盐酸坦索罗辛在输尿管结石冲击波碎石术后中的作用  

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

作　　者：刘志敏[1] 刘波[1] 潘铁军[1] 沈国球[1] 文瀚东[1] 涂忠[1] 杨家荣[1] 

机构地区：[1]广州军区武汉总医院,湖北武汉430070

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

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.

关 键 词：输尿管结石 碎石术 

分 类 号：R693.4[医药卫生—泌尿科学]