盐酸羟考酮注射液复合酮咯酸氨丁三醇用于剖宫产术后镇痛的临床观察

目的：观察盐酸羟考酮注射液复合酮咯酸氨丁三醇用于剖宫产术后镇痛的效果及安全性。方法选择腰?硬联合麻醉下剖宫产手术患者75例,ASAⅠ或Ⅱ级,随机均分为盐酸羟考酮组（ O组）,盐酸羟考酮复合酮咯酸氨丁三醇组（ OT组）,酮咯酸氨丁三醇组（T组）。术后镇痛泵配方为O组羟考酮1 mg／kg ＋托烷司琼5 mg;OT组羟考酮0．5 mg／kg＋酮咯酸氨丁三醇1．5 mg／kg＋托烷司琼5 mg;T组酮咯酸氨丁三醇3 mg／kg＋托烷司琼5 mg,三组均以生理盐水稀释至100 mL。观察术后6、12、24、48 h的切口痛VAS评分、宫缩痛评分及BCS评分;记录麻醉前、术后12、24、36 h血清P物质（ SP ）浓度;记录术后48 h内的不良反应,术后12、36 h的缩宫素使用量和子宫底高度。结果与T组比较,术后6、12、24 h O组和OT组的切口痛VAS评分和宫缩痛评分明显降低、BCS评分明显升高（P＜0．05）,术后12、24、36 h O组和OT组SP浓度明显降低（P＜0．05）,O组和OT组胃绞痛发生率明显降低（P＜0．05）。与术前比较,三组患者术后12、24、36 h的SP浓度均明显升高（P＜0．05）。结论盐酸羟考酮复合酮咯酸氨丁三醇用于剖宫产术后镇痛,镇痛效果好,不影响子宫复旧,不良反应少。     

卡前列素氨丁三醇预防前置胎盘剖宫产产后出血的临床观察

目的观察卡前列素氨丁三醇预防前置胎盘剖宫产产后出血的效果。方法将66例前置胎盘剖宫产产妇随机分为观察组和对照组各33例。2组均予5%葡萄糖溶液+缩宫素静脉滴注,对照组在剖宫产术中胎儿娩出后即在子宫体部注射缩宫素及米索前列醇口服;观察组则于子宫体注射卡前列素氨丁三醇。术毕统计2组阴道积血量和24h内的出血量,并记录第3产程时间和不良反应发生情况。结果观察组阴道积血量和24h出血量均少于对照组,第3产程时间短于对照组,差异均有统计学意义(P<0.05);观察组不良反应发生率为12.1%低于对照组的42.4%,差异有统计学意义(P<0.05)。结论卡前列素氨丁三醇预防前置胎盘剖宫产产后出血安全有效。     

地佐辛与酮咯酸氨丁三醇在颈髓过伸伤的镇痛效果比较

目的 回顾性分析比较地佐辛与酮咯酸氨丁三醇在颈髓过伸伤中不同疼痛程度的患者的镇痛效果,指导合理选择镇痛药物. 方法 回顾性分析2012年12月至2015年12月解放军第98医院80例颈髓过伸伤出现痛觉过敏患者的病历资料,以长海痛尺评分评定患者疼痛程度,长海痛尺评分≥3分为用药指征,随机分为观察组和对照组,观察组给于地佐辛7.5mg肌注,对照组给于酮咯酸氨丁三醇60mg肌注,比较2组对于不同疼痛程度患者用药后疼痛评分情况,3分以下为有效,≥3分为无效镇痛,并观察2组用药后发生的不良反应情况. 结果 从镇痛有效率比较,2组用药30min后,中重度疼痛,观察组有效率100.0%,对照组有效率94.7%,差异无统计学意义(P>0.05),均为有效镇痛.剧烈以上疼痛,观察组镇痛有效率95.0%,对照组有效率仅为42.9%,差异有统计学意义(P<0.01),地佐辛镇痛效果优于酮咯酸氨丁三醇.从镇痛前后疼痛评分比较,2组在中重度疼痛镇痛后评分差异无统计学意义(P>0.05);观察组与对照组剧烈以上疼痛镇痛后评分分别为(1.32±0.99)、(3.40±2.20),差异有统计学意义(P<0.05).观察组药品不良反应发生率(20.0%)高于对照组(7.5%),差异有统计学意义(P<0.05). 结论 在颈髓过伸伤的镇痛治疗中,中重度疼痛可选择地佐辛或酮咯酸氨丁三醇,剧烈以上疼痛地佐辛镇痛效果明显优于酮咯酸氨丁三醇,但地佐辛不良反应率较高,因此临床用药上建议根据疼痛评分来合理选择镇痛药.     

Percutaneous Absorption of Nicardipine and Ketorolac in Rhesus Monkeys

Vehicle effects on the percutaneous absorption of nicardipine base, nicardipine hydrochloride, ketorolac acid, and ketorolac tromethamine were determined using the rhesus monkey as an in vivo model for human skin penetration. Vehicles investigated included blends of propylene glycol, trimethylene glycol, ethanol, Azone, Tween 20, water, and long-chain fatty acids. Formulations were prepared such that the compound dose, application area, and percentage saturation of the compound in the vehicle were held constant. Variations in absorption of the compounds were therefore attributable to vehicle effects. Each formulation was applied to three monkeys for a period of 24 hr using 10 Hill Top Chambers. Plasma samples were taken at appropriate intervals for 36 to 48 hr. The results indicated that trimethylene glycol and Tween 20 did not enhance absorption of the test compounds despite claims by other investigators. Azone and ethanol provided moderate enhancement of both the rate and the extent of absorption, while long-chain fatty acids in combination with propylene glycol significantly enhanced penetration. In general, higher fluxes were observed with the more lipophilic compounds nicardipine base and ketorolac acid as compared to the hydrochloride and tromethamine salts.     

水囊压迫联合卡前列素氨丁三醇治疗产后出血的临床研究

探讨宫腔水囊压迫联合卡前列素氨丁三醇治疗产后出血的效果。方法对甘肃省白银市第一人民医院2011年8月至2013年12月收治的162例产后大出血患者的临床资料进行回顾性分析,采用宫腔水囊压迫联合卡前列素氨丁三醇治疗的82例为观察组,采用宫腔纱条填塞联合缩宫素治疗的80例为对照组,分析两组止血有效率、放置时间、取出时间、术后2 h及24 h出血量,再次出血率、子宫切除的情况。结果观察组止血有效率高于对照组(98.8%vs 92.5%,P0.05);产后2 h出血量少于对照组[(25.8±12.3)m L vs(41.1±9.6)m L,P0.05];再次出血发生率低于对照组(1.22%vs 3.75%,P0.05);子宫切除率低于对照组(1.22%vs 7.50%,P0.05)。结论宫腔水囊压迫联合卡前列素氨丁三醇治疗产后出血疗效显著,值得临床推广。     

The excretion of ketorolac tromethamine into breast milk after multiple oral dosing

Summary We have studied the transfer of the analgesic ketorolac tromethamine into breast milk in ten women aged between 22 and 35 years. Ketorolac administration was started between 2 and 6 days after delivery. The breast milk was not fed to the infant because of maternal antibiotic use (6 patients) or because of jaundice of the baby.10 mg of ketorolac was given four times daily for two days. Plasma and milk samples were collected on the two dosing days and on the first day after dosing. The plasma and milk were assayed for ketorolac concentrations by HPLC; the quantification limits were 10 ng·ml^–1 and 5 ng·ml^–1 respectively.The maternal plasma concentrations were within established ranges for ketorolac. In four patients the concentration of ketorolac in the milk was never above 5 ng·ml^–1. At 2 h after dosing on both Days 1 and 2 there were quantifiable concentrations of ketorolac in the milk. The range was 5.2 ng·ml^–1 to 7.9 ng·ml^–1. The ratio of breast milk: plasma concentrations of ketorolac ranged from 0.015 to 0.037.The maximum potential amount of ketorolac that an infant may be exposed to daily could range from 3.16 mg to 7.9 mg, assuming a consumption of between 400 ml and 1 l of breast milk. On a weight-adjusted basis this is equivalent to between 0.16% and 0.40% of the total daily maternal dose.Klinikum der Stadt Mannheim, Gynaecological Clinic, Mannheim, (until 1986: Krankenanstalt Rotes Kreuz, Munich)     

Pharmacokinetics of Ketorolac and p-Hydroxyketorolac Following Oral and Intramuscular Administration of Ketorolac Tromethamine

Ketorolac tromethamine (KT), a potent analgesic with cyclooxygenase inhibitory activity, was administered in an open, randomized, single-dose study of Latin-square design to 12 healthy male volunteers. Doses of 30 mg oral (po) and 30, 60, and 90 mg intramuscular (im) KT were administered in solution. Plasma samples were analyzed for ketorolac (K) and its inactive metabolite, p-hydroxyketorolac (PHK), by reversed-phase high-performance liquid chromatography (HPLC). The 30-mg im dose was found to be similar to the 30-mg po dose with respect to total AUC values for both K and PHK. The amount of PHK circulating in plasma was very low as judged by AUC ratios (PHK/K × 100) of 1.9 and 1.5% for the 30-mg po and im doses, respectively. The rate of absorption of K and formation of PHK, as determined by C _max and T _max values, was significantly slower following the im doses. Total AUC and C _max for K and PHK increased linearly with dose after im administration of 30, 60, and 90 mg of KT. The mean plasma half-life of K was remarkably consistent between po and im administration and was independent of dose, ranging from 5.21 to 5.56 hr. The plasma metabolic profile was similar following both routes of administration and graded im doses.     

Analgesic efficacy of ketorolac 0.5% ophthalmic solution (Accular) in paediatric strabismus surgery

This prospective double-blind study was designed to assess the analgesic efficacy of ketorolac 0.5% ophthalmic solution compared with placebo in 30 healthy children undergoing extraocular muscle recession for correction of strabismus. After paracetamol 20 mg.kg-1 preoperatively, a standard anaesthetic was given. There were no significant differences in Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and faces pain scale (FPS) scores, requirement for supplementary analgesia or in postoperative vomiting between the two groups over the following 24 h. This study did not demonstrate improved postoperative analgesia when topical ketorolac eye drops were given in addition to paracetamol. This observed lack of efficacy may reflect difficulties in the use of CHEOPS and FPS in this age group with this pain model.     

Acetaminophen or ketorolac for post myringotomy pain in children? A prospective,double-blinded comparison

Myringotomy with tube placement (BMT) is the most frequent surgical procedure performed in children. The purpose of this prospective, double-blinded study was to determine if 15 mg·kg^?1 of acetaminophen (paracetamol) provides analgesia similar to that provided by ketorolac, 1 mg·kg^?1, at a lower cost. One-hundred-and-thirty-two children, ages six months to nine years, scheduled for elective BMT were randomized to receive oral acetaminophen or ketorolac 30 min preoperatively. An Objective Pain Scale 1 Broadman LM, Rice LJ, Hannallah RS. Testing the validity of an objective pain scale for infants and children. Anesthesiology 1989; 69 : A770.
score was assessed upon arrival to the PACU and at five, ten and 20 min. Time of awakening, time of PACU and day surgery discharge and incidence of vomiting were recorded. Groups were comparable in demographics, side effects and time to discharge. Median pain scores were lower in the ketorolac group at five and ten min but no differences were seen at discharge nor in postdischarge analgesic requirements. Is ten min of better analgesia worth the cost of ketorolac? We conclude that the slight analgesic benefit from ketorolac does not justify its cost in this setting.     

止血带、卡前列素氨丁三醇联合低位B-Lynch缝合术在前置胎盘剖宫产中的应用效果分析

目的探讨联合应用止血带、卡前列素氨丁三醇及低位B-Lynch缝合术以减少前置胎盘剖宫产产后出血的效果。方法回顾性分析2011年1月~2016年12月期间我院因前置胎盘行剖宫产终止妊娠的产妇65例,根据术中止血方法分组:30例术中行止血带、低位B-Lynch缝合术联合卡前列素氨丁三醇止血者为观察组,35例行传统"8"字形缝合联合缩宫素处理者为对照组,对比两组的临床效果。结果观察组的术中出血量及术后24 h出血量均显著低于对照组(P0.05),观察组的手术时间较对照组显著缩短(P0.05);观察组与对照组的子宫切除率比较(0.00%vs 2.86%),无显著性差异(P0.05)。结论对前置胎盘剖宫产产妇应用止血带、卡前列素氨丁三醇及低位B-Lynch缝合术联合治疗可提高止血效果,减少产后出血,缩短手术时间,值得在临床上推广应用。