【摘要】 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6～20mm,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≥10mm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<10mm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≥10mm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。更多还原

【Abstract】 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.更多还原