目的 觀察非甾體抗炎藥依托芬那酯凝膠聯(lián)合中樞性肌松藥替扎尼定對治療有潛在胃腸道風(fēng)險(xiǎn)的急性痙攣性頸肩腰痛的療效和安全性。 方法 2012年3月－5月共診斷急性痙攣性頸肩痛及腰痛患者375例，依據(jù)排除標(biāo)準(zhǔn)排除33例，根據(jù)分組標(biāo)準(zhǔn)將有潛在胃腸道疾病風(fēng)險(xiǎn)者設(shè)為試驗(yàn)組（A組，n=63），明確無胃腸道疾病史者按照年齡、性別和疼痛部位與試驗(yàn)組進(jìn)行配伍設(shè)為陽性對照組（B組，n=63）和安慰劑對照組（C組，n=63），未分組144例不納入統(tǒng)計(jì)。試驗(yàn)組服用替扎尼定2 mg，2次/d，同時(shí)外用依托芬那酯凝膠5～10 cm均勻涂抹患處，3次/d；對照組服用替扎尼定2 mg，2次/d，同時(shí)口服塞來昔布0.2 g，2次/d；安慰劑對照組服用替扎尼定2 mg，2次/d，同時(shí)安慰劑1粒，2次/d。觀察藥物療效和不良反應(yīng)。 結(jié)果 A組隨訪57例，平均起效時(shí)間為（2.17 ± 0.99） d，總有效44例（77.2%），胃腸道不良反應(yīng)2例（3.5%）；B組隨訪54例，平均起效時(shí)間為（1.78 ± 0.96） d，總有效45例（83.3%），胃腸道不良反應(yīng)發(fā)生3例（5.5%）；C組隨訪55例，平均起效時(shí)間（4.10 ± 1.63） d，總有效35例（63.6%），胃腸道不良反應(yīng)發(fā)生2例（3.6%）。 結(jié)論 依托芬那酯凝膠和口服非甾體抗炎藥療效和起效時(shí)間相當(dāng)，胃腸道耐受性較好，聯(lián)合用藥效果優(yōu)于單獨(dú)使用肌松藥。對于有潛在胃腸道風(fēng)險(xiǎn)的痙攣性頸肩腰背痛患者可選擇外用非甾體抗炎藥聯(lián)合中樞性肌松藥的治療方案，以獲得更好的療效以及較高耐受性。
引用本文： 許凱,成薇婷,郭風(fēng)勁. 依托芬那酯凝膠聯(lián)合替扎尼定治療潛在胃腸道風(fēng)險(xiǎn)的急性頸肩腰部疼痛療效及安全性研究. 華西醫(yī)學(xué), 2012, 27(12): 1784-1787. doi: 復(fù)制
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- 1. 張伯勛, 王巖. 現(xiàn)代頸肩腰腿痛診斷與治療學(xué)[M]. 北京: 人民軍醫(yī)出版社, 2004: 248-264.
- 2. 李端. 藥理學(xué) [M]. 5版. 北京: 人民衛(wèi)生出版社, 2003: 166-177.
- 3. Lanas A, Esplugues JV, Zapardiel J, et al. Education-based approach to addressing non-evidence-based practice in preventing NSAID-associated gastrointestinal complications[J]. World J Gastroenterol, 2009, 15(47): 5953-5959.
- 4. 楊岫巖, 許韓師. 非甾體抗炎藥的化學(xué)分類及其對環(huán)氧合酶選擇性的認(rèn)識[J]. 中華內(nèi)科雜志, 2002, 41(7): 496-497.
- 5. Morita I, Schindler M, Regier MK, et al. Different intracellular locations for prostaglandin endoperoxide H synthase-1 and -2[J]. J Biol Chem, 1995, 270(18): 10902-10908.
- 6. 楊南萍, 左川, 蘇白海. NSAIDs的作用機(jī)制研究進(jìn)展[J]. 華西醫(yī)學(xué), 1999, 14(2): 254.
- 7. Whelton A. COX-1 sparing and COX-2 inhibitory drugs: the renal and hepatic safety and tolerability profiles of celecoxib[J]. Arch Intern Med, 2000, 7(3): 151-152.
- 8. Nadarajah A, Abrahan L, Lau FL, et al. Efficacy and tolerability of celecoxib compared with diclofenac slow release in the treatment of acute ankle sprain in an Asian population[J]. Singapore Med J, 2006, 47(6): 534-542.
- 9. Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group[J]. N Engl J Med, 2000, 343(21): 1520-1528.
- 10. Warden SJ. Prophylactic use of NSAIDs by athletes: a risk/benefit assessment[J]. Phys Sportsmed, 2010, 38(1): 132-138.
- 11. Vanderstraeten G, Schuermans P. Study on the effect of etofenamate 10% cream in comparison with an oral NSAID in strains and sprains due to sports injuries[J]. Acta Belg Med Phys, 1990, 13(3): 139-141.
- 12. Watanabe K, Watanabe H, Maeda-Hagiwara M, et al. Influence of a muscle relaxant, tizanidine, on gastric acid secretion and gastric ulcer in rats[J]. Nihon Yakurigaku Zasshi, 1983, 82(4): 237-245.
- 13. Bijlsma JW. Treatment of endoscopy-negative NSAID-induced upper gastrointestinal symptoms with cimetidine: an international multicentre collaborative study[J]. Aliment Pharmacol Ther, 1988, 2(Suppl 1): 75-83.