高选择性α1受体阻滞剂在输尿管结石体外冲击波碎石术后辅助治疗中的应用

Application of highly selective alpha 1-blockers after extracorporeal shock wave lithotripsy for ureteral stone

目的 探讨高选择性α1受体阻滞剂在输尿管结石体外冲击波碎石术（ESWL）术后辅助治疗中的临床应用价值.方法 将120例输尿管结石采用ESWL治疗后的患者按随机数字表法分为三组,每组40例.坦索罗辛组给予高选择性α1受体阻滞剂坦索罗辛0.4 mg,1次/d;多沙唑嗪组给予选择性α1受体阻滞剂多沙唑嗪4 mg,1次/d;对照组为空白对照组,未给予任何输尿管平滑肌松弛剂.每例患者的观察时间为2周.结果 共有4例患者因药物不良反应而退出.坦索罗辛组、多沙唑嗪组的排石率[分别为89.7%（35/39）、83.8%（31/37）]均明显高于对照组[65.0%（26/40）]（P＜0.05）;排石时间[分别为（3.1±1.2）、（3.7±1.4）d]均明显短于对照组[（6.5±1.1）d]（P＜0.05）;肾绞痛发生率[分别为12.8%（5/39）、21.6%（8/37）]、石街形成率[分别为7.7%（3/39）、13.5%（5/37）]均明显低于对照组[45.0%（18/40）和40.0%（16/40）]（P＜0.05）.坦索罗辛组和多沙唑嗪组临床疗效比较差异无统计学意义（P＞0.05）.坦索罗辛组中仅1例患者出现体位性低血压,多沙唑嗪组7例患者出现体位性低血压,两组比较差异有统计学意义（P＜0.05）.结论 输尿管结石ESWL术后使用高选择性α1受体阻滞剂辅助治疗有助于结石的排出,明显缩短排石时间,减少肾绞痛发生率,且安全,患者可以耐受,可推荐作为输尿管结石ESWL术后的辅助排石方法.

Objective To investigate the application of highly selective alpha 1-blockers in treatment of ureteral stone after extracorporeal shock wave lithotripsy （ESWL）. Methods One hundred and twenty patients with ureteral stone who accepted ESWL were divided into three groups by random digits table,each 40 cases. Tamsulosin group received tamsulosin （0.4 mg,once daily） after ESWL,doxazosin group received doxazosin （4 mg,once daily） ,control group were given no ureteral smooth musclar relaxant served. All patients were observed for 2 weeks. Results During the 2 weeks, only 4 patients withdrew due to adverse drug reactions. In tamsulosin group and doxazosin group, the stones expulsion rate [89.7%（35/39）, 83.8%（31/37） respectively] were significantly higher than control group [65.0%（26/40）] （P〈0.05）, the expulsion time [（3.1-1.2）, （3.7 ± 1.4） d] were significantly lower than control group [（6.5 ±1.1） d] （P 〈0.05）,the incidence of renal colic [12.8%（5/39）, 21.6%（8/37）] and the stone street formation rate [7.7% （3/39）, 13.5% （5/37）] were significantly lower than control group [45.0% （18/40） and 40.0% （16/40）] （P 〈 0.05）. But there was no significant difference between tamsulosin group and doxazosin group （P 〉 0.05）. Orthostatic hypotension occurred in 1 patient in tamsulosin group, but 7 patients experienced orthostatic hypotension in doxazosin group,the difference was significant （P 〈 0.05）.Conclusions Highly selective alpha 1-blockers can improve the stone-free rate of ureteral stone after ESWL,reduce expulsion time,decrease renal colic rate,and it is safe and tolerated. It can be regarded as an auxiliary clearance method after ESWL for ureteral stone.