宁泌泰联合坦索罗辛对双J管综合征的预防作用

Preventive effect of Ningmitai combined with tamsulosin in double-J stent syndrome

目的：探讨宁泌泰联合坦索罗辛治疗输尿管镜钬激光碎石术后留置双J管患者的临床疗效。方法选择本院2010年1月至2013年1月收治的行输尿管镜钬激光碎石术的患者117例，患者术后均留置双J管，按使用药物的不同分组：单用坦索罗辛组（30例），术后服用α1受体阻滞剂坦索罗辛每日1次，每次0.4 mg；单用宁泌泰组（29例），术后服用宁泌泰每日3次，每次1.52 g；坦索罗辛组联合宁泌泰（联合用药组，30例），术后给予坦索罗辛联合宁泌泰，手术对照组（28例），两种药物都不应用。术后约3 d拔除尿管，保留双J管1个月，3组用药时间均为1个月，评估各组患者不同泌尿系统症状分级、疼痛指数分级患者数及肉眼血尿发生率。结果3种不同治疗方法改善症状分级（χ2＝22.038，P＝0.000）、疼痛指数分级（χ2＝9.876，P＝0.020）、血尿（χ2＝8.000，P＝0.046）患者数方面比较差异均有统计学意义，联合用药组无症状和轻度症状分级患者数较坦索罗辛组、宁泌泰组、手术对照组明显增多（无症状：14比6、3、2例，轻度：13比9、5、4例），疼痛指数分级＞Ⅱ度患者数（7比9、14、17例）、血尿发生率〔26.6%（8/30）比56.7%（17/30）、58.6%（17/29）、53.6%（15/28）〕均较坦索罗辛组、宁泌泰组、手术对照组减少。坦索罗辛和宁泌泰联合用药在改善症状方面具有协同增强效应，在减轻疼痛发生率方面较单用坦索罗辛更有优势，并可降低并发症的发生率。结论宁泌泰联合坦索罗辛可有效预防双J管综合征。

Objective To investigate the clinical outcomes derived from Ningmitai combined with tamsulosin to prevent double-J stent syndrome after laser lithotripsy with ureteroscope. Methods 117 patients underwent laser lithotripsy with ureteroscope and then placed a double-J stent for draining were collected from January 2010 to January 2013. Patients with double-J stent placement were divided into four groups determined by dosage regimen. Tamsulosin group （30 cases） was treated with tamsulosin （0.4 mg once daily） lonely, Ningmitai group （29 cases） was treated with Ningmitai （1.52 g, trice time a day） lonely, tamsulosin combined Ningmitai group （30 cases） was treated with tamsulosin and Ningmitai at the same time, operation control group （28 cases） was neither tamsulosin nor Ningmitai. The catheter was removed on the 3rd day post-lithotripsy and then remained double-J stent for 1 month. The scores of urinary tract, pain and the incidence of gross hematuria were assessed. Results The significant differences in the improvement of symptom score （χ2=22.038, P=0.000）, pain score （χ2=9.876, P=0.020） and hematuria （χ2=8.000, P=0.046） were found among tamsulosin group, Ningmitai group, and tamsulosin combined Ningmitai group. The number of patients with symptomless, slight symptom in tamsulosin combined Ningmitai group were higher than those of tamsulosin group, Ningmitai group, operation control group （symptomeless：14 vs. 6, 3 and 2 cases;slight symptom：13 vs. 9, 5, 4 cases）. The number of patients with〉Ⅱpain score （7 vs. 9, 14, 17 cases） and incidence of hematuriag [26.6%（8/30） vs. 56.7%（17/30）, 58.6% （17/29）, 53.6% （15/28）] were lower in tamsulosin combined Ningmitai group than those of tamsulosin group, Ningmitai group, operation control group. The drug combination of Ningmitai with tamsulosin had the synergism to relived symptom and pain, and showed the more obviousthan lonely use. Conclusion The drug combination of Ningmitai with tamsulosin can be used in clinic for prophylactic purpose to prevent double-J syndrome.