Perlin E, Finke H, Castro O, Rana S, Pittman J, Burt R, Ruff C, McHugh D
Department of Medicine, Howard University Hospital, Washington, D.C. 20060.
Am J Hematol. 1994 May;46(1):43-7. doi: 10.1002/ajh.2830460108.
Twenty one patients with sickle cell disease admitted to the hospital with the pain of vaso-occlusive crisis (VOC) were treated by continuous IV infusion of ketorolac or normal saline for up to 5 days. All patients received supplemental IM injections of meperidine, 100 mg, as necessary, but not more frequently than every 3 hr. Over the 5 days the ketorolac treated patients (KT) required 33% less meperidine than did the placebo treated patients (PL), P = 0.04, and had significantly better pain relief as assessed by categorical, visual analog, and pain relief scales. By the end of 5 days infusions had been discontinued in six KT and one PL. The time to discontinuation of the infusion was significantly shorter in KT, (P = 0.009). The median duration of hospital stay from the start of treatment was 3.3 days for KT and 7.2 days for PL, P = 0.027. Adverse events were mainly related to the digestive system. This study showed that continuous infusion of ketorolac significantly reduced total meperidine requirement and that the analgesia produced by this combination was superior to that produced by meperidine alone. Further evaluation of this drug in the management of sickle cell VOC is warranted.
21例因血管闭塞性危机（VOC）疼痛入院的镰状细胞病患者，接受了酮咯酸或生理盐水持续静脉输注治疗，最长达5天。所有患者必要时接受100mg哌替啶肌内补充注射，但给药频率不超过每3小时一次。在这5天里，酮咯酸治疗组（KT）患者所需的哌替啶比安慰剂治疗组（PL）少33%，P = 0.04，并且根据分类、视觉模拟和疼痛缓解量表评估，疼痛缓解情况明显更好。到第5天结束时，6例KT患者和1例PL患者停止了输注。KT组输注停止时间明显更短，（P = 0.009）。从治疗开始计算，KT组的中位住院时间为3.3天，PL组为7.2天，P = 0.027。不良事件主要与消化系统有关。本研究表明，持续输注酮咯酸可显著降低哌替啶的总需求量，并且这种联合用药产生的镇痛效果优于单独使用哌替啶。有必要对该药物在镰状细胞病VOC治疗中的应用进行进一步评估。
