中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2011年
11期
965-967
,共3页
周哲%张祥华%于普林%董碧蓉%蹇在金%鲁翔%钱芸娟%方宁远%高海青%祝世法%王建业
週哲%張祥華%于普林%董碧蓉%蹇在金%魯翔%錢蕓娟%方寧遠%高海青%祝世法%王建業
주철%장상화%우보림%동벽용%건재금%로상%전예연%방저원%고해청%축세법%왕건업
前列腺增生%诊疗准则
前列腺增生%診療準則
전렬선증생%진료준칙
Prostatic hyperplasia%Practice guideline
目的 了解良性前列腺增生(benign prostate hyperplasia,BPH)在老年科的诊断和治疗现状,促进BPH诊断和治疗的规范化.方法 抽取我国23个城市的老年科门诊BPH患者,完成老年科BPH门诊登记调查表.问卷内容包括患者的基本情况、诊疗情况和治疗效果.结果 对4001份调查问卷的分析显示,患者平均国际前列腺症状评分(IPSS)(18.8±5.9)分,中、重度症状患者分别占53.8％和42.0％.并存疾病的患病率依次为高血压(63.9％)、冠心病(40.4％)、糖尿病(32.4％)和高脂血症(25.7％).BPH相关并发症的发生率依次为尿路感染(21.0％)、尿路结石(8.3％)、反复血尿(1.8％)、肾积水(1.7％)和疝气(0.6％).医师采用的诊疗手段中,未进行直肠指诊的占27.2％,未进行血清前列腺特异性抗原(PSA)检查的占89.5％.在药物治疗的患者中,68.1％的患者处方中有a受体阻滞剂,92.9％的处方中有5α还原酶抑制剂,11.8％的处方中有中药和植物制剂,0.4％的处方中有M受体阻滞剂.首次处方中,单药治疗的占51.1％,2种药物联合治疗的占46.6％.在中重度症状患者中,遵医嘱规律服药的占60.6％,已停药的占13.9％.需要调整处方的原因依次为药物疗效差(23.4％)、不良反应多(5.4％)、价格昂贵(3.5％)、服用不方便(2.9％)等.结论 老年科门诊BPH患者以中重度症状为主,BPH治疗的同时还需考虑并存的疾病和BPH相关并发症；医师需进一步认识直肠指诊和PSA检查的重要性,联合治疗对于改善患者下尿路症状效果显著,长期治疗效果更好.
目的 瞭解良性前列腺增生(benign prostate hyperplasia,BPH)在老年科的診斷和治療現狀,促進BPH診斷和治療的規範化.方法 抽取我國23箇城市的老年科門診BPH患者,完成老年科BPH門診登記調查錶.問捲內容包括患者的基本情況、診療情況和治療效果.結果 對4001份調查問捲的分析顯示,患者平均國際前列腺癥狀評分(IPSS)(18.8±5.9)分,中、重度癥狀患者分彆佔53.8％和42.0％.併存疾病的患病率依次為高血壓(63.9％)、冠心病(40.4％)、糖尿病(32.4％)和高脂血癥(25.7％).BPH相關併髮癥的髮生率依次為尿路感染(21.0％)、尿路結石(8.3％)、反複血尿(1.8％)、腎積水(1.7％)和疝氣(0.6％).醫師採用的診療手段中,未進行直腸指診的佔27.2％,未進行血清前列腺特異性抗原(PSA)檢查的佔89.5％.在藥物治療的患者中,68.1％的患者處方中有a受體阻滯劑,92.9％的處方中有5α還原酶抑製劑,11.8％的處方中有中藥和植物製劑,0.4％的處方中有M受體阻滯劑.首次處方中,單藥治療的佔51.1％,2種藥物聯閤治療的佔46.6％.在中重度癥狀患者中,遵醫囑規律服藥的佔60.6％,已停藥的佔13.9％.需要調整處方的原因依次為藥物療效差(23.4％)、不良反應多(5.4％)、價格昂貴(3.5％)、服用不方便(2.9％)等.結論 老年科門診BPH患者以中重度癥狀為主,BPH治療的同時還需攷慮併存的疾病和BPH相關併髮癥；醫師需進一步認識直腸指診和PSA檢查的重要性,聯閤治療對于改善患者下尿路癥狀效果顯著,長期治療效果更好.
목적 료해량성전렬선증생(benign prostate hyperplasia,BPH)재노년과적진단화치료현상,촉진BPH진단화치료적규범화.방법 추취아국23개성시적노년과문진BPH환자,완성노년과BPH문진등기조사표.문권내용포괄환자적기본정황、진료정황화치료효과.결과 대4001빈조사문권적분석현시,환자평균국제전렬선증상평분(IPSS)(18.8±5.9)분,중、중도증상환자분별점53.8％화42.0％.병존질병적환병솔의차위고혈압(63.9％)、관심병(40.4％)、당뇨병(32.4％)화고지혈증(25.7％).BPH상관병발증적발생솔의차위뇨로감염(21.0％)、뇨로결석(8.3％)、반복혈뇨(1.8％)、신적수(1.7％)화산기(0.6％).의사채용적진료수단중,미진행직장지진적점27.2％,미진행혈청전렬선특이성항원(PSA)검사적점89.5％.재약물치료적환자중,68.1％적환자처방중유a수체조체제,92.9％적처방중유5α환원매억제제,11.8％적처방중유중약화식물제제,0.4％적처방중유M수체조체제.수차처방중,단약치료적점51.1％,2충약물연합치료적점46.6％.재중중도증상환자중,준의촉규률복약적점60.6％,이정약적점13.9％.수요조정처방적원인의차위약물료효차(23.4％)、불량반응다(5.4％)、개격앙귀(3.5％)、복용불방편(2.9％)등.결론 노년과문진BPH환자이중중도증상위주,BPH치료적동시환수고필병존적질병화BPH상관병발증；의사수진일보인식직장지진화PSA검사적중요성,연합치료대우개선환자하뇨로증상효과현저,장기치료효과경호.
Objective To evaluate the current status of diagnosis and treatment for benign prostatic hyperplasia (BPH) in geriatrics department,and to promote the standardization of diagnosis and treatment.Methods The BPH patients in geriatrics outpatients from 23 cities were included.General conditions,diagnosis and treatment,and the effect of treatment were recorded in registry questionnaire.Results The analysis of 4001 questionnaires showed that the mean international prostate symptom score (IPSS) was (18.8±5.9),and the percent of the moderate and severe symptom was 53.8％ and 42.0％,respectively.The morbidities of coexist diseases were 63.9％ (hypertension),40.4 ％ (coronary disease),32.4 ％ (diabetes mellitus) and 25.7 ％ (hyperlipidemia).BPH-related complications were urinary infection (21.0％),urinary stone (8.3％),recurrent hematuria (1.8％),hydronephrosis (1.7％),and hernia (0.6％).In the initial evaluation of BPH,27.2％ of doctors didn't finish digital rectal examination,and 89.5％ of doctors didn't complete PSA test.Among patients with medical therapy,a-receptor blocker was used in 68.1％,5α-reductase inhibitor in 92.9％,Chinese medicine and plant drugs in 11.8％,and M-receptor blocker in 0.4％ of the prescriptions.During the first prescription,monotherapy was recorded in 51.1％,and combination therapy with two drugs was recorded in 46.6 ％.In the patients with moderate and severe symptoms,60.6％ of patients took the drugs regularly,13.9％ of patients withdrew the drugs.The reasons for drug adjustment were poor efficacy (23.4％),serious side effects (5.4％),high cost (3.5％),taking inconveniently (2.9％),etc.Conclusions Most BPH patients in geriatrics department have moderate and severe symptoms.Coexist diseases and BPH-related complications should be considered during treatment of BPH.Doctors should realize the importance of digital rectal examination and PSA test.Combination therapy has more efficacy for improving lower urinary symptoms,and long-term application may be better.
