坦索洛辛联合哌替啶治疗妊娠期输尿管结石的临床分析

Clinical analysis of tamsulosin combined with pethidine in treatment of ureteral calculi during pregnancy

目的探讨坦索洛辛联合哌替啶治疗妊娠期输尿管结石的疗效和安全性。方法将64例妊娠期输尿管结石患者(均为首次肾绞痛发作)分为坦索洛辛联合哌替啶治疗组(n=26)和单用哌替啶治疗组(n=38)。治疗前后48 h,采用视觉类比量表(VAS)对两组患者的疼痛程度进行评估;妊娠后1个月内行B超复查,结石仍然存在者进行输尿管镜下钬激光碎石,比较两组的结石排出率和手术率。结果坦索洛辛联合哌替啶组中25例患者疼痛缓解,仅1例再次肌肉注射盐酸哌替啶后症状缓解;哌替啶单用组中24例经治疗后疼痛缓解(其中1例因患肾肾盂分离>20 mm行双J管置入术),14例需再次肌肉注射盐酸哌替啶(其中4例因顽固性肾绞痛行双J管置入术)。坦索洛辛联合哌替啶组治疗前后VAS差值为6.7±0.3,哌替啶单用组为5.0±0.6,两组比较差异有统计学意义(P<0.05)。妊娠结束后,坦索洛辛联合哌替啶组的结石排出率显著高于哌替啶单用组(96.2%和63.2%)(P<0.01),其中联合组中段和下段的结石排出率均显著高于单用组(100%和50%,100%和72.2%)(P<0.05)。坦索洛辛联合哌替啶组手术率显著低于哌替啶单用组(3.8%和31.6%)(P<0.01)。结论对于妊娠期输尿管结石引起的肾绞痛,坦索洛辛联合哌替啶可明显提高临床症状缓解率,降低患者的疼痛评分,提高结石排出率,其疗效在输尿管中、下段结石较为明显。

Objective To investigate the efficacy and safety of tamsulosin combined with pethidine in the treatment of ureteral calculi during pregnancy. Methods Sixty-four pregnant women with nreteral calculi （renal colic for the first time） were divided into tamsulosin combined with pethidine group （n = 26） and pethidine group （n = 38）. The degree of pain was evaluated by visual analogue scale （VAS） 48 h before and after treatment in two groups. B ultrasound was performed in 1 month after the end of pregnancy, YAG laser lithotripsy was carried out for those with residual stone, and stone clearance rate and operation rate were compared between two groups. Results In tamsulosin combined with pethidine group, 25 patients experienced pain relief, and the other 1 patient needed another dose of pethidine hydrochloride. In pethidine group, 24 patients achieved pain relief after treatment （double J stent was inserted in 1 patient）, and the other 14 patients needed another dose of pethidine hydrochloride （ double J stent was inserted in 4 patients）. VAS decreased by 6.7 -＋ 0.3 and 5.0 ＋- 0.6 in tamsulosin combined with pethidine group and pethidine group respectively, and there were significant differences between them （ P 〈 0.05）. At the end of pregnancy, the stone clearance rate in tamsulosin combined with pethidine group was significantly higher than that in pethidine group （96.2% vs 63.2%, P 〈 0.01）, and the stone clearance rates in middle or lower segment of ureter in tamsulosin combined with pethidine group were significantly higher than those in pethidine group （100% vs 50%, P 〈0.05; 100% vs 72.2%, P 〈 0.05）. The operation rate in tamsulosin combined with pethidine group was significantly lower than that in pethidine group （3.8% vs 31.6%, P 〈0.01）. Conclusion For patients with renal colic due to ureteral calculi during pregnancy, tamsulosin combined with pethidine may provide favorable pain relief ratio and stone clearance rate, especially in middle or lower ureteral segment.