CAJ | 학술논문

目的评估a-受体阻滞剂盐酸坦索罗辛对输尿管结石体外冲击波碎石术(ESWL)后对结石排出作用的影响.方法 2012年1月～2013年12月,140例输尿管结石患者(上段24例,中下段116例;结石最大直径平均1.0±0.44cm大小),行ESWL后,随机分两组,对照组70例,山莨菪碱片5mg,3次/d,共14d;实验组70例,盐酸坦索罗辛0.4mg,1次/d,共14d.两组均持续到结石被排除或最长30d.随访评定结石大小、位置、清除时间和止痛剂是否使用.结果两组间的年龄、石头位置无差异(P＞0.05).实验组结石全部清除率为94.3％,对照组为80.0％(P＜0.05).在盐酸坦索罗辛组肾绞痛的发生率明显降低(P＜0.05),使用的双氯芬酸钠的剂量少于对照组,但差异没有统计学意义.对于较大的结石(直径＞ 1.2cm)的清除率有明显的不同(90.0％ VS 44.4％,P＜0.01),但是较小的结石(直径＜0.7cm)则并非如此(87.5％ VS 80.0％,P＞0.05).盐酸坦索罗辛组石街自发排出,然而对照组中22.9％的患者需要行输尿管镜碎石术.结论 a受体阻滞剂可以促进结石排出,尤其是输尿管结石ESWL中较大的石头,并且还可以促进石街的排出.盐酸坦索罗辛在常规的ESWL后有一定的排石作用.
목적 평고a-수체조체제염산탄색라신대수뇨관결석체외충격파쇄석술(ESWL)후대결석배출작용적영향.방법 2012년1월～2013년12월,140례수뇨관결석환자(상단24례,중하단116례;결석최대직경평균1.0±0.44cm대소),행ESWL후,수궤분량조,대조조70례,산랑탕감편5mg,3차/d,공14d;실험조70례,염산탄색라신0.4mg,1차/d,공14d.량조균지속도결석피배제혹최장30d.수방평정결석대소、위치、청제시간화지통제시부사용.결과 량조간적년령、석두위치무차이(P＞0.05).실험조결석전부청제솔위94.3％,대조조위80.0％(P＜0.05).재염산탄색라신조신교통적발생솔명현강저(P＜0.05),사용적쌍록분산납적제량소우대조조,단차이몰유통계학의의.대우교대적결석(직경＞ 1.2cm)적청제솔유명현적불동(90.0％ VS 44.4％,P＜0.01),단시교소적결석(직경＜0.7cm)칙병비여차(87.5％ VS 80.0％,P＞0.05).염산탄색라신조석가자발배출,연이대조조중22.9％적환자수요행수뇨관경쇄석술.결론 a수체조체제가이촉진결석배출,우기시수뇨관결석ESWL중교대적석두,병차환가이촉진석가적배출.염산탄색라신재상규적ESWL후유일정적배석작용.
Objectives To evaluate a role of tamsulosin as adjunctive therapy after extracorporeal shock wave lithotripsy(ESWL) in patients with stones in the kidney and ureter.Methods A placebo-controlled,randomized,double-blind clinical trial prospectively performed between January 2012 and December 2013 on 140 patients with 5 ～ 15mm in diameter ureteral stones referred to our ESWL center.The study group(70) received 0.4 mg tamsulosin and the control group (70) received placebo daily until stone clearance or for a maximum of 30 days.The parameters assessed were stone size,position,clearance time,effect on steinstrasse and analgesic requirement.Results The overall clearance rate was 94.3％ (66 of 70) in the study group and 80％ (56 of 70) in the control group(P ＜ 0.05).With larger stones(＞ 1.2cm) the difference in the clearance rate was significant (P ＜ 0.01) but not so with the smaller stones (＜ 0.7cm,P ＞ 0.05).The average dose of analgesic used was lower with tamsulosin than with controls,without statistical significance.Steinstrasse resolved spontaneously in the tamsulosin group whereas 22.9％ (16 of 70) required intervention in the placebo group.There was no difference between the 2 groups with regard to age,stone size or location.Conclusions The alpha-blocker tamsulosin seemed to facilitate stone clearance,particularly with larger stones during shock wave lithotripsy for ureteral calculus.It also appeared to improve the outcome of steinstrasse.Tamsulosin may have a potential role in routine shock wave lithotripsy.