盐酸坦索罗辛在输尿管结石冲击波碎石术后中的作用被引量：9

A role for tamsulosin after shock wave lithotripsy in the treatment of ureteral calculi

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摘要目的评估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。 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.

作者刘志敏刘波潘铁军沈国球文瀚东涂忠杨家荣

机构地区广州军区武汉总医院

出处《国际泌尿系统杂志》 2015年第5期664-666,共3页 International Journal of Urology and Nephrology

关键词输尿管结石碎石术 Ureteral Calculi Lithotripsy

分类号 R693.4 [医药卫生—泌尿科学]

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参考文献6

1Dellabella M,Milanese G,Muzzonigro G. Randomized trial of theefficacy of tamsulosin,nifedopine and phloroglucinol in medical ex-pulsive therapy for distal ureter calculi[ J]. J Urol,2005 ,174: 167-172.
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6杨成宇,闫惠忠,王慕华,高利军.盐酸坦洛新缓释片与盐酸坦索罗辛缓释胶囊在输尿管结石体外冲击波碎石后辅助排石中作用的比较[J].中国药物与临床,2010,10(4):452-453. 被引量：17

二级参考文献4

1Dellabella M,Milanese G,Muzzonigro G.Randomized trial of the efficacy of tamsulosin,nifedopine and phloroglucinol in medical expulsive therapy for distal ureter calculi.J Urol,2005,174:167-172.
2Yilmaz E,Batislam E,Basar MM,et al.The comparison and efficacy of 3 different alpha 1 adrenergic blockers for distal ureteral stones.J Urol,2005,173:2010-2012.
3Dellabella M,Milanese G,Muzzonigro G.Efficacy of tamsulosin in the medical management of juxtravesical ureteral stones.J Uro,2003,170:2202-2205.
4Kupeli B,Irkilata L,Gurocak SD,et al.Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy.Urology,2004,64:1111-1115.