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目的研究盐酸坦索罗辛联合速尿注射液在体外冲击波碎石(ESWL)后治疗输尿管不同部位结石中的临床效果及不良反应。方法入组研究对象共238例,随机分为观察组(共120例,其中输尿管中上段结石55例,输尿管下段结石65例)与对照组(共118例,其中输尿管中上段结石58例,输尿管下段结石60例)。对照组采用单纯速尿及抗炎解痉止痛治疗,观察组在对照组基础上加用盐酸坦索罗辛,观察两组用药后不同部位输尿管结石的排出时间、清石率、绞痛再发率及疼痛程度、应用止痛药情况以及药物不良反应情况。结果两组患者结石体积在输尿管不同部位比较差异无统计学意义(P>0.05)。观察组结石排出时间中上段为(5.36±2.12)d、下段(4.34±2.42)d,均明显短于对相应部位对照组[(8.76±1.51)d和(7.20±1.03)d];观察组结石清石率中上段89.09%、下段92.31%,均高于相应部位对照组(74.14%及80.00%)。观察组再次发生肾绞痛25例(中上段19例,下段6例),其中13例使用止痛药;对照组肾绞痛再发54例(中上段40例,下段14例),止痛药使用30例。观察组ESWL后疼痛程度中上段结石(1.73±0.41)分、下段结石(1.45±0.31)分,对照组中上段结石(2.17±0.43)分、下段结石(1.92±0.22)分,以上结石的排出时间、清石率、绞痛再发率及疼痛程度、应用止痛药情况两组对比的差异均有统计学意义(P<0.05)。观察组4例(中上段及下段各2例)发生药物不良反应均为体位性低血压;对照组3例(中上段2例,下段1例)发生药物不良反应均为头痛;差异各组比较无统计学意义(P>0.05)。结论体外冲击波碎石后口服盐酸坦索罗辛联合应用速尿可有效缩短排石时间,提高清石率,降低肾绞痛再发率,减轻疼痛强度,且不增加不良反应,临床应用安全有效。
Objective To study the clinical effects and adverse reactions of tamsulosin hydrochloride combined with furosemide injection in the treatment of stones in different parts of ureter after ESWL. Methods A total of 238 subjects were enrolled in the study. They were randomly divided into observation group (120 cases in total, including 55 cases of upper ureteral calculi and 65 cases of lower ureteral calculi) and 118 cases of control group (58 cases of upper ureteral calculi, ureter Lower stones 60 cases). The control group was treated with furosemide alone and antispasmodic analgesia. The observation group was given tamsulosin hydrochloride on the basis of the control group. The time of ureteral stone discharge, the rate of clear stone and the recurrence of angina in both groups were observed Rate and degree of pain, the application of painkillers and adverse drug reactions. Results There was no significant difference in the volume of stone between the two groups in different parts of ureter (P> 0.05). In the observation group, the upper part of the stone discharge time was (5.36 ± 2.12) d and the lower part (4.34 ± 2.42) d, both of which were significantly shorter than those of the control group [(8.76 ± 1.51) d and (7.20 ± 1.03) d] The rate of clear stone in the middle and upper part of the stone was 89.09% and 92.31% in the lower part, both of which were higher than those of the corresponding control group (74.14% and 80.00%). In the observation group, there were 25 cases of renal colic (middle and upper part of the 19 cases, 6 cases of the lower), of which 13 cases of painkillers; control group, 54 cases of recurrence of renal colic (upper 40 cases, lower 14 cases) 30 cases. In the observation group, the pain in the upper ESWL group was 1.73 ± 0.41 and the lower stone was 1.45 ± 0.31 in the control group, 2.17 ± 0.43 in the upper group and 1.92 ± 0.22 in the lower group, Time, the rate of clear stone, recurrence rate of angina and the degree of pain, the application of painkillers the difference between the two groups were statistically significant (P <0.05). In the observation group, 4 cases (2 cases in middle and upper part and 2 cases in lower part) had postoperative adverse drug reactions, respectively. In the control group, 3 patients (two in middle and upper part and one in lower part) had headache. Adverse reactions were found in all groups No statistical significance (P> 0.05). Conclusion Combined use of tamsulosin hydrochloride and furosemide hydrochloride after oral extracorporeal shock wave lithotripsy can effectively shorten the time of stone discharging, improve the rate of clear stone, reduce the recurrence rate of renal colic, relieve the pain intensity, and not increase the adverse reaction, so the clinical application is safe and effective .