丙帕他莫复合舒芬太尼在老年患者全髋置换术后多模式镇痛中的效果

目的：观察丙帕他莫复合舒芬太尼在老年患者全髋置换术后多模式镇痛中的效果及安全性。方法60例接受全髋置换术的老年患者，随机分成2组，分别为丙帕他莫复合舒芬太尼组（A组）与舒芬太尼组（B组），每组30例。 A组术后静脉自控镇痛（ PCIA）配方：丙帕他莫8 g＋舒芬太尼1μg/kg＋10 mg托烷司琼＋生理盐水，总量100 mL；B组PCIA配方：舒芬太尼2μg/kg＋10 mg托烷司琼＋生理盐水，总量100 mL。两组镇痛液负荷量5 mL， PCIA镇痛泵维持量1．8 mL/h，追加量0．5 mL，锁定时间15 min。观察术后4、8、12、24、48 h静息及活动时疼痛VAS评分、镇静Ramsay评分，记录镇痛泵药物消耗容量及自控按压次数，并记录不良反应。结果两组老年患者术后各时点静息及活动时镇痛评分比较差异无显著性意义，P＞0．05；B组术后4、8、12 h Ramsay评分与A组比较差异有显著性意义，B组分别为3．17±0．95、3．23±0．90、3．13±0．82，A组分别为2．43±0．77、2．40±0．77、2．33±0．71，P＜0．01；两组镇痛泵药物消耗容量及自控按压次数比较差异无显著性意义，P＞0．05；镇痛期间不良反应发生率比较差异有显著性意义，恶心、头晕发生率B组分别为26．67％、23．33％，高于A组的6．67％、3．33％， P＜0．05。结论丙帕他莫复合舒芬太尼用于老年患者全髋置换术后多模式镇痛安全有效，不良反应发生率低。     

丙帕他莫超前镇痛配合舒芬太尼术后静脉镇痛对乳腺癌术后疼痛的影响

目的：探讨丙帕他莫超前镇痛配合舒芬太尼术后静脉镇痛对乳腺癌术后疼痛的影响。方法采用随机综合平衡序贯法将该院于2013年1月至2015年11月收治的69例拟行外科手术的乳腺癌患者分为观察组（34例）和对照组（35例）。对照组给予单纯舒芬太尼术后静脉镇痛,观察组给予丙帕他莫超前镇痛＋舒芬太尼术后静脉镇痛。对比两组术后1h、4h、8h、12h和24 h疼痛程度和认知功能,并观察不良反应。结果术后1 h两组VAS和MMES评分差异均无统计学意义（P＞0．05）,术后4 h、8 h、12 h和24 h观察组VAS和MMES评分均较对照组显著降低（P＜0．05）,且术后4 h、8 h和12 h均较术后1 h显著升高（P＜0．05）,术后24 h均较术后1 h显著降低（P＜0．05）,术后24h均较术后4 h、8 h和12 h显著降低（P＜0．05）;观察组镇痛泵按压次数明显少于对照组,差异有统计学意义（ P＜0．05）;观察组总不良反应发生率为5．88％,较对照组的25．71％显著降低（ P＜0．05）。结论采用丙帕他莫超前镇痛配合舒芬太尼术后静脉镇痛可以显著减轻乳腺癌患者术后疼痛程度,还可改善认知功能,且不良反应少,安全可靠,成效显著。     

Propacetamol and diclofenac alone and in combination for analgesia after elective tonsillectomy

BACKGROUND: Diclofenac and paracetamol have different mechanisms and sites of action. Therefore, we tested if their combination is more effective for analgesia after tonsillectomy than either drug alone with respect to rescue analgesic consumption and visual analog scale values. METHODS: The analgesic effects of intravenously administered propacetamol (injectable pro-drug of paracetamol) and diclofenac or a combination on postoperative pain were compared in 71 adult elective tonsillectomy patients in a randomized, double-blind study. After induction of anesthesia the patients received monotherapy with 2 g propacetamol (n = 25) or 75 mg diclofenac (n = 25), or a combined treatment with 2 g propacetamol and 75 mg diclofenac (n = 21) in physiologic saline as an infusion. Postoperatively the propacetamol dosage was repeated twice and diclofenac once on the ward. Oxycodone (0.03 mg kg(-1)) was used as a rescue analgesic by patient-controlled analgesia. RESULTS: On average the patients needed oxycodone 15.3, 13.2 and 10.6 times in the propacetamol, diclofenac and combination groups, respectively (NS). A verbal rating scale and a visual analog scale were employed for assessing post-tonsillectomy pain, nausea and patient satisfaction in all groups. No statistically significant differences were found between the groups. Twelve of the 25 (48%) patients having received propacetamol complained of pain at the cannulation site. CONCLUSION: Combined treatment with propacetamol and diclofenac with the dosages used provided clinically only a minor advantage over monotherapy with propacetamol or diclofenac with respect to postoperative analgesia or the incidence of side-effects in adult tonsillectomy patients.     

非成瘾性镇痛剂丙帕他莫与盐酸哌替啶治疗中等手术后疼痛的双盲对比研究

目的 评价非成瘾性镇痛剂丙帕他莫与度冷丁治疗中等手术后疼痛的效果。方法 120名（年龄18-75岁）接受腹部外科，妇科及矫形外科手术后疼痛达到中度或重度的病人参加本研究。研究组用盐酸丙帕他莫（propacetamol HCL)2g溶解稀释静脉滴注，在静脉滴注时肌注生理盐水1.0mL；对照组用甘露醇（用作安慰剂，dummy drug）1.6g溶解稀释静脉滴注，左静脉滴注开始时肌注盐酸哌替啶（dolantin用作对照）50mg(1.0ml）。按随机双盲原则进行治疗，每个病例的用药观察期为6小时。结果与结论 研究期间均未出现明显不良反应。也无皮疹发生。按盲后显示盐酸丙帕他莫和盐酸哌替啶具有相似的安全性和有效性。但盐酸丙帕他莫不具有成瘾性，作为中等手术后镇痛药有广泛的应用前景。     

Symptomatic intravenous antipyretic therapy: efficacy of metamizol,diclofenac, and propacetamol

Fever is a common symptom in cancer patients. The most frequent causes of fever are infections, malignancy itself, various medications, transfusions, and allergy. Although it is necessary to treat the cause of fever, if possible, symptomatic fever management is also important. Surprisingly, little attention is paid to this topic in the medical literature, despite the fact that it is a very frequent problem. In order to support symptomatic fever therapy, we wanted to study the patients' discomfort accompanying fever and the beneficial effects of the symptomatic fever management. To the best of our knowledge, there is an absence of studies in this area, despite the fever discomfort can be an important reason for the antipyretic treatment, mainly in cancer patients. In this non-randomized open label pilot study, three intravenous antipyretics were tested in five groups of patients: diclofenac (75 mg, brief intravenous [IV] infusion) vs. metamizol (2500 mg or 1000 mg, brief IV infusion) vs. propacetamol (2000 mg or 1000 mg, slow IV injection or brief IV infusion). The study included 254 febrile episodes mainly in hemato-oncological patients with axillary temperature at least 38°C. The main study endpoints were: changes in axillary temperature, improvement in patient comfort, and number and nature of adverse events. To support justification for symptomatic fever management in febrile patients, we asked the first 45 study subjects to fill in a questionnaire concerning their opinions about fever, fever-associated discomfort, and relief upon antipyretic therapy. All study medications had a significant antipyretic effect. However, metamizol at the dose 2500 mg was considered as the most effective, while propacetamol at the dose 1000 mg showed the lowest antipyretic efficacy. Concerning tolerability and adverse events, there were significant differences among the treatment groups. Diclofenac and metamizol (both 2500 mg and 1000 mg) were tolerated at best. All tested antipyretics significantly improved comfort in febrile patients. Overall, 87% of patients declared improvement in their comfort after administration of antipyretics. Based on the results of the present study, the choice of the antipyretic drug should depend on the clinical status of patient, contraindications, and potential adverse events and risks of the selected agent. It is advisable to use proparacetamol at the higher dosage and to administer it as a brief IV infusion in order to avoid injection-related adverse events. The symptomatic antipyretic treatment in febrile cancer patients is supported by patients themselves and has a significant role in the complex supportive care. Discomfort of patients during fever episodes may be greater than previously thought.     

Pharmacokinetics and antipyretic effects of an injectable pro-drug of paracetamol (propacetamol) in children

Propacetamol is a soluble injectable form of paracetamol, which is quickly hydrolysed after intravenous injection. We report the pharmacokinetic results of this drug in children between 10 months and 14 years of age. Three minutes after an i.v. administration of 15 mgkg^-1 the mean plasma paracetamol concentration was about 25 μgml^-1. In a course of repeated administration of propacetamol, the plasma concentration 3 min after the fourth dose remained at about the same value, showing that there was no accumulation of paracetamol. The pharmacokinetic parameters (half life, total clearance and distribution volume) were similar to those in adults. At 15 mgkg^-1 doses, the antipyretic effect is well-established.     

丙帕他莫超前镇痛在乳突根治术中的应用

目的观察丙帕他莫用于乳突根治术超前镇痛时的效果和安全性。方法42例ASAI一Ⅱ级行乳突根治术的患者依次交替分为两组,每组21例。观察组术前15rain静脉缓注丙帕他莫2g、对照组予静脉缓注同等容量生理盐水。所有患者术后给予患者静脉自控镇痛（PCIA）。观察并记录切皮前、切皮即刻、切皮后1min、5min,磨电钻即刻及5min时平均动脉压（MAP）、心率（HR）变化;观察并记录术后2,4,6,12,24h的视觉模拟评分（VAS）、24h芬太尼用量和不良反应。结果与对照组比较,观察组MAP、HR在切皮前、切皮即刻、切皮后1min、5min和磨电钻即刻比较差异无统计学意义（P〉0．05）,而观察组磨电钻后5rainMAP、HR比较差异有统计学意义（P〈0．05）。术后2,4,6h观察组镇痛评分优于对照组（P〈0．05）,其余时间点两组问镇痛评分比较差异无统计学意义（P〉0．05）;术后24h观察组的芬太尼用量低于对照组（P〈0．05）;两组不良反应发生率的差异有统计学意义（P〈0．05）。结论乳突根治术超前应用丙帕他莫,能减少术后芬太尼的用量,并能减轻不良反应的发生。     

盐酸丙帕他莫用于胸腔镜下肺大疱切除术后镇痛的疗效观察

目的研究盐酸丙帕他莫对胸腔镜下肺大疱切除手术患者术后镇痛效果的影响。方法60例ASAI～Ⅱ级行胸腔镜下肺大疱切除手术患者随机分为2组。A组手术结束前给予盐酸丙帕他莫,B组手术结束前给予芬太尼。观察记录2组苏醒时平均动脉压（MAP）、心率（HR）及拔管时间,对2组患者苏醒后10min（T1）,术后1（T2）、2（T3）、3（T4）及4（T5）h的疼痛程度进行视觉模拟（VAs）评分。结果苏醒时MAP及FiR2组间比较无显著性差异;A组拔管时间比B组明显缩短;术后VAS评分T1、T2时点较低,但2组间无显著性差异;在T3、T4、T5时点VAS评分A组明显低于B组。结论盐酸丙帕他莫对胸腔镜下肺大疱切除术后患者镇痛效果确切,不增加不良反应的发生率,可优化临床用药。     

Analgesic efficacy and safety of nefopam vs. propacetamol following hepatic resection*

In order to compare the morphine-sparing effect, analgesic efficacy and tolerance of nefopam and propacetamol given at their highest recommended doses, 120 patients undergoing elective hepatic resection were randomly assigned to receive postoperative intravenous patient-controlled analgesia with morphine alone, or in combination with nefopam (20 mg.4 h-1) or propacetamol (2 g.6 h-1). Compared with the control group (43 [7-92] mg), median [range] cumulative morphine consumption for 24 h after the study started was halved in the nefopam group (21 [3-78] mg, p <0.001) and 20% lower in the propacetamol group (35 [6-84] mg, p = 0.15). Analgesia was superior in the nefopam group despite the lower morphine consumption. Adverse effects were comparable in the three groups, except for significantly more nausea in the control group (39% vs. 17 and 26% in the nefopam and propacetamol groups, respectively) and more sweating in the nefopam group (17% vs. 0 and 3% in the control and propacetamol groups, respectively). Overall patient satisfaction was better (p < 0.001) in patients given nefopam (97%) than those receiving morphine alone (82%) or propacetamol (74%).     

丙帕他莫对开胸手术后患者自控镇痛的影响

目的探讨丙帕他莫对开胸手术后患者自控镇痛(PCA)的影响。方法 120例拟行开胸手术并要求术后镇痛的患者随机分为I组(对照组)和II组(丙帕他莫组)。II组在术毕前30min给予丙帕他莫1g(生理盐水稀释为50ml)。I组给予等量生理盐水。PCA配方为舒芬太尼100μg+布托啡诺5mg+格拉斯琼10.5mg,负荷量为舒芬太尼5μg+格拉斯琼1.5 mg。置PCA泵后记录不同时间点疼痛VAS评分、镇静程度、各项生命体征;PCA按压次数、追加舒芬太尼剂量及副作用。结果 I组1、2hVAS评分、PCA总按压次数、追加药物显著高于II组(P<0.05)。两组其余时间VAS评分、镇静程度以及副作用发生率无显著性差异(P>0.05)。结论 PCA初期,丙帕他莫可减少开胸手术的患者术后镇痛药物的用量。