关于COX2选择性抑制剂的争论  

Controversies Over Selective COX2 Inhibitor

作　　者：马柯[1] 江伟[1] 

机构地区：[1]上海交通大学附属第六人民医院麻醉科,上海200233

出　　处：《麻醉与监护论坛》2005年第4期257-260,共4页Forum of Anesthesia and Monitoring

摘　　要：近年来对选择性环氯合酶Ⅱ（COX2）抑制剂疗效和副反应问题的争论较多，本综述主要从临床疼痛治疗角度进行综合分析。COX2选择性抑制剂和传统的非甾体类药物相比，可明显的减轻胃肠道副作用，并且可以和阿片类药物同作用，提高疗效。单纯从疼痛治疗的角度看，选择性COX2抑制剂在疼痛治疗方面有很广泛的适应证。但近年来基有报告COX2抑制剂可能会增加心血管事件和肾功能损害的发生率，虽然大型Meta分析显示和传统非甾件类药物并没有显著差异。最近的研究表明COX2的生理学功能非常复杂，可能发挥致炎和抗炎的双向效应，和COX2有功能上的重叠及作用上的互补共同对机体发挥保护作用。阻断COX2可能会导致部分正常生理功能的缺失。提示临床医师要注意科掌用药，要始终注意风险效益相平衡的原则。Recently, there are many controversies about the effectiveness and side effecls of selecbve COX2 inhibgor This review analyzed the value of the drug on pare management Selective COX2 ibhibdor has much less gastrointesfinal side effect than NSAIDs Besides it also can synergize the opoids Therefore, selective COX2 inhibitor is a kind of effective drug anc easy tc use for pain management However. some recent case roperi indicated that seleebve COX2 inhibitor may led to cardiovascular Incident and renal damage, though Meta analysis didn＇t show the clinical significances Some researcn showed more complex physiological effects of COX than expected and suggested that COX2 might have pro-and antiqnflammagon according to the different inflammatory phase. Meanwhile, COX2, can proeuce protection to organ,sin together with COX2 Inhibiting COX2 may have impacts on some of normal functions In summary, physicians should pay more attention to balance the risks and benefits of selective COX2 inhibitor.

关 键 词：抑制剂 疼痛 选择性COX2抑制剂 选择性抑制剂 阿片类药物 疼痛治疗 胃肠道副作用 Meta分析 正常生理功能 临床医师 

分 类 号：R743.31[医药卫生—神经病学与精神病学] R971.1[医药卫生—临床医学]