坦索罗辛和硝苯地平在输尿管下段结石辅助排石中作用的比较

Comparison of tamsulosin versus nifedipine for the management of lower ureteral stones

目的分析比较坦索罗辛和硝苯地平在输尿管下段结石辅助排石中的疗效。方法180例输尿管下段结石患者随机分3组,每组60例。结石直径0．4～1．0 cm。组1为对照组,未给予输尿管平滑肌松弛剂;组2给予硝苯地平10 mg,3次／d;组3给予坦索罗辛0．4 mg,1次／d。每例患者治疗观察期不超过2周。结果2周内结石排出者组1为26例(43．3％),组2为44例(73．3％),组3为49例(81．7％),组2、3与组1比较排石率差异有统计学意义(P<0．05)。平均排石时间组1～3分别为9、8、4 d,组1与组3比较差异有统计学意义(P<0．05),组2与组3比较差异无统计学意义(P>0．05)。2周内组1～3因再次发生肾绞痛而需镇痛治疗者分别为5例(8．3％)、1例(1．7％)和0例,组间比较差异有统计学意义(P<0．05)。2周内3组均未出现明显副作用,无因不能耐受而退出者。结论坦索罗辛和硝苯地平在输尿管下段结石辅助排石方面安全、有效,能明显提高排石率。

expulsive therapy in Objective To compare the efficacy of tamsulosin and nifedipine for the adjunctive patients with lower ureteral stones. Methods A total of 180 patients with stones （0.4- 1.0 cm in diameter） located in the lower ureter （juxtavesical or intramural tract） were randomly divided into 3 groups （60 cases in each group）. Group 1 served as controls; group 2 received nifedipine （10mg, 3 times daily） ; and group 3 received tamsulosin （0.4 mg, once daily）. All patients were observed for 2 weeks. Results During 2 weeks, expulsion of stones was observed in 26 cases （43.3%） of group 1, in44 （73.3%） of group 2, and 49 （81.7%） of group 3. The difference in expulsion rates between groups 2, 3 and group 1 was statistically significant （P 〈 0.05 ）. The mean expulsion time of groups 1, 2 and 3 was 9, 8 and 4 d, respectively, with significant difference between groups 1 and 3 （ P 〈 0.05 ） , but no significant difference between groups 2 and 3 （P 〉 0.05 ）. In groups 1 , 2 and 3, renal colic recurred within 2 weeks and analgesics were used in 5 cases （8.3%） , 1 （ 1.7% ） and 0, respectively, with significant difference between the groups （P 〈 0.05 ）. All the patients tolerated the expulsive therapy and no one withdrew from treatment. No obvious side effect occurred. Conclusions It is demonstrated that tamsulosin and nifedipine are safe and effective for adjunctive expulsive treatment for lower ureteral stones. They both can significantly improve the stone expulsion rate.