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目的:探讨排石汤联合盐酸坦洛新辅助体外冲击波碎石术(ESWL)治疗上尿路结石的临床疗效。方法:选择我院2015年1月~2016年9月收治的120例上尿路结石患者,采取随机数字表将其分成两组,每组60例。两组患者均行ESWL治疗,并于术后辅助使用盐酸坦洛新,观察组在上述治疗基础上联合排石汤治疗,对比两组的临床疗效以及治疗前后血清肌酐(Scr)、中性粒细胞明胶酶相关载脂蛋白(NGAL)、半胱氨酸蛋白酶抑制剂C(Cys-C)、肾小球滤过率(GFR)水平的变化情况。结果:观察组总有效率为96.60%,对照组为86.67%,观察组总有效率明显高于对照组(P<0.05)。观察组结石排净率为95.00%,明显高于对照组(P<0.05);肾绞痛发生率为6.67%,明显低于对照组(P<0.05),结石排出时间、血尿持续时间均显著短于对照组(P<0.01)。两组1年复发率对比差异无统计学意义(P>0.05)。两组患者术后2 h、1 d血清NGAL、Cys-C水平逐渐升高,GFR逐渐下降,术后3 d上述指标逐渐恢复。观察组术后1 d、3 d NGAL、Cys-C水平明显低于对照组,GFR明显高于对照组(P<0.01)。两组术前术后各时点Scr比较差异均无明显统计学意义(P>0.05)。结论:排石汤联合盐酸坦洛新辅助ESWL治疗上尿路结石的临床疗效显著,并可有效改善ESWL引起的肾损伤。
Objective: To investigate the clinical efficacy of Paishi Decoction combined with tamsulosin hydrochloride plus extracorporeal shock wave lithotripsy (ESWL) in the treatment of upper urinary tract calculi. Methods: A total of 120 patients with upper urinary tract stones admitted to our hospital from January 2015 to September 2016 were randomly divided into two groups (60 in each group). ESWL treatment was performed in both groups, and tamsulosin hydrochloride was adjuvant after the operation. The observation group was treated with Paishi Decoction on the basis of the above treatment. The clinical efficacy, serum creatinine (Scr), neutrophil The change of gelatinase-associated apolipoprotein (NGAL), cystatin C (Cys-C) and glomerular filtration rate (GFR) Results: The total effective rate was 96.60% in the observation group and 86.67% in the control group. The total effective rate in the observation group was significantly higher than that in the control group (P <0.05). The stone removal rate in the observation group was 95.00%, significantly higher than that in the control group (P <0.05); the incidence of renal colic was 6.67%, significantly lower than that in the control group (P <0.05); the stone discharge time and hematuria duration were significantly Shorter than the control group (P <0.01). There was no significant difference in relapse rate between the two groups at 1 year (P> 0.05). The levels of serum NGAL and Cys-C gradually increased at 2 h and 1 d after operation in both groups, and the GFR gradually decreased. The indexes gradually recovered on the 3rd postoperative day. The levels of NGAL and Cys-C in the observation group at 1 and 3 days after operation were significantly lower than those in the control group, and GFR was significantly higher than that in the control group (P <0.01). There was no significant difference in Scr between the two groups before and after operation (P> 0.05). Conclusion: Paishi Decoction and tamsulosin hydrochloride adjuvant ESWL are effective in treating upper urinary tract calculi, and can effectively improve the renal damage caused by ESWL.