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【摘要】 目的 探讨氨酚曲马多治疗骨科急慢性疼痛的疗效。方法 对骨科门诊124例疼痛患者(111例急性疼痛,13例慢性疼痛)其疼痛的程度用视觉模拟评分法(VAS)进行评分后,给予氨酚曲马多治疗5 d,然后再次对疼痛进行评分并对疗效进行评价,并记录不良反应。结果 急性疼痛患者治疗前平均疼痛的VAS评分为(5.38±1.43),治疗后平均疼痛的VAS评分为(3.50±1.69),二者有统计学意义;慢性疼痛患者治疗前平均疼痛的VAS评分为(4.83±1.30),治疗后平均疼痛的VAS评分为(4.00±1.47),二者有统计学意义。急性疼痛患者的不良反应主要为头晕14%、恶心4.5%、呕吐8.1%;慢性疼痛患者没有不良反应的发生。结论 氨酚曲马多对于治疗骨科急慢性疼痛安全性较好,总体效果满意。
【关键词】 氨酚曲马多;急慢性疼痛;疗效
Efficacy of Paracetamol and tramadol in the treatment of acute and chronic orthopedic pain
DING Yue,ZENG Zhan-peng,XU Jie,et al.Department of Orthopaedics,Sun Yat-sen Memorial Hospital,Guangzhou 510120,China
【Abstract】 Objective To observe the efficacy of paracetamol and tramadol in the treatment of acute and chronic orthopedic pain.Methods The extent of pain of 124 patients(111 cases of acute pain and 13 cases of chronic pain)was assessed in visual analogue scale(VAS)for the first visit and assessed again after the treatment of paracetamol and tramadol.Evaluate the efficacy of the treatment finally.Results The VAS of average pain before and after treatment was 5.38±1.43 and 3.50±1.69 in patients of acute pain,while the VAS of average pain before and after treatment was 4.83±1.30 and 4.00±1.47 in patients of chronic pain,and both were statistically significant.The incidence of adverse reactions in patients with acute pain was 23.4%,mainly dizziness 14%,nausea 4.5%,vomiting 8.1%,while patients with chronic pain were in no adverse event.Conclusion Paracetamol and Tramadol for the treatment of acute and chronic pain was in good safety,and the overall results were satisfactory.
【Key words】Paracetamol and tramadol; Acute and chronic pain; Effectiveness.
作者单位:510120广州,中山大学附属孙逸仙纪念医院骨外科
近年来,多模式镇痛在疼痛的控制中得到广泛的应用,不同作用机制的镇痛药物已被联合应用于急慢性疼痛的治疗当中,其镇痛效果、耐受性和安全性都较单一使用某种药物要好。氨酚曲马多(西安杨森制药有限公司生产,每片含37.5 mg曲马多和325 mg对乙酰氨基酚)是近年来的一种复合镇痛药物,其保留了对乙酰氨基酚的快速镇痛效果,又有曲马多的持久镇痛效果[1],已经应用于口腔科、乳腺癌术后镇痛等,但在国内骨科领域中应用相对较少,尤其对慢性疼痛的疗效方面文献报导较少。2008年7~10月,对我院骨科门诊124例疼痛患者(111例急性,13例慢性)给予氨酚曲马多片治疗,评价治疗前后疼痛的缓解以及不良反应的发生,现报告如下。
1 资料与方法
1.1 研究对象 2008年7~10月,以124例就诊于我院骨科门诊的疼痛患者为研究对象,其中急性疼痛111例(疼痛持续时间
表1
急性疼痛患者疼痛程度VAS评分
VAS评分治疗前治疗后t值P值
最痛VAS6.29±1.464.32±1.6311.850.05
平均疼痛VAS4.83±1.314.00±1.472.29 [4] McCarberg,B.Tramadol extended-release in the management of chronic pain.Ther Clin Risk Manag,2007,3(3):401-10.
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[7] 金勋杰,等.氨酚曲马多治疗骨科中重度疼痛的疗效及安全性的研究.中华关节外科杂志(电子版),2009,3(3):68-69.
[8] 翟文勇,张兆川.氨酚曲马多治疗骨科腰椎术后疼痛的临床观察.中国医药指南:学术版,2009,7(21):78-780.
[9] Edwards,J.E.,H.J.McQuay and R.A.Moore,Combination analgesic efficacy:individual patient data meta-analysis of single-dose oral tramadol plus acetaminophen in acute postoperative pain.J Pain Symptom Manage,2002,23(2):121-130.
[10] Emkey,R,et al.Efficacy and safety of tramadol/acetaminophen tablets(Ultracet)as add-on therapy for osteoarthritis pain in subjects receiving a COX-2 nonsteroidal antiinflammatory drug:a multicenter,randomized,double-blind,placebo-controlled trial.J Rheumatol,2004,31(1):150-156.
[11] MD,G.E.R.,et al.,Tramadol/Acetaminophen combination tablets for the treatment of chronic lower back pain:A multicenter,randomized,double-blind,placebo-controlled outpatient study*1.Clinical Therapeutics,2003,23(9):1429-1445.
