• 華中科技大學同濟醫(yī)學院（武漢，430030）1附屬同濟醫(yī)院骨科，2中西醫(yī)結(jié)合醫(yī)院腫瘤科;

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險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)排除標準排除33例，根據(jù)分組標準將有潛在胃腸道疾病風險者設為試驗組（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組進行配伍設為陽性對照組（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。試驗組服用替扎尼定2 mg，2次/d，同時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，同時安慰劑1粒，2次/d。觀察藥物療效和不良反應。 結(jié)果 　A組隨訪57例，平均起效時間為（2.17 ± 0.99） d，總有效44例（77.2%），胃腸道不良反應2例（3.5%）；B組隨訪54例，平均起效時間為（1.78 ± 0.96） d，總有效45例（83.3%），胃腸道不良反應發(fā)生3例（5.5%）；C組隨訪55例，平均起效時間（4.10 ± 1.63） d，總有效35例（63.6%），胃腸道不良反應發(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間相當，胃腸道耐受性較好，聯(lián)合用藥效果優(yōu)于單獨使用肌松藥。對于有潛在胃腸道風險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,郭風勁. 依托芬那酯凝膠聯(lián)合替扎尼定治療潛在胃腸道風險的急性頸肩腰部疼痛療效及安全性研究. 華西醫(yī)學, 2012, 27(12): 1784-1787. doi: 復制

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  1. 1. 　張伯勛, 王巖. 現(xiàn)代頸肩腰腿痛診斷與治療學[M]. 北京: 人民軍醫(yī)出版社, 2004: 248-264.
  2. 2. 　李端. 藥理學 [M]. 5版. 北京: 人民衛(wèi)生出版社, 2003: 166-177.
  3. 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. 4. 　楊岫巖, 許韓師. 非甾體抗炎藥的化學分類及其對環(huán)氧合酶選擇性的認識[J]. 中華內(nèi)科雜志, 2002, 41(7): 496-497.
  5. 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. 6. 　楊南萍, 左川, 蘇白海. NSAIDs的作用機制研究進展[J]. 華西醫(yī)學, 1999, 14(2): 254.
  7. 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. 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. 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. 10. 　Warden SJ. Prophylactic use of NSAIDs by athletes: a risk/benefit assessment[J]. Phys Sportsmed, 2010, 38(1): 132-138.
  11. 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. 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. 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.