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目的分析硝苯地平辅助输尿管结石排出的有效性和安全性。方法计算机检索Pubmed、Embase、Cochrane、CNKI、VIP、CBM、万方数据库,纳入关于硝苯地平治疗输尿管结石的随机对照试验,检索时间均为建库至2016年6月。由两位研究者按照纳入与排除标准独立进行文献筛选、资料提取和方法学质量评价,对纳入研究进行Meta分析。结果共纳入11项研究,5468例患者。系统评价结果显示:硝苯地平组排石率高于标准治疗组〔RR=1.52,95%CI(1.10,2.10),P=0.01〕,低于坦索罗辛组〔RR=0.83,95%CI(0.75,0.92),P<0.01〕;硝苯地平组排石时间短于标准治疗组〔WMD=-2.45,95%CI(-3.41,-1.48),P<0.01〕,长于坦索罗辛组〔WMD=2.48,95%CI(2.40,2.57),P<0.01〕;3个研究比较了硝苯地平组与标准治疗组的镇痛剂使用量,显示硝苯地平组镇痛剂使用量低于标准治疗组(P<0.05);7个研究比较了硝苯地平与坦索罗辛的镇痛剂用量,其中2个研究显示两者差异无统计学意义(P>0.05),另外5个研究显示硝苯地平组使用量明显高于坦索罗辛组(P<0.05);硝苯地平组轻中度不良反应发生率高于标准治疗组和坦索罗辛组〔RR=2.71,95%CI(1.59,4.60),P<0.01;RR=1.28,95%CI(1.02,1.61),P<0.05〕,严重不良反应发生率间无差异(P>0.05)。结论硝苯地平能够有效的辅助输尿管结石排出,但疗效不如坦索罗辛,二者严重不良反应率间无明显差异。
Objective To analyze the efficacy and safety of nifedipine-assisted ureteral calculi. Methods Pubmed, Embase, Cochrane, CNKI, VIP, CBM, Wanfang database were included in this study. Randomized controlled trials of nifedipine in the treatment of ureteral calculi were performed. The retrieval time was from June to June 2016. Two investigators independently conducted literature screening, data extraction and methodological quality evaluation according to inclusion and exclusion criteria, and conducted meta-analysis on the included studies. Results A total of 11 studies were included, 5468 patients. The results of systematic reviews showed that the rate of stone removal in the nifedipine group was significantly higher than that in the standard treatment group [RR = 1.52, 95% CI (1.10, 2.10, P = 0.01] CI (0.75,0.92, P <0.01). The nifedipine group was shorter than the standard treatment group (WMD = -2.45,95% CI -3.41, -1.48, P <0.01) Xinzhi group 〔WMD = 2.48,95% CI (2.40,2.57), P <0.01〕; three studies compared the use of analgesics in the nifedipine group and the standard treatment group, showing the use of nifedipine analgesics (P <0.05). Seven studies compared the analgesic dosage of nifedipine and tamsulosin, and two of them showed no significant difference (P> 0.05). In addition, Five studies showed that the use of nifedipine was significantly higher than that of tamsulosin (P <0.05). The incidence of mild to moderate adverse reactions in the nifedipine group was higher than that in the standard treatment and tamsulosin groups (RR = 2.71 , 95% CI (1.59,4.60), P <0.01; RR = 1.28,95% CI (1.02,1.61), P <0.05). There was no significant difference in the incidence of serious adverse reactions between two groups (P> 0.05). Conclusion Nifedipine can effectively assist the ureteral stone discharge, but the curative effect is not as good as tamsulosin, there is no significant difference between the two serious adverse reaction rate.