泌尿排石汤与耳穴贴压结合体外冲击波碎石术治疗肾输尿管结石临床研究

Clinical study on the treatment of ureteral calculi with extracorporeal shock wave lithotripsy combined with urinary stone decoction and ear acupoint pressure

目的：评价泌尿排石汤与耳穴贴压结合体外冲击波碎石术（extracorporeal shock wave lithotripsy, ESWL）治疗肾输尿管结石的疗效。方法将符合入选标准的110例肾输尿管结石患者采用随机数字表法分为2组，每组55例。2组均给予ESWL治疗，中医组在ESWL术后服用泌尿排石汤结合耳穴贴压，常规组在ESWL术后服用排石颗粒。2组均治疗2周。依据肾-输尿管-膀胱摄影、B超复查结果评价患者碎石效果，记录排石时间、术后疼痛发作程度，以及腰腹疼痛、尿痛、血尿、腰部叩击痛情况，计算缓解率。结果治疗后，中医组手术成功率为90.9%（50/55）、常规组为76.4%（42/55），2组比较差异有统计学意义（χ2＝4.251，P＝0.009）；中医组排石时间为（7.3±3.8）d、常规组为（11.2±4.3）d，2组比较差异有统计学意义（t＝4.032，P＜0.01）；术后第1、3、5、7天，中医组VAS评分分别为（4.1±0.8）分、（4.5±0.9）分、（3.8±0.8）分、（2.2±0.8）分，分别低于常规组的（5.0±1.2）分、（5.3±1.3）分、（4.5±0.8）分、（2.9±0.9）分，2组比较差异有统计学意义（t值分别为4.783、4.492、4.503、3.691，P＜0.01）。术后第7天，中医组腰腹疼痛缓解率为60.0%（33/55）、尿痛缓解率为79.1%（34/43）、血尿缓解率为81.0%（17/21），常规组分别为40.0%（22/55）、59.6%（28/47）、52.0%（13/25），2组比较差异均有统计学意义（χ2值分别为4.400、3.982、4.217，P 值均＜0.05）。结论泌尿排石汤与耳穴贴压结合 ESWL 可有效改善肾输尿管结石患者的临床症状，减轻患者疼痛，有利于结石的排出。

Objective To evaluate the therapeutic effect of ESWL combined with urinary stone decoction and ear acupoint pressure for the patients with renal and ureteral calculi.Methods A total of 110 patients with renal and ureteral calculi were randomly divided into the Chinese medicine （CM） and conventional groups, 55 in each group. Both groups were given ESWL treatment as basic treatment. Chinese medicine group were given the urinary stone decoction and auricular acupressure, and the conventional group used stone granules. Both groups were treated for 2 weeks. According to the photography of ultrasound, the changes of calculi, time of lithagogue, pain relief after operation and the effect rates of pain relief on abdomen and waist, of remission of haematuria, and of urinate pain. ResultsAfter treatment, the successful rates of operation in the CM group was 90.9% （50/55）, and conventional group was 76.4% （42/55）. There was significant difference between 2 groups （χ2=4.251,P=0.009）. The time of stone removal in CM group was significantly shorter than that in the conventional group （7.3 ± 3.8 dvs. 11.2 ± 4.3 d,t=4.032,P〈0.001）. After 1st, 3rd, 5th, 7th days, the VAS pain scores in the CM group were significantly lower than those in the conventional group （4.1 ± 0.8vs. 5 ± 1.2,t=4.783;4.5 ± 0.9vs. 5.3 ± 1.3,t=4.492; 3.8 ± 0.8vs. 4.5 ± 0.8,t=4.503; 2.2 ± 0.8vs. 2.9 ± 0.9,t=3.691; allP〈0.01）. After 7th day, the rates of abdominal pain relief was 60% （33/55）, pain relief was 79.1% （34/43）, the remission of hematuria was 81% （17/21） in the CM group, and the control group were 40% （22/55）, 59.6% （28/47）, 52% （13/25）. There were significant differences between 2 groups on these indices （χ2 values were 4.400, 3.982, 4.217,P values were 0.036, 0.046, 0.040）.Conclusions The ESWL combined with urinary stone decoction and ear acupoint pressure could improve the symptoms of patients with kidney ureteral stones.