效果与吗啡相近 ,而其副作用低于吗啡 ,应用于手术患者术后镇痛安全可靠     

Efficacy of Preventive Analgesia with Tramadol or Lornoxicam for Percutaneous Nephrolithotomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

Background: Prevention of postoperative pain provides better and more rapid convalescence for patients.Objective: The aim of this study was to compare the preventive analgesic effect of tramadol and lornoxicam in the early postoperative period in patients undergoing percutaneous nephrolithotomy (PCNL).Methods: Patients who were scheduled for elective PCNL at the Cumhuriyet University Hospital, Sivas, Turkey, were enrolled in this prospective, double-blind, placebo-controlled study. The patients were randomly assigned to 1 of 3 groups: tramadol, lornoxicam, and normal saline (NS). Ten minutes before induction of anesthesia, the tramadol group received tramadol 100 mg IV, the lornoxicam group received lornoxicam 8 mg IV, and the NS group received NS 2 mL IV. Anesthesia was induced using fentanyl 1 μg/kg and thiopental sodium 4 to 7 mg/kg. Vecuronium 0.1 mg/kg was used for muscle relaxation. Desflurane 4% to 6% and 50%:50% oxygen/nitrous oxide were used for maintenance. Oxygen saturation, heart rate, and mean blood pressure were recorded before induction and during the postoperative period. During the postoperative period, visual analogue scale O/AS) scores, time to first analgesic (TFA), total analgesic consumption (TAC), and patient satisfaction scores were determined. Data about postoperative nausea and vomiting and other adverse events and complications were also collected.Results: Seventy-three patients were assessed for enrollment and 60 (33 women, 27 men; mean [SD] age, 44.69 [11.27] years; age range, 20-62 years) were included in the study. The baseline demographic characteristics and duration of surgery were similar in all 3 groups. The mean (SD) VAS scores in the tramadol group were significantly lower than in the NS group at 15 and 30 minutes and 1, 2, 4, and 12 hours after surgery (all, P < 0.05). The VAS scores in the lornoxicam group were significantly lower than in the NS group at 15 and 30 minutes and 1 hour (all, P < 0.05). The VAS score at 1 hour after surgery was significantly lower in the tramadol group than in the lornoxicam group (18 [8] vs 32 [16]; P < 0.05); however, there were no other significant differences in VAS scores between the active groups. A significantly shorter TFA was associated with the NS group when compared with the tramadol and lornoxicam groups (46 [27] vs 354 [187] and 180 [118], respectively; both, P < 0.05). TFA was significantly shorter in the lornoxicam group when compared with the tramadol roup (180 [118] vs 354 [187]; P < 0.05). TAC was significantly higher in the NS group than in the tramadol and lornoxicam groups (270 [47] vs 115 [74] and 145 [72], respectively; both, P < 0.05). Patient satisfaction score (range) was significantly lower in the NS group when compared with the tramadol and lornoxicam groups (0 [0-1] vs 3 [0-3] and 2 [0-3], respectively; both, P < 0.05). There were no other significant between-group differences observed.Conclusions: Tramadol and lornoxicam were more effective than NS in preventing early postoperative pain. The preventive analgesic effect of tramadol was comparable with that of lornoxicam, except at 1 hour when tramadol was more effective among these patients undergoing PCNL. Both drugs were well tolerated.     

氯诺昔康对老年患者全髋置换术后舒芬太尼皮下自控镇痛效果的影响

目的：研究氯诺昔康对老年髋关节置换术患者舒芬太尼自控皮下镇痛（patientcontrolledsubcutaneousanalgesia,PCSA）效果的影响。方法：择期全麻下全髋置换术后老年患者125例,年龄70～90岁,ASAⅡ-Ⅲ,随机分为5组（n=25）：S1L组（舒芬太尼0．4／ug·kg^-1.d^-1氯诺昔康32mg）;S。L组（舒芬太尼0．6／ag·kg“·d^-1＋氯诺昔康32mg）;S1组（舒芬太尼0．4肚g·kg。·d^-1）;S2组（舒芬太尼0．6肛g·kg^-1·d^-1）;S。组（舒芬太尼0．8ug·kg^-1·d^-1）。5组均用生理盐水稀释至100ml用于术后镇痛,采用PCSA模式,负荷剂量2ml,背景输注速率2mL／h,按压单次给药剂量0．5mL,锁定时间为15min。采用视觉模拟评分法（visualanaloguescale,VAS）、Ramsay镇静评分法（ramsaysedationscore,RSS）,记录术后2、4、8、12、24、48hVAS评分、RSS评分;镇痛期间镇痛泵按压次数（D,）、实际有效注药次数（D2）、患者总体满意度（totalsatisfactorydegree,TSD）评分;脉搏血氧饱和度（SpO：）、平均动脉压（MAP）、心率（HR）、呼吸频率（RR）、头晕嗜睡、恶心呕吐、皮肤痛痒、异常出血等不良反应的发生情况。结果：镇痛期间S。L组VAS评分、D,、D2、TSD值低于S,L、S1和S2组（P〈0．05）,与S。组比较差异无统计学意义,RSS评分高于S1L、S1组（P〈0．05）,头晕嗜睡、恶心呕吐发生率低于S。组（P〈O．05）。结论：氯诺昔康可增强高龄髋关节置换术患者舒芬太尼术后镇痛效果,而不增加不良反应。     

不同促渗剂对氯诺昔康体外经皮吸收的影响

目的 考察氮酮、月桂醇、油酸等几种常用促渗剂在不同浓度和联合使用对氯诺昔康体外经皮渗透的影响.方法 用改良的Franz扩散池作为离体透皮试验装置,用pH8的磷酸盐缓冲液作为接收液,以稳态流量(Js)、增渗倍数(ER)及滞后时间为考察指标,观察不同促渗剂对氯诺昔康经皮吸收的促进作用.结果 油溶性促渗剂促渗效果要好于水溶性...