静脉氯诺昔康联合硬膜外吗啡用于妇科术后镇痛

目的:观察静脉氯诺昔康联合硬膜外单次吗啡用于妇科开腹手术后的患者自控镇痛的有效性和不良反应,寻找更加安全有效的术后镇痛方案.方法:110例择期妇科开腹手术患者,随机分为C组、F组、L组、M组和ML组(n=22),术后行镇痛治疗.术毕,C组硬膜外腔注射生理盐水5mL,F组应用芬太尼静脉患者自控镇痛(PCIA),L组应用氯诺昔康静脉PCA,M组硬膜外腔单次注射吗啡2mg,ML组硬膜外腔单次注射吗啡1mg复合应用氯诺昔康静脉PCA.术后8,16,24,36和48h用视觉模拟评分(VAS评分)评价镇痛效果.结果:术后各时间点,F组、L组和ML组的VAS评分均明显低于C组(P<0.01),ML组的VAS评分也低于F组(P<0.01).术后8,16,24和36h的VAS评分,ML组和M组分别低于L组和C组(P<0.05).L组氯诺昔康用量(27.6±4.4)mg,ML组氯诺昔康用量(19.2±3.6)mg.ML组的用药量明显低于L组(P<0.01).L组、M组和ML组的胃肠道副作用发生率低于F组(P<0.05),四组分别为13.6%(3例)、4.6%(1例)、9.1%(2例)和31.8%(7例).结论:氯诺昔康联合硬膜外吗啡用于妇科开腹手术后的镇痛治疗可以提高镇痛效果和减少各自用药量及副作用.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

氯诺昔康用于无痛人工流产的可行性研究

目的探讨氯诺昔康复合丙泊酚麻醉用于无痛人流的可行性。方法将90例无痛人流患者随机分为3组，每组各30例．组Ⅰ：氯诺昔康（可赛风）0．15mg／kg；组Ⅱ：芬太尼1μg／kg；组Ⅲ：氯胺酮0．4mg／kg，3组均给予复合丙泊酚静脉麻醉。监测患者术前、扩宫颈、注射缩宫素和术毕的生命体征变化，记录丙泊酚用量、睁眼时间、术后不良反应的发生情况，评定术中及术后10min的镇痛效果。结果3组间MAP、HR、RR、术中镇痛效果、丙泊酚用量及睁眼时间差异均无显著性（P〉0．05）；Ⅰ组术后10min镇痛效果明显优于Ⅱ、Ⅲ组（P〈0．05）；3组患者术后不良反应的发生率差异无显著性（P〉0．05）。结论氯诺昔康复合丙泊酚麻醉可安全用于无痛人流，尤其减轻术后宫缩痛方面优于芬太尼和氯胺酮。     

氯诺昔康预先镇痛在无痛人工流产手术中的应用

目的:观察氯诺昔康预先镇痛应用于无痛人工流产手术的效果.方法:60例自愿实施全麻人工流产手术的门诊患者随机分为两组,联合组术前2h口服氯诺昔康8mg,术中使用异丙酚麻醉;异丙酚组无术前用药,术中用药同联合组.两组患者异丙酚的诱导剂量均为2mg/kg,术中根据患者的躯体反应必要时追加异丙酚.记录诱导前后的血压、心率、异丙酚用量、术中肢动情况、追加用药的量及例数、清醒时间及术后患者下腹疼痛的视觉模拟疼痛评分.结果:注药后2min的血压变化两组比较有显著性差异(P＜0.05);异丙酚用量、术中肢动情况、清醒时间、追加用药的量及例数两组有显著性差异(P＜0.05),联合组患者术后清醒和定向力恢复迅速,下腹疼痛程度轻于对照组,术后5、10min的疼痛评分两组比较有显著性差异(P＜0.05).结论:氯诺昔康预先镇痛应用于无痛人工流产手术,可减少异丙酚用量、缩短术后清醒时间,使循环更趋平稳,对患者术后的下腹疼痛有明显镇痛作用.     

注射用氯诺昔康所致不良反应的相关因素和帕累托图分析

目的：分析注射用氯诺昔康致不良反应（ADR）的相关因素和特点,为临床更加合理使用该药提供依据。方法：汇集2006年1月-2015年12月,北京10个区县关于注射用氯诺昔康的ADR报告,并对患者的年龄、性别、ADR发生时间、用药方法、使用剂量与ADR累及系统等进行相关因素分析和帕累托图分析。结果：共收集注射用氯诺昔康ADR病例103例,符合要求病例88例：患者平均年龄48岁,多为中老年患者;男性55例（占62.5%）,女性33例（占37.5%）;出现ADR最长用药时间为14 d,最短用药时间为5 min内;有75例首次用药即发生ADR,占85.23%;累及系统分为9种类型,其中以皮肤和胃肠道损害多见;合理使用剂量以8 mg/次、1次/d居多,占64.77%;超说明书用药中,有25例为16 mg/次,1次/d,占28.41%;有5例24 mg/次,1次/d,占5.68%,有1例32 mg/次,2次/d,占1.14%。结论：ADR发生率与患者的年龄、性别、用法用量及超说明书用药等因素有一定关系,尤其是中老年患者在应用氯诺昔康时应格外注意。临床药师在工作中应做好合理用药的宣传教育,加强用药监护,确保注射用氯诺昔康的用药安全。     

UPLC-MS/MS法快速测定中药及保健食品中非法添加17种抗炎镇痛类化学药的研究

目的建立一种快速、准确检测中药及保健食品中非法添加17种抗炎镇痛类化学药(对乙酰氨基酚、阿司匹林、非那西丁、马来酸氯苯那敏、罗非昔布、吡罗昔康、氯诺昔康、美洛昔康、醋酸泼尼松、舒林酸、萘普生、醋酸地塞米松、保泰松、奥沙普秦、塞米昔布、双氯芬酸钠、吲哚美辛)的方法。方法采用UPLC-MS/MS法,以Waters Acquity BEH-C18柱(100 mm×2.1 mm,1.7μm)为色谱柱,以0.1%甲酸甲醇溶液(A)-0.1%甲酸水溶液(B)为流动相,梯度洗脱:0~4 min,40%A;4~5 min,40%~50%A;5~6 min,50%~60%A;6~12 min,60%~80%A;12~13 min,80%A;13~14 min,80%~40%A;体积流量0.2 m L/min,柱温40℃。选择ESI离子源、多反应监测(MRM)模式测定17种临床常用的抗炎镇痛类化学药,通过比较MRM通道中样品峰与对照品峰的分子离子峰、二级碎片离子峰、色谱保留时间等信息确定添加的化学药物,并根据外标法以质谱峰面积计算添加药物的准确量。结果在上述色谱及质谱条件下,对乙酰氨基酚、阿司匹林、非那西丁、马来酸氯苯那敏、罗非昔布、吡罗昔康、氯诺昔康、美洛昔康、醋酸泼尼松、舒林酸、萘普生、醋酸地塞米松、保泰松、奥沙普秦、塞米昔布、双氯芬酸钠、吲哚美辛17种化学药物的分离度良好,方法检测限(LOD)均在0.3~5.0 ng/g,定量限(LOQ)均在0.9~15.0 ng/g,加样回收率均在90.5%~113.8%。样品中检出了对乙酰氨基酚、醋酸泼尼松、双氯芬酸钠、吲哚美辛、马来酸氯苯那敏、萘普生。结论方法简便、准确,灵敏度高,可作为抗炎镇痛类中药及保健食品中非法添加化学药的定性定量测定方法。     

氯诺昔康与吗啡用于开胸手术后患者自控镇痛的比较

目的:在肋间神经阻滞的基础上,比较氯诺昔康与吗啡用于开胸手术后患者自控镇痛的疗效及不良反应.方法:择期行开胸手术的患者35例,术前均行肋间神经阻滞,术后随机双盲分为两组,给予患者自控镇痛:M组给予吗啡0.5 mg·mL-1 氟哌利多0.02 mg·mL-1,L组给予氯诺昔康0.32 mg·mL-1 氟哌利多0.02 mg·mL-1.镇痛效果评价采用VAS评分.结果:两组患者术后各时段的VAS评分无显著性差异,而不良反应的发生率L组明显少于M组.结论:在术前肋间神经阻滞的基础上,通过PCA系统静脉输注氯诺昔康,也能提供开胸手术后满意的镇痛治疗,疗效与吗啡相似.     

氯诺昔康用于术后患者自控镇痛的临床疗效和安全性

目的:评价非甾体抗炎药氯诺昔康用于妇科全子宫切除术后患者自控镇痛(PCA)的疗效及安全性。方法:60例全身麻醉下行全子宫切除术术后出现中度以上疼痛的患者随机分为氯诺昔康组和吗啡组。患者根据需要启动PCA泵(氯诺昔康0.8mg/次,吗啡1mg/次,锁定时间5min)。由疼痛缓解程度(PAR)、疼痛缓解总和(TOT-PAR)和患者24h镇痛总体效果来评价镇痛效果,同时监测血小板聚集率、肝、肾功能,并观察胃肠道反应等。结果:氯诺昔康组和吗啡组的TOTPAR和镇痛总体印象评分无显著性差异(P>0.05)。吗啡组起效早于氯诺昔康 组。氯诺昔康组的恶心呕吐的发生率明显低于吗啡组。2组血小板聚集率无显著性差异(P>0.05)。结论:氯诺昔康用于妇科全子宫切除术后PCA镇痛,其镇痛效应与吗啡相近,不良反应较少。     

西吡氯铵修饰的脂质体用于氯诺昔康的经皮局部递送

目的：研究一种可用于氯诺昔康局部递送的经皮给药系统。方法：比较不同处方脂质体（普通脂质体和传递体）的理化性质,优选最佳处方;将该给药系统应用于猪皮肤,通过Franz扩散池进行离体皮肤渗透研究。结果：以0.8%的磷脂酰胆碱制备的囊泡具有较高的包封率和载药量,粒径小于200 nm,粒径分布均匀（PDI<0.3）;比较囊泡通量值发现,传递体具有最高的渗透系数,沉积在表皮层和真皮层中的药物量也观察到类似的结果。结论：传递体的形变能力使其能更好地渗透到更深的皮肤层;阳离子表面活性剂对角质层脂质组织的破坏增强了药物在皮肤中的递送能力。传递体有效增强了活性成分的吸收,在治疗作用上将表现得更好。     

Comparative assessment of the effectiveness and tolerability of lornoxicam 8 mg BID and diclofenac 50 mg TID in adult indian patients with osteoarthritis of the hip or knee: A 4-week, double-blind, randomized, comparative, multicenter study

Background: Reports of cardiovascular adverse events (AEs) associated with the use of cyclooxygenase-2 inhibitors for the treatment of osteoarthritis (OA) have prompted the quest for a better-tolerated NSAID.Objective: The aim of this study was to compare the effectiveness and tolerability of lornoxicam 8 mg BID and diclofenac 50 mg TID in adult Indian patients with OA of the hip or knee.Methods: This 4-week, double-blind, randomized, comparative, multicenter study was undertaken to compare oral lornoxicam and diclofenac in patients with OA. Patients who met the selection criteria were enrolled consecutively from the outpatient clinics of each of the participating hospitals in India. Participants completed the Western Ontario and McMasters Individual Osteoarthritis Index (WOMAC-OA), WOMAC Composite Index (WOMAC-CI) (for pain, stiffness, and physical function), and a 10-cm visual analog scale (VAS) (0-10 where 0 = no pain and 10 = worst possible pain or severe or excruciating pain) at each study visit (weeks 0 [baseline], 2, and 4 [or at early termination]). Patients' and physicians' global assessments of arthritis control were measured at each study visit when laboratory and clinical AEs were also monitored. The primary end points were the WOMAC-OA, the WOMAC-CI, and VAS scores for pain among the patients who completed the study.Results: Of the 273 patients (159 men, 114 women; mean [SD] age, 44.73 [10.72] years; range, 28-68 years) enrolled in the study, 13 (7 in the lornoxicam group and 6 in the diclofenac group) were lost to follow-up and their effectiveness and tolerability results were not included in the study analysis. Over the 4-week study period, both drugs provided significant (P < 0.05) sustained relief of OA symptoms compared with baseline. Compared with baseline, the mean pain score (WOMAC-CI) decreased 90.6% (13.88 [4.47] vs 1.30 [1.49]; P < 0.05) in the lornoxicam group and 88.9% (14.15 [4.56] vs 1.57 [1.49]; P < 0.05) in the diclofenac group after 4 weeks of treatment. After 4 weeks of treatment, the VAS pain score decreased from baseline 83.1% (8.04 [2.70] vs 1.36 [1.43]; P < 0.05) in the lornoxicam group and 79.3% (7.98 [2.98] vs 1.65 [1.47]; P < 0.05) in the diclofenac group. Compared with baseline, the improvement rated at 2 weeks was not significantly different between the 2 groups. Lornoxicam and diclofenac were well tolerated. The rate of mild to moderate adverse gastrointestinal events was not significantly different in the lornoxicam group compared with the diclofenac group (14.6% vs 18.4%). Similarly, overall tolerability between the 2 groups was not significantly different. None of the patients experienced cardiovascular AEs (eg, edema or increased blood pressure).Conclusion: The results of the present study suggest that lornoxicam was comparable to diclofenac in effectiveness and tolerability after 4 weeks of treatment in these adult Indian patients with OA of the hip or knee who completed the study.