特拉唑嗪联合硝苯地平治疗输尿管末段结石的随机对照临床研究

Efficacy of terazosin and nifedipine in the medical management of distal ureteral stones

目的探讨α1肾上腺素能受体拮抗剂和钙拈抗剂联合应用治疗输尿管末段结石的作用。方法输尿管末段结石患者60例，随机平均分为2组。对照组患者同时服用环丙沙星0．5g，2次／d，共7d；消炎痛25mg，3次／d，共7d；尿石通7g，3次／d。治疗组在对照组治疗方案上加用特拉唑嗪2mg，每晚1次，硝苯地平10mg，3次／d。以结石排出输尿管或治疗随访满4周作为疗效观察终点。结果2组均无因发生药物不良反应退出研究者。治疗组结石横径平均（4．8±1．3）mm，纵径平均（6．6±1．6）mm，结石中心距输尿管口平均（5．8±5．3）mm。对照组结石横径平均（4．5±1．2）mm。纵径平均（6．4±1．4）mm。结石中心距输尿管口平均（5．1±4．3）mm。2组比较差异均无统计学意义（P〉0．05）。2组患者4周内结石排出率分别为93．3％和63．3％，差异有统计学意义（P〈0．05）。治疗组排石时间平均（4．9±2．5）d，对照组（7．8±3．6）d，差异有统计学意义（P〈0．01）。2组患者观察期间再发绞痛而需要再次急诊处理者分别为4例（13．30）和12例（40．00），差异有统计学意义（P〈O．05）。治疗组肌注哌替啶平均（0．2±0．7）次。对照组（1．1±1．6）次，差异有统计学意义（P〈0．01）。结论特拉唑嗪与硝苯地平联合应用可提高输尿管末段结石的排出率，缩短结石排出时间，减少绞痛再发及止痛药物应用，可作为输尿管末段结石药物治疗的一线疗法。

Objective To evaluate the clinical efficacy of α1-adrenergic antagonist and calcium antagonist in the medical management of distal ureteral stones. Methods A total of 60 patients with newly developed stones in the distal ureter （within 3 cm near the ureteral orifice） were randomly divided into 2 groups. In control group, 30 cases were treated with ciprofloxacin 0.5 g twice daily plus indomathacin 25 mg 3 times daily for 7 d and Chinese medicine Niaoshitong 7 g 3 times daily. In study group,30 cases were treated with terazosin 2 mg daily and nifedipine 10 mg 3 times daily in addition to the same drugs as used in control group. Ultrasound or radiology follow-up was performed weekly till stone expulsion or till 4 weeks. Results No severe adverse reactions related to the drugs were noted and no patient withdrew from the study. The mean transverse diameter, the length of the stone and the distance from the stone center to the ureteral orifice were （4.8 ± 1.3）mm, （6.6 ± 1.6 ）mm, （5.8 ± 5.3）mm,respectively in study group;and （4.5±1.2）mm, （6.4±1.4）mm, （5.1±4.3）mm,respectively in control group,with no significant difference between the 2 groups （P〉0.05）. The stone expulsion rate （within 4 weeks） was 93.3% （28/30） in study group and 63.3% （19/30） in control group （P〈0.05）. The mean expulsion time was （4.9±2.5）d and （7.8±3.6）d,respectively （P〈0.01）. The emergency re-treatment rate for the recurrent renal colic during the follow up was 13.3% （4/30） in study group and 40.0 % （12/30） in control group （P〈0.05）. The mean number of pethidine injections was 0.2±0.7 and 1.1 ± 1.6, respectively（P〈0.01 ）. Conclusions Treatment of distal ureteral stones with terazosin and nifedipine can increase the stone expulsion rate, shorten expulsion time,de crease renal colic relapse and analgesic use. This combination expulsion regimen can be recommended as the first line therapy for the distal ureteral stones.