COX-2抑制剂在术后镇痛的临床应用-医学课件.pptVIP

PCA吗啡 帕瑞昔布(PRX)40mg BID +安慰剂QID 丙帕他莫(PCT)2g QID +安慰剂BID PRX BID + PCT QID 安慰剂BID +安慰剂QID The incidence of endoscopically detected upper GI ulceration was significantly lower with DYNASTAT? (parecoxib sodium for injection) than with the nonselective NSAIDs, ketorolac and naproxen.1-3 Both oral and injectable NSAIDs studied produced significantly more ulceration than DYNASTAT (P ≤0.05)1-3 The incidence of gastroduodenal ulceration with DYNASTAT was comparable to placebo1-3 This graph reflects the combined incidence of gastroduodenal ulcers from 3 different 7-day endoscopic trials in healthy subjects1-3 The GI ulceration/bleeding associated with nonselective NSAIDs is believed to be due to COX-1 inhibition. By sparing COX-1, the COX-2 inhibitors, such as DYNASTAT, provide the analgesic and anti-inflammatory effects of nonselective NSAIDs, with the added benefit of an improved upper GI safety profile1 Study Design: Results of 3 randomized, double-blind, placebo-controlled, parallel-group, 7-day studies of DYNASTAT in healthy adults aged 18 to 75 years who were ulcer free by endoscopy at baseline. Subjects were counted as having a gastroduodenal ulcer if either gastric or duodenal ulcer (or both) was present. An ulcer was defined as any break in the mucosa at least 3 mm in diameter with unequivocal depth. Due to restrictions on use in the United States, ketorolac was administered for the last 5 days only. Placebo was administered on days 1 and 2 in this treatment group.3 Study 1: DYNASTAT 40 mg IV bid vs ketorolac 15 mg IV qid and placebo (N=92).1Study 2: DYNASTAT 40 mg IV bid vs ketorolac 30 mg IV qid and placebo (N=122).2 Study 3: DYNASTAT 20 mg IV bid vs naproxen 500 mg PO bid, ketorolac 30 mg IV qid, and  placebo (N=166).3 References: 1. Stoltz RR, Harris SI, Kuss ME, et al. Upper GI mucosal effects of parecoxib sodium in healthy elderly subjects. Am J Gastroenterol. 2002;97:65-71. 2. Harris SI, Stoltz RR, LeComte D, Hubbard RC. Parecoxib sodium de