中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
6期
2433-2437
,共5页
叶烈夫%傅长德%杨泽松%何延瑜%詹汉雄%林玉琴%许庆均%张志刚%黄水通%胡敏雄%叶世华%陈松茂%陈如
葉烈伕%傅長德%楊澤鬆%何延瑜%詹漢雄%林玉琴%許慶均%張誌剛%黃水通%鬍敏雄%葉世華%陳鬆茂%陳如
협렬부%부장덕%양택송%하연유%첨한웅%림옥금%허경균%장지강%황수통%호민웅%협세화%진송무%진여
肾结石%碎石术%α1肾上腺素能受体阻滞剂
腎結石%碎石術%α1腎上腺素能受體阻滯劑
신결석%쇄석술%α1신상선소능수체조체제
Kidney calculi%Lithotripsy%Adrenergic alpha-1 receptor antagonists
目的评估高选择性α1受体阻滞剂坦索罗辛对肾结石体外震波碎石（ ESWL ）术后辅助排石作用的有效性及安全性。方法140例单发的非下盏部位的肾结石患者，结石大小6～20 mm，ESWL碎石成功后随机分为两组，每组70例。对照组给予标准治疗包括中成药尿石通丸及司帕沙星，试验组接受标准治疗基础上加用坦索罗辛，随访2个月。结果试验组（坦索罗辛组）单次ESWL后结石排出率、结石排出时间、石街形成率、肾绞痛发生次数及哌替啶的使用次数等指标均优于对照组（ P值分别为0.009，0.000，0.028，0.012，0.002），但两组之间的结石排净率差异无统计学意义（ P＝0.125）。按结石大小进行分组分析，结石≥10 mm患者中，坦索罗辛组的结石排净率高于对照组，差异有统计学意义（ P＝0.044），且其余各项指标均优于对照组（ P＜0.05）。结石＜10 mm者，坦索罗辛组仅结石排出时间与肾绞痛发生次数两项指标优于对照组（ P＝0.001，0.026）。坦索罗辛组药物副作用发生率与对照组相比差别无统计学意义（ P＝0.085），且症状轻微，无一例患者因副作用停止治疗。结论坦索罗辛能够促进并加快肾结石单次ESWL术后碎石排出，减少石街形成并降低肾绞痛发生频率及止痛针使用，对于≥10 mm肾结石患者还能够提高结石排净率，用于辅助排石安全有效。
目的評估高選擇性α1受體阻滯劑坦索囉辛對腎結石體外震波碎石（ ESWL ）術後輔助排石作用的有效性及安全性。方法140例單髮的非下盞部位的腎結石患者，結石大小6～20 mm，ESWL碎石成功後隨機分為兩組，每組70例。對照組給予標準治療包括中成藥尿石通汍及司帕沙星，試驗組接受標準治療基礎上加用坦索囉辛，隨訪2箇月。結果試驗組（坦索囉辛組）單次ESWL後結石排齣率、結石排齣時間、石街形成率、腎絞痛髮生次數及哌替啶的使用次數等指標均優于對照組（ P值分彆為0.009，0.000，0.028，0.012，0.002），但兩組之間的結石排淨率差異無統計學意義（ P＝0.125）。按結石大小進行分組分析，結石≥10 mm患者中，坦索囉辛組的結石排淨率高于對照組，差異有統計學意義（ P＝0.044），且其餘各項指標均優于對照組（ P＜0.05）。結石＜10 mm者，坦索囉辛組僅結石排齣時間與腎絞痛髮生次數兩項指標優于對照組（ P＝0.001，0.026）。坦索囉辛組藥物副作用髮生率與對照組相比差彆無統計學意義（ P＝0.085），且癥狀輕微，無一例患者因副作用停止治療。結論坦索囉辛能夠促進併加快腎結石單次ESWL術後碎石排齣，減少石街形成併降低腎絞痛髮生頻率及止痛針使用，對于≥10 mm腎結石患者還能夠提高結石排淨率，用于輔助排石安全有效。
목적평고고선택성α1수체조체제탄색라신대신결석체외진파쇄석（ ESWL ）술후보조배석작용적유효성급안전성。방법140례단발적비하잔부위적신결석환자，결석대소6～20 mm，ESWL쇄석성공후수궤분위량조，매조70례。대조조급여표준치료포괄중성약뇨석통환급사파사성，시험조접수표준치료기출상가용탄색라신，수방2개월。결과시험조（탄색라신조）단차ESWL후결석배출솔、결석배출시간、석가형성솔、신교통발생차수급고체정적사용차수등지표균우우대조조（ P치분별위0.009，0.000，0.028，0.012，0.002），단량조지간적결석배정솔차이무통계학의의（ P＝0.125）。안결석대소진행분조분석，결석≥10 mm환자중，탄색라신조적결석배정솔고우대조조，차이유통계학의의（ P＝0.044），차기여각항지표균우우대조조（ P＜0.05）。결석＜10 mm자，탄색라신조부결석배출시간여신교통발생차수량항지표우우대조조（ P＝0.001，0.026）。탄색라신조약물부작용발생솔여대조조상비차별무통계학의의（ P＝0.085），차증상경미，무일례환자인부작용정지치료。결론탄색라신능구촉진병가쾌신결석단차ESWL술후쇄석배출，감소석가형성병강저신교통발생빈솔급지통침사용，대우≥10 mm신결석환자환능구제고결석배정솔，용우보조배석안전유효。
Objective To define the efficacy and safety of the highly selective α1 blocker tamsulosin as adjunctive expulsion therapy after extracorporeal shock wave lithotripsy ( ESWL ) in patients with kidney stones . Methods 140 patients with single 6-20 mm non-lower-pole kidney stone were enrolled in this study from March 2009 to October 2011 .After one session of successful ESWL , they were randomized into two groups of 70 patients each.Control group received a standard medical therapy which consisted of a traditional Chinese medicine ( niaoshitong ) and sparfloxacin ,while study group was given tamsulosin in addition to standard therapy .Patients were followed up for 2 months.Results Parameters including stone expulsion rate , mean expulsion time, rate of steinstrasse development ,number of renal colic episodes and analgesics used were in favor of the tamsulosin group and the differences were significant ( P=0.009 ,0.000 ,0.028 ,0.012 ,0.002 respectively ) .Unfortunately the stone free rate was not significantly different between two groups ( P=0.125 ) .In the subgroup analysis ,patients with stone≥10 mm had significantly greater stone free rate in the tamsulosin group ( 62.8%) compared with the control group (40.5%,P=0.044),and all other parameters were significantly in favor of the tamsulosin group (P<0.05).For patients with stone<10 mm,only mean expulsion time and number of renal colic episodes were significantly different between two groups ( P=0.001 ,0.026 ) .The incidence of side effects was not significantly different between two groups ,and all side effects were minimal which did not require cessation of therapy in any patient .Conclusions After a single session of ESWL for renal calculi , tamsulosin helps to facilitate stone fragmentation passage , decrease expulsion time ,reduce steinstrasse development ,colic episodes and amount of analgesics required ,but the stone free rate is significantly increased only for renal stones≥10 mm in size.Adjuvant treatment with tamsulosin is effective in improving the outcome of ESWL with minimal side effects .
