PDE5i治疗无效的青壮年ED患者的临床治疗对策(附100例报告)  

Clinical treatment of young PDE5 inhibitor nonresponder ED patients(Report of 100 cases)

作　　者：王进[1] 李森[1] 张友朋[1] 程永彪[1] 管日戬 曾汉青[1] 朱朝辉[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022

出　　处：《临床泌尿外科杂志》2016年第4期331-335,共5页Journal of Clinical Urology

摘　　要：目的：观察5型磷酸二酯酶抑制剂（PDE5i）治疗无效的青壮年男性勃起功能障碍（erectile dysfunction,ED）患者的临床特征,并探讨其治疗对策。方法：收集2012年10月-2014年5月就诊的100例PDE5i治疗无效的患者,年龄19-45岁,无其他基础疾病,通过调查问卷、IIEF-5评分、性生活日志（SEP）分析治疗无效的临床特征,并有针对性的给予小剂量PDE5i规律性口服、阴茎负压勃起装置（VED）、阴茎负压缩窄装置（VCD）、阴茎血管手术等个性化治疗方案,评价治疗对策及其效果。结果：本组所有患者不同程度地存在服药时间、药物剂量、服药方式、服药后性交尝试次数、情绪状态以及配偶配合情况等不利因素,通过第一方案正确指导用药及性教育后,36%（36/100）患者调整了用药,12周回访IIEF-5评分增加（3.278±3.086）分,有效率（SEP3回答＂是＂）达到47.2%（17/36）。上述治疗无效以及直接选择第二方案他达拉非10mg隔日口服＋VED＋VCD联合治疗12周者有47例,IIEF-5评分增加（6.667±4.247）分,有效率53.5%（23/43）,3例失访,1例因疼痛不适停止治疗,6例放弃选择进一步手术治疗;上述治疗无效以及确诊为阴茎背深静脉漏并接受了阴茎背深静脉结扎＋小剂量PDE5i治疗12周者有46例,IIEF-5评分增加（9.750±5.737）分,有效率72.7%（32/44）,2例术后失访;4例提示存在动脉性ED,拒绝阴茎假体手术等治疗。上述方法治疗总有效率达72%（72/100）。结论：PDE5i治疗无效的ED患者病因复杂,正确的服药时间、剂量、方式以及良好情绪状态和配偶配合程度可以改善药物作用,同时VED、VCD以及阴茎血管手术也可作为二、三线治疗措施,个体化治疗方案值得在临床上广泛推广。Objective：To investigate the possible etiologies of young male erectile dysfunction（ED）patients who were nonresponsive to phosphodiesterase type 5inhibitor（PDE5i）therapy,and therapeutic strategies for their treatment.Method：Data from 100PDE5 inonresponder patients aging 19-45 exhibiting no other diseases were collected from October 2012 to May 2014.Data were collected and analyzed through questionnaires,IIEF-5scores,and sexual encounter profiles（SEP）in order to ascertain causes of unresponsive therapy.A targeted low dose PDE5 iwas orally administered and analyzed along with data collected from penile vacuum erection device（VED）,penile vacuum constriction device（VCD）,and personalized treatment regimens including but not limited to penile vascular surgery in order to evaluate effects of treatment strategies.Result：All patients exhibited varying medication time,dosage,and methods of administration.Given treatment with PDE5 i,frequency of sexual intercourse attempts,individual emotional state,and spousal relationship,etc,negatively factored into rehabilitation results.Through proper pharmaceutical instruction and education on the treatment procedure,36%（36/100）of patients adjusted their PDE5 itreatment regimen,resulting in a reported increase in IIEF-5score（3.278±3.086）and an increased efficacy of 47.2%（17/36）.Forty-seven patients were given a combined treatment of PDE5 iand VED,2could not be available for follow-up.The results of data analysis revealed an increase of IIEF-5score（6.667±4.247）and an increased efficacy of 53.5%（23/43）.Three cases were discarded,and one of which was due to pain and discomfort resulting in a discontinuation of treatment.Six cases gave up the next treatment.Forty-six patients were diagnosed with deep dorsal penile vein leakage and accepted ligation of deep dorsal vein along with alow dosage of PDE5 ifor 12weeks,and two could not be available for follow-up.Results from this regimen revealed an increase of IIEF-5score（9.750±5.737）and an i

关 键 词：勃起功能障碍 5型磷酸二酯酶抑制剂 阴茎康复 个体化治疗 

分 类 号：R697[医药卫生—泌尿科学]