盐酸罂粟碱对于常规治疗无效的结石引发急性肾绞痛疗效观察

Therapeutic Effect of Papaverine Hydrochloride in Acute Calculus-caused Renal Colic Unresponsive to Conventional Treatment

目的探讨盐酸罂粟碱对常规治疗无效的结石引发的急性肾绞痛的临床疗效。方法选择2004年6月—2007年9月首都医科大学附属北京同仁医院门急诊科采用常规解痉镇痛治疗无效结石引发急性肾绞痛患者89例,随机分成3组,分别采取不同的治疗方法并评估其疗效,第1组采用山莨菪碱及赖氨匹林静脉滴注,第2组采用盐酸罂粟碱静脉滴注,第3组采用哌替啶静脉滴注。治疗前后患者均采用形象化模拟评分法(VAS)评价疼痛程度。结果治疗1h后,VAS评分第2组(1.05±0.23)分和第3组(0.98±0.40)分均明显低于第1组的(3.74±2.45)分,差异有统计学意义(P<0.05);第2组和第3组比较,差异无统计学意义(P>0.05)。第1组和第2组患者均未出现明显不良反应,第3组9例(30.0%)患者出现轻至中度的镇定作用,2例(6.7%)患者发生轻度心动过缓和低血压。治疗4h后仍有6例患者存在剧烈肾绞痛(VAS评分>7分),其中5例患者行体外震波碎石术后疼痛明显缓解。1例患者因结石过大体外碎石无效而入院行急诊肾造瘘术。结论盐酸罂粟碱对于结石引起的常规治疗无效的急性肾绞痛疗效显著,可作为哌替啶等毒麻药品的替代品。

Objective To evaluate the therapeutic effect of papaverine hydrochloride in calculus-caused acute renal colic unresponsive to conventional treatment.Methods Eighty calculus-caused acute renal colic patients unresponsive to conventional treatments in Emergency Department of Beijing Tongren Hospital from 2004 to 2007 were divided randomly into groups Ⅰ（given intravenous Raceanisodamine Hydrochloride and Aspirin-Dl-Lysine）,Ⅱ（given intravenous papaverine hydrochloride）,Ⅲ（given intravenous pethidine）.Pains were assessed by vision analog score（VAS） in all patients before or after treatment.Results After 1h of treatment,VAS was significantly lower in groups Ⅱ,Ⅲ（1.05±0.23,0.98±0.40,respectively）than in group Ⅰ（3.74±2.45）,the difference was significant（P0.05）,but there was not between groups Ⅱ,Ⅲ（P0.05）.No obvious adverse reactions were noted in groups Ⅰ,Ⅱ,but in group III,mild or moderate sedation noted in 9 patients,mild bradycardia and hypotension in 2.Four hours after treatment 6 patients still had severe renal colic（VAS7）,5 of them improved after extracorporeal shock wave lithotripsy（ESWL）,1 was hospitalized to undergo emergency renal fistulization due to ineffective ESWL.Conclusion Papaverine hydrochloride,remarkably effective to calculus-caused acute renal colic unresponsive to conventional treatment,can be used as a substitute for anesthesia drugs such as pethidine.