氢吗啡酮超前镇痛在老年肩关节镜手术患者中的应用

目的 探讨氢吗啡酮超前镇痛对老年肩关节镜手术患者围术期疼痛程度、血流动力学及应激反 应的影响。方法 选取2022年1月-12月于泰州市人民医院择期行全麻下单侧肩关节镜手术患者90例作为研 究对象。根据随机数字表法分为观察组和对照组,每组45例。观察组麻醉诱导前10 min静脉注射氢吗啡 酮,对照组静脉注射等体积的生理盐水,之后均行常规气管插管全麻,手术结束后送入PACU复苏,统 一术后镇痛方案,比较两组不同时间点[麻醉诱导前（T0）、插管即刻（T1）、手术切皮时（T2）、手 术结束时（T3）、气管拔管时（T4）、出麻醉复苏室时（T5）、术后4h（T6）、术后8h（T7）、术后 24h（T8）]围术期血流动力学[平均动脉压（MAP）、心率（HR）]、VAS评分、应激指标[去甲肾上腺素 （NE）、肾上腺素（E）、皮质醇（Cor）、血糖（Glu）水平]。结果 观察组T1~T5时间点MAP及HR 低于对照组,T5~T8时间点VAS评分低于对照组,T2及T3时间点Glu和血清NE、E及Cor含量低于对照 组（P＜0.05）。结论 氢吗啡酮超前镇痛可有效减轻老年肩关节镜手术患者围术期疼痛程度、降低围术期 应激反应及血流动力学波动,值得临床应用。     

Modeling the economic and health consequences of managing chronic osteoarthritis pain with opioids in Germany: comparison of extended-release oxycodone and OROS hydromorphone

ABSTRACT

Objective: The Osmotic controlled-Release Oral delivery System (OROS) hydromorphone ensures continuous release of hydromorphone over 24 hours. It is anticipated that this will facilitate optimal pain relief, improve quality of sleep and compliance. This simulation compared managing chronic osteoarthritis pain with once-daily OROS hydromorphone with an equianalgesic dose of extended-release (ER) oxycodone administered two or three times a day.

Methods: This discrete event simulation follows patients for a year after initiating opioid treatment. Pairs of identical patients are created; one receives OROS hydromorphone the other ER oxycodone; undergo dose adjustments and after titration can be dissatisfied or satisfied, suffer adverse events, pain recurrence, or discontinue the opioid. Each is assigned an initial sleep problems score, and an improved score from a treatment dependent distribution at the end of titration; these are translated to a utility value. Utilities are assigned pre-treatment, updated until the patient reaches the optimal dose or is non-compliant or dissatisfied. The OROS hydromorphone and ER oxycodone doses are converted to equianalgesic morphine doses using the following ratios: hydromorphone to morphine ratio; 1:5, oxycodone to morphine ratio; 1:2. Sensitivity analyses explored uncertainty in the conversion ratios and other key parameters. Direct medical costs are in 2005 euros.

Results: Over 1 year on a mean daily morphine-equivalent dose of 90?mg, 14% were estimated to be dissatisfied with each opioid. OROS hydromorphone was predicted to yield 0.017 additional quality-adjusted life years (QALYs)/patient for a small additional annual cost (€141/patient), yielding an incremental cost-effectiveness ratio (ICER) of €8343/QALY gained. Changing the assumed conversion ratio for oxycodone:morphine to 1:1.5 led to lower net costs of €68 per patient, €3979/QALY, and for hydromorphone to 1:7.5 to savings.

Conclusion: Based on these analyses, OROS hydromorphone is expected to yield health benefits at reasonable cost in Germany.     

氢吗啡酮术后镇痛对全髋置换术患者的炎性因子和血液流变学的影响

目的：研究盐酸氢吗啡酮术后镇痛对全髋置换术患者的炎性细胞因子水平和血液流变学的影响。方法将100例全髋置换术患者随机分为两组。对照组50例患者,给予患者舒芬太尼术后镇痛。观察组50例患者,给予患者盐酸氢吗啡酮术后镇痛。比较两组患者血液流变学（红细胞、血浆黏度、全血黏度、全血还原黏度）与炎性细胞因子水平（CRP、IL-1、TNF-α、IL-6）。结果观察组与对照组在治疗前的血液流变学、炎性细胞因子水平相比较无统计学意义（P>0.05）。治疗后1d以及5d,观察组的红细胞的聚集指数、电泳指数、刚性指数,血浆黏度,全血黏度、全血还原黏度均低于对照组,两者相比有统计学差异(P<0.05）。治疗后1d以及5d,观察组的炎性细胞因子水平（CRP、IL-1、TNF-α、IL-6）均低于对照组,两者相比有统计学差异(P<0.05）。结论盐酸氢吗啡酮能够使全髋置换术患者的血液流变学更加稳定,并能明显降低患者的炎性细胞因子水平,减弱炎症反应,值得临床推广。     

氢吗啡酮复合左布比卡因在小儿骶管麻醉中的应用

目的探讨氢吗啡酮复合左布比卡因在小儿骶管麻醉中的应用效果。方法选取拟于本院择期行腹股沟斜疝或鞘膜积液手术的患儿50例为研究对象。随机分成C组(应用0.20%左布比卡因)和H组(应用0.20%左布比卡因复合10 mcg/kg氢吗啡酮混合液),每组各25例。比较两组苏醒时间,镇痛时间,运动阻滞、瘙痒、躁动发生情况以及苏醒期恶心呕吐、呼吸抑制等并发症的发生情况。结果两组患儿运动阻滞、躁动、恶心呕吐、呼吸抑制等的发生率差异无统计学意义(P0.05),术后2h、4 h、24 h东安大略儿童医院疼痛评估评分(CHEOPS疼痛评分)比较,差异无统计学意义(P0.05);术后6 h、8 h、10 h,H组CHEOPS疼痛评分显著低于C组(P0.01)。相比C组,H组镇痛时间显著延长(P0.05),术后瘙痒的发生率明显增高(P0.05)。结论骶管氢吗啡酮能够安全应用于小儿骶管麻醉及术后镇痛,延长左布比卡因镇痛持续时间,且不影响术后运动阻滞功能,无明显不良反应。     

Dependence in rats after one injection of heroin-, LAAM- or hydromorphone-zinc tannate.

Complex zinc tannate salts of heroin, hydromorphone and l-alpha-acetylmethadol were synthesized and injected in a slow-release vehicle, into rats. One, 3, 7, 10 and 14 days after the drug was administered rats were injected with naloxone hydrochloride (10 mg/kg) and during the following 4 hours body weights, core temperature and behavioral signs such as diarrhea, writhing, teeth chattering and wet dog shakes were recorded. On every naloxone testing day the narcotic-treated groups presented behavioral signs of abstinence, but weight loss and temperature changes were much less consistent. Reduction of core temperature following naloxone administration seems to be an earlier indicator of physical dependence than weight loss. According to the parameters tested a level of physical dependence can persist for at least two weeks after a single injection of these narcotic salts.     

Eliminating analgesic meperidine use with a supported formulary restriction

PURPOSE: Meperidine is a commonly used analgesic despite unique disadvantages compared with other opioid analgesics. The objective of this study was to measure the effects of a meperidine formulary restriction on the prescribing of parenteral opioid analgesics. MATERIALS AND METHODS: The study was performed at a single 750-bed tertiary care teaching hospital in Rochester, NY. The formulary restriction limited meperidine to use exclusively for rigors or procedural sedation and was supported by an educational initiative and a computerized order entry system. Independent computerized pharmacy records were used to capture all doses of parenteral morphine, meperidine, and hydromorphone administered to patients in the emergency department or on a medical or surgical inpatient floor during data-collection periods. Baseline data were collected during two 3-day periods before the formulary restriction; then comparison data were collected during three 3-day periods over 15 months after the formulary restriction. RESULTS: The number of administered doses of meperidine per day decreased from 37.5 (20.8% of parenteral opioid doses before the restriction) to 0.22 (0.1% of parenteral opioid doses, P = .001). The total number of opioid doses and morphine doses given did not change, whereas the number of hydromorphone doses increased significantly postrestriction, from 16.0 doses per day (8.9% of total) to 59.7 doses per day (29.5%) (P = .009). CONCLUSION: Meperidine formulary restriction, supported by an educational program and computerized order entry, effectively eliminated analgesic meperidine use. Hydromorphone use increased proportionately to offset the decreased use of meperidine.     

盐酸氢吗啡酮注射液无菌检查的方法验证

目的:验证盐酸氢吗啡酮注射液无菌检查的方法。方法:采用中国药典2005年版无菌检查法中的薄膜过滤法(附录ⅪH)。结果:盐酸氢吗啡酮注射液对生孢梭菌存在抑制作用,以金黄色葡萄球菌为阳性对照菌,至少需要0．1％的蛋白胨水溶液600 ml冲洗。结论:经方法学验证,该方法准确可靠,可作为盐酸氢吗啡酮注射液的无菌检查方法。     

Effect of intravenous injection speed on responses to cocaine and hydromorphone in humans

RATIONALE: It is commonly accepted that the relative abuse liability of drugs is positively related to the rate of delivery to the central nervous system; however, few controlled studies have tested this hypothesis in humans. OBJECTIVES: The aims of this study were to evaluate systematically the effects of modifying intravenous infusion speed on the pharmacodynamic responses related to abuse liability and toxicity of intravenous cocaine and hydromorphone. METHODS: Twelve experienced opiate and cocaine users completed this 3-week inpatient study. After completing a safety session, participants were tested on 9 separate test days with intravenous cocaine (30 mg/70 kg), hydromorphone (3 mg/70 kg), and placebo, each administered under double-blind and randomized conditions at infusion rates of 2, 15, and 60 s. Dependent outcome measures included a range of physiological, subjective, and observer-rated measures, and continuous electrocardiographic monitoring was conducted for safety monitoring. RESULTS: Subjective responses to cocaine (for example, "high," "liking") were significantly greater when cocaine was infused more rapidly. Physiological responses to cocaine were largely unaltered with no evidence of increased toxicity with faster infusion speeds. None of the effects of hydromorphone were altered by varying the speed of infusion. CONCLUSIONS: This study provides empirical evidence for the commonly accepted belief that the abuse liability of cocaine can be enhanced by increasing the rate of the intravenous infusion; this principal may not hold true for opioids but further work would be required to rule this out. The data also indicate that moderate doses of cocaine can be administered over a range of infusion speeds commonly used in experimental settings without appreciably altering the apparent medical risks.     

Buprenorphine and naloxone alone and in combination in opioid-dependent humans

Subjective, physiological and behavioral effects of subcutaneously administered hydromorphone (6 mg), naloxone (0.2 mg), buprenorphine (0.2 and 0.3 mg), and two buprenorphine-naloxone combinations (buprenorphine 0.2 mg plus naloxone 0.2 mg and buprenorphine 0.3 mg plus naloxone 0.2 mg) were assessed under double-blind conditions in six opioid-dependent volunteers. Physiologic measures and subject- and observer-rated behavioral responses were measured before dosing and for 120 min after drug administration. Hydromorphone decreased pupil diameter and respiration, increased blood pressure and increased scores on subjective measures indicating opioid-like effects. Buprenorphine given alone had no significant effect on any variable measured. Naloxone given alone produced opioid abstinence-like effects which were measurable on subject- and observer-rated behavioral measures and physiological measures. Buprenorphine in combination with naloxone somewhat attenuated the naloxone-precipitated withdrawal response. Overall, the naloxone-buprenorphine combinations produced effects which were qualitatively similar to the effects of naloxone alone, suggesting a low potential for abuse of the combination product by opioid-dependent individuals.Supported by a grant from Reckitt and Colman Pharmaceutical Division and USPHS Grants DA-00050 and DA-04089 from the National Institute on Drug Abuse