20例经鞘内镇痛系统注射吗啡治疗癌性疼痛疗效评估

目的观察经鞘内镇痛系统注射吗啡治疗重度癌痛的疗效及并发症。方法 20例视觉模拟评分(VAS)重度癌性疼痛患者,经鞘内镇痛系统注射吗啡。观察患者术前、术后第1,3,7和30天各时间点的VAS评分、术后第1,3,7与30天各时间点鞘内吗啡用量、不良反应发生率。结果 20例癌性疼痛患者鞘内注射吗啡后各时间点与术前比较VAS评分存在统计学差异(P<0.05),第7天及第30天鞘内吗啡用量与术后第1天和第3天比较有统计学差异(P<0.05),不良反应发生率降低。结论经鞘内镇痛系统注射吗啡可以有效地治疗重度癌痛,副作用少,值得推广。     

难治性癌痛患者行吗啡鞘内输注镇痛治疗的效果分析

目的 分析吗啡鞘内输注镇痛治疗难治性癌痛患者的临床效果。方法 90例难治性癌痛患者,采用随机数字表法分为实验组和对照组,各45例。对照组患者采用静脉输注吗啡方式镇痛,实验组患者采用鞘内输注吗啡方式镇痛。比较两组患者的视觉模拟评分法(VAS)评分、不良反应发生情况、生活质量评分。结果 治疗后24 h、72 h、1周,实验组患者的VAS评分分别为(5.26±0.25)、(4.56±0.15)、(4.31±0.22)分,均显著低于对照组的(6.13±0.18)、(5.19±0.24)、(4.82±0.19)分,差异具有统计学意义(P<0.05)。实验组患者的不良反应发生率4.44%显著低于对照组的20.00%,差异具有统计学意义(P<0.05)。实验组患者的生理机能、情感职能、精神健康、社会功能评分分别为(37.52±6.46)、(36.69±7.12)、(45.38±7.25)、(43.82±6.33)分,均显著高于对照组的(21.23±6.97)、(14.25±5.38)、(24.26±6.58)、(21.73±5.36)分,差异具有统计学意义(P<0.05)。结论 在...     

鞘内注射治疗疼痛的药物及研究进展

在进一步了解脊髓尤其是脊角的生理后,科学家发现在脊髓水平上的药理控制可以显著改变痛感.在脊角的初级痛觉传入突触与多种负责痛觉改变(激活,放大或抑制)的受体和神经传导物质相混合,构成了蛛网膜下腔(鞘内,下同)应用镇痛药物的生理基础,在鞘内注射了阿片或非阿片类药物后,它们能够改变痛觉的传输.以下就对常用鞘内药物做一个简单的综述.     

罗哌卡因复合吗啡鞘内注射治疗顽固性癌痛的疗效

目的对罗哌卡因复合吗啡鞘内注射治疗顽固性癌痛的临床疗效进行分析。方法将2018年1～12月我院收治30例顽固性癌痛患者作为此次研究对象,均予以罗哌卡因复合吗啡鞘内注射治疗的方式,对比治疗前后的效果。结果 (1)治疗后患者NRS评分与吗啡日用剂量均低于治疗前,差异有统计学意义(P 0.05)。(2)治疗后患者生活质量评分(食欲、睡眠、精神状况、社会交流、情绪、工作)高于治疗前,差异有统计学意义(P 0.05)。(3)治疗后患者呕吐恶心、嗜睡发生率低于治疗前,差异有统计学意义(P 0.05)。结论罗哌卡因复合吗啡鞘内注射治疗顽固性癌痛的效果较为理想,不仅缓解了疼痛,更提高了患者的生活质量,是治疗顽固性癌痛的首选药物。     

加巴喷丁预防腰麻时鞘内注射吗啡引起瘙痒的临床观察

目的：观察加巴喷丁预防腰麻时鞘内注射吗啡引起瘙痒的效果.方法：选择80例在腰麻下行下肢骨科手术患者,随机分成加巴喷丁组（G组,手术前2 h口服加巴喷丁400 mg）和对照组（C组,无术前用药）,所有患者均鞘内0.5%等比重布比卡因15 mg和吗啡0.2 mg.观察两组患者给予吗啡后2,4,8,12,24 h的瘙痒程度,记录两组患者瘙痒发生率、瘙痒出现时间、持续时间.结果：G组、C组患者瘙痒的发生率分别是47.5%和77.5%,差异有统计学意义（P＜0.05）;瘙痒出现时间分别是（6.1±1.4）h和（2.8±0.7）h,差异有统计学意义（P＜0.05）;与G组相比,C组在注射吗啡后2,4,8 h时间点的瘙痒程度显著增加（P＞0.05或0.01）.在注射后12,24 h差异无统计学意义（P＆gt;0.05）.结论：腰麻时给予0.5%等比重布比卡因15 mg和吗啡0.2 mg行下肢骨科手术前口服加巴喷丁400 mg可以降低瘙痒的发生率、减轻瘙痒程度、延迟瘙痒的起始时间.     

癌性疼痛患者应用鞘内镇痛泵的护理

目的:研究癌性疼痛患者应用鞘内镇痛泵的护理方法。方法:选择100例癌性疼痛患者,将其鞘内放置特殊导管并与体外全自动输注泵连接,通过此系统向病人体内输注镇痛药物,并给于相应的护理,达到镇痛目的。结果:患者疼痛评分治疗前为7-10分,治疗后评分为1-3分,差异有显著统计学意义(P<0.05)。结论:通过应用鞘内镇痛泵并给于相应的护理,病人疼痛评分明显降低,疼痛明显减轻,治疗效果显著。     

剖宫产术后鞘内注射不同剂量吗啡镇痛的疗效观察

目的探讨剖宫产术后鞘内注射不同剂量吗啡镇痛的效果及不良反应,优化吗啡鞘内注射的临床剂量。方法将我院96例行剖宫产的产妇随机分组,每组24例,患者均采用腰-硬联合麻醉(CESA)。鞘内注药:A组:0.5%的罗哌卡因15mg;B组:0.5%的罗哌卡因15mg+吗啡0.3mg;C组:0.5%的罗哌卡因15mg+吗啡0.6mg;D组:0.5%的罗哌卡因15mg+吗啡1.2mg。观察镇痛效果及不良反应。结果 B组、C组的VAS疼痛评分均显着高于A、D组,差异有统计学意义(P<0.05),在镇痛效果上C组与B组镇痛效果满意,C组在各时段均优于B组的镇痛作用。在不良反应上,吗啡用量越少,不良反应亦越少。结论鞘内注射吗啡镇痛用于剖宫产术,可减少局麻药用量,术后镇痛效果满意,不良反应少,是一种安全有效的术后镇痛方法。     

经皮下输注装置鞘内吗啡镇痛的疗效及经济学评价

目的：评估经皮下输注装置鞘内输注吗啡治疗癌性疼痛的有效性和经济性。方法：收集2017年4月至2018年4月采用经皮下输注装置鞘内吗啡输注治疗的32例晚期癌痛病例,统计患者的疼痛程度、住院时长和住院费用等一般信息,评价鞘内镇痛对癌痛患者疼痛程度、日常生活能力和镇痛药物用量的影响,分析患者鞘内镇痛前后每日镇痛所需费用的变化,以及鞘内镇痛前后每日镇痛费用的差额与住院费用平衡所需时长。结果：行鞘内镇痛术的癌痛患者平均疼痛持续时间为（10.6±9.7）月,平均住院时长和住院费用分别为（13.0±5.8）d和（48 237.0±11 137.0）元。鞘内镇痛能够显著降低癌痛患者的疼痛程度（VAS评分：6.81±0.16 vs.2.69±0.22）、镇痛药物用量[（105.94±23.04）mg vs.（1.62±0.44）mg]和每日镇痛费用[（211.71±99.31）元vs.（5.62±0.15）元],但对患者的日常生活能力没有显著的改善作用（68.75±25.84）vs.（65.47±25.09）。鞘内镇痛前后每日镇痛费用的差额与住院费用抵消所需要的平衡时间为（515.87±325.56）d。结论：经皮下输注装置鞘内吗啡镇痛能够有效治疗晚期癌痛,减少镇痛药物用量和每日镇痛费用,但不能改善患者的生活质量和降低癌痛患者的总镇痛费用。     

硫酸吗啡控释片直肠给药治疗癌性疼痛临床观察

目的:观察硫酸吗啡控释片(美施康定)直肠给药治疗癌性疼痛的疗效、生活质量与毒副反应。方法:对入选的41例恶心、呕吐、梗阻、吞咽困难的癌痛患者予美施康定直肠给药每12h一次,对照组32例予美施康定口服给药每12h一次。结果:直肠给药组止痛总有效率97.56％,毒副反应发生率19.52％,Karnofsky评分由(45.24±8.21)提高到(66.22±11.6);口服治疗组止痛总有效率96.87％,毒副反应发生率56.24％,Karnofsky评分由(47.81±12.11)提高到(66.72±10.36)。两组在疗效及生活质量上无明显差异(P>0.05),毒副反应发生率有明显差异(P<0.01)。结论:美施康定直肠给药治疗癌性疼痛疗效肯定,毒副反应较轻,适用于无法口服治疗的病人。     

鞘内吗啡联合皮下自控术后镇痛的效果观察

目的:比较鞘内吗啡镇痛、皮下自控镇痛以及鞘内吗啡联合皮下自控镇痛在术后镇痛中的临床效果。方法:研究对象为300例行剖宫产术患者,ASA(美国麻醉医师协会)～级。随机分为鞘内吗啡镇痛组(A组)、皮下自控镇痛组(B组)和鞘内吗啡联合皮下自控镇痛组(C组),每组100例。A组鞘内吗啡0.6 mg,B组术终前接皮下自控镇痛泵,C组鞘内吗啡0.4 mg+皮下自控镇痛(镇痛泵于术后12 h开启)。记录三组术后4,8,12,24,48 h各时点疼痛视觉模拟评分法(VAS)和恶心、呕吐、皮肤瘙痒以及呼吸抑制等不良反应的发生情况。结果:术后8,12 h的VAS评分A组明显低于B组,术后24,48 h的VAS评分B组明显低于A组,C组的VAS评分于术后8,12 h明显低于B组,术后24,48 h明显低于A组。结论:鞘内吗啡、皮下自控镇痛均能产生良好的术后镇痛效果,将鞘内吗啡与皮下镇痛联合应用优于二者单独使用时的镇痛效果,并可减少各自用药量及不良反应的发生。     

Choice of intrathecal drug in the treatment of neuropathic pain – new research and opinion

ABSTRACT

Introduction: The choice of the proper intrathecal drug to treat neuropathic pain has been subject to much debate in recent years.

Areas Covered: Currently, the United States Food and Drug Administration (USFDA) has approved two drugs for chronic intrathecal use for the treatment of pain; however, there has been substantial growth in the development of other intrathecal drugs that can be used for neuropathic pain. We performed a PubMed literature search looking at intrathecal drug research for neuropathic pain between January 2005 to May 2019 and discuss current practices and mechanisms in treating these complex patients.

Expert Opinion: On-label intrathecal drugs are recommended if efficacious with acceptable side effects. In those suffering from neuropathic pain, clinical evidence suggests additional drug algorithms for treating these patients are necessary. There is ample room for growth in the development and approval of novel drugs for intrathecal delivery to manage neuropathic pain.     

毒扁豆碱对大鼠的镇痛效应及静脉注射毒扁豆碱与蛛网膜下腔注射吗啡的相互作用(英文)

目的 :观察在术后不同阶段静脉注射胆碱酯酶抑制剂毒扁豆碱对鼠痛阈的影响 ,以及静注毒扁豆碱和蛛网膜下腔注射吗啡的药物相互作用。方法 :6组SD大鼠 ,置入蛛网膜下腔和股静脉导管。采用辐射热刺激诱发的鼠腿撤退试验测痛阈 ,测试分别于术后 1～ 3h和术后 3d进行。动物分别接受静注毒扁豆碱、蛛网膜下腔注射吗啡及两者联合给药。比较术后 1～ 3h和 3d各种药物对痛阈的影响、联合给药与单独给药对痛阈的影响。药物的镇痛效应以最大可能效应的百分比 ( %MPE)表示。结果 :毒扁豆碱术后 1～ 3h静注导致 %MPE明显提高 ;毒扁豆碱与吗啡的联合给药效应在术后早期更明显 ;小剂量联合给药的镇痛作用明显大于双倍剂量单独给药的镇痛作用 ;联合给药的测得效应值明显大于估计叠加效应值。结论 :胆碱酯酶抑制剂毒扁豆碱在术后早期产生镇痛作用 ;静注毒扁豆碱与蛛网膜下腔注射吗啡的联合给药呈协同效应。     

Innovations in bioadhesive vaginal drug delivery system

Introduction: Vagina, due to its anatomical position and physiological characteristics is increasingly being explored as a site for drug delivery in recent years. This route coupled with bioadhesion phenomena has born fruitful results in delivering drugs both locally as well as systemically.

Areas covered: Bioadhesive vaginal drug delivery system has been used for the treatment of local diseases affecting the vagina like candidiasis, STD, vaginal dryness, and so on. Also, research has demonstrated that drugs can be successfully delivered to systemic circulation via vaginal mucosa for treatment of various diseases like migraine and osteoporosis. Besides, this vaginal route has also been used for uterine targeting of drugs. This review focuses on these recent innovations that have been patented in the area of bioadhesive vaginal drug delivery systems. The review also highlights certain physicochemical characteristics of bioadhesive polymers that affect drug delivery through this route.

Expert opinion: An in-depth study of this review will give an insight into the potential areas that can be explored while designing a bioadhesive vaginal drug delivery system. Also, the in vitro and in vivo experimental results discussed in the review will help stimulate research in development and optimization of newer formulations.     

硫酸吗啡与盐酸吗啡普通片对照治疗中、重度癌痛84例

目的:评价硫酸吗啡与盐酸吗啡普通片对癌症疼痛的镇痛疗效及不良反应.方法:采用多中心随机对照试验,试验组(n=44)用硫酸吗啡,对照组(n=40)用盐酸吗啡,起始量均为10～30mg,每4～6h用1次,进行个体剂量滴定,达到无痛或基本无痛的维持量继续应用,共7d.结果:2组的疼痛完全缓解率分别为77.3%与77.5%,显著缓解率为95.5%与97.5%,总有效率为100%.结论:硫酸吗啡与盐酸吗啡片治疗中、重度癌痛均有显著疗效.     

Intrathecal drug delivery for pain management: recent advances and future developments

ABSTRACT

Introduction: Chronic pain conditions of malignant and non-malignant etiology afflict a large group of the population and pose a vast economic burden on society. Intrathecal drug therapy is a viable treatment option in such patients who have failed conservative medical measures and less invasive pain management procedures. However, the clinical growth of intrathecal therapy in managing intractable chronic pain conditions continues to face many challenges and is likely underutilized secondary to its high-complexity and lack of understanding.

Areas covered: This review will briefly discuss the history of intrathecal drug delivery systems (IDDS), cerebrospinal fluid (CSF) flow dynamics, types of IDDS, indications and patient profile suitable for this therapy, and risks and complications related to IDDS. We will also discuss challenges faced by physicians utilizing this therapy and the future changes that are needed for making this treatment modality more efficacious.

Expert opinion: IDDS offer an effective therapy for pain control in patients suffering from chronic intractable pain conditions. These devices provide a safer alternative to oral opioid medications with reduced systemic side effects. Adherence to best practices and continued clinical and basic science research is important to ensure continuing success of this therapy.     

壳聚糖在靶向制剂中的应用进展

壳聚糖是一种天然高分子化合物，壳聚糖及其衍生物具有优良的生物相容性和生物可降解性，在制药业有广阔的应用前景。综述了近几年来壳聚糖及其衍生物在靶向制剂中的应用。     

An evaluation of intrathecal ziconotide for the treatment of chronic pain

Ziconotide, the synthetic form of cone snail peptide ?-conotoxin MVIIA, is a neurone-specific N-type calcium channel blocker with an analgesic and neuroprotective effect. Intrathecal ziconotide has been recommended for approval by the FDA for the management of chronic pain. Spinally administered ziconotide produces analgesia by blocking neurotransmitter release from primary nociceptive afferents and prevents the propagation of pain signals to the brain. It has an advantage over intrathecal morphine in that there is no development of tolerance after prolonged use. Systemic toxicity is considerably reduced by administration of smaller doses intrathecally and selective delivery to the site of action in the nervous system. Nevertheless, there are neurological adverse effects due to delay in clearance of ziconotide from the neural tissues. Overall, ziconotide has a favourable risk/benefit ratio with advantages over several currently available intrathecal therapies for pain.     

重视吗啡治疗癌痛病人的个体差异

吗啡是癌痛治疗的首选药物,经过20余年的努力,全球吗啡的消耗量得到快速增长,我国也不例外。然而我国癌症病人中70%以上仍在疼痛,近一半的病人忍受着重度疼痛的折磨。本文从三个方面分析了癌痛病人未得到足够止痛的主要原因：一是药物的剂量不足或副作用处置不当;二是病人或病人家属对阿片类药物的＂成瘾性＂过度担心;三是药品供应与管理上过分强调严格。临床医师、药师应不断加强业务知识的更新,多方协作、共同努力,不断开拓新思路,树立为病人解除疼痛折磨的观点,规范应用有效的治疗药品,真正做到为癌痛病人解除疼痛的折磨而尽心尽力。     

川芎嗪治疗心脑血管疾病的纳米载药系统的研究进展

川芎嗪(tetramethylpyrazine,TMP)是从传统中药川芎中提取的生物碱单体,具有广泛的药理活性,尤其在治疗高血压、冠心病等心血管疾病方面受到广泛的关注。但由于TMP的不稳定性和生物利用度较差、代谢快且半衰期短等问题,在一定程度上限制了其在临床上的广泛应用,应用纳米载药系统可解决这一问题。本文主要对TMP治疗心脑血管疾病的药理作用及其应用纳米载药系统治疗心脑血管疾病的研究进展进行综述,以期为TMP的进一步开发研究提供参考。