氢氯噻嗪联合坦索罗辛对输尿管下段结石患者体外冲击波碎石术后辅助排石的效果观察

Effect of hydrochlorothiazide combined with tamsulosin on lower ureteral calculi after extracorporeal shock wave lithotripsy

目的观察氢氯噻嗪联合坦索罗辛对输尿管下段结石患者体外冲击波碎石(ESWL)术后辅助排石的效果。方法选取2012年1月至2016年2月在南通大学附属海安医院就诊的输尿管下段结石患者120例,按随机数字表法将患者分为A、B、C组,各40例。3组患者均接受ESWL治疗,术后当日A组服用尿石通丸;B组服用尿石通丸和盐酸坦索罗辛缓释胶囊;C组服用尿石通丸、盐酸坦索罗辛缓释胶囊和氢氯噻嗪,疗程均为14 d。术后随访时间为3个月,比较3组患者的结石排出率、结石排净率、结石排出时间、肾绞痛发作率、止痛剂使用率、石街形成率以及不良反应和并发症发生率。结果 B组和C组的结石排出率和结石排净率明显高于A组[90.0%(36/40)、95.0%(38/40)比72.5%(29/40),80.0%(32/40)、87.5%(35/40.)比50.0%(20/40)],结石排出时间、肾绞痛发作率、止痛剂使用率和石街形成率明显短于/低于A组[(1.7±0.9)、(1.5±0.3)d比(3.1±1.2)d,27.50%(11/40)、7.5%(3/40)比52.5%(21/40),40.0%(16/40)、12.5%(5/40)比70.0%(28/40),2.5%(1/40)、2.5%(1/40)比12.5%(5/40)],C组结石排出时间、肾绞痛发作率和止痛剂使用率明显短于/低于B组,差异均有统计学意义(均P<0.05)。3组间不良反应发生率差异无统计学意义(P>0.05)。B组和C组的并发症发生率明显低于A组[7.5%(3/40)、2.5%(1/40)比17.5%(7/40)],且C组明显低于B组比较,差异均有统计学意义(均P<0.05)。结论氢氯噻嗪联合坦索罗辛用于输尿管下段结石ESWL术后可明显促进患者结石排出,降低石街形成率,而且可以减少肾绞痛发作和止痛剂使用率,并有效预防并发症的发生,疗效明显且不良反应轻微。

Objective To observe the effect of hydrochlorothiazide combined with tamsulosin on lower ureteral calculi after extracorporeal shock wave lithotripsy（ESWL）. Methods Totally 120 lower ureteral calculi patients undergoing ESWL from January 2012 to February 2016 in Haian Hospital Affiliated to Nantong University were randomly divided into group A, B, C, with 40 cases in each group. Patients in group A took Niaoshitong pills after operation; group B took Niaoshitong pills plus tamsulosin hydrochloride sustained-release capsules; group C took Niaoshitong pills, tamsulosin hydrochloride sustained-release capsules and hydrochlorothiazide; the course of treatment was 14 d. Stone expelling rate, stone emptying rate, stone expelling time, renal colic attack rate, analgesic drug use rate, steinstrasse formation rate, adverse reactions and complications were analyzed during 3 months follow-up. Results Stone expelling rate and emptying rate in group B and C were significantly higher than those in group A［90.0%（36/40）, 95.0%（38/40） vs 72.5%（29/40）; 80.0%（32/40）, 87.5%（35/40） vs 50.0%（20/40）］（P＜0.05）. Stone expelling time, renal colic rate, analgesic drug use rate and steinstrasse formation rate in group B and C were significantly shorter/lower than those in group A［（1.7±0.9）,（1.5±0.3）d vs （3.1±1.2）d; 27.5%（11/40）、7.5%（3/40） vs 52.5%（21/40）; 40.0%（16/40）、12.5%（5/40） vs 70.0%（28/40）; 2.5%（1/40）, 2.5%（1/40） vs 12.5%（5/40）］; stone expelling time, renal colic rate and analgesic drug use rate in group C were significantly shorter/lower than those in group B（P＜0.05）. There was no significant difference of adverse reaction rate among groups（P＞0.05）. Complication rate in group B and C was significantly lower than that in group A［7.5%（3/40）, 2.5%（1/40） vs 17.5%（7/40）］; complication rate in group C was significantly lower than that in group B（P＜0.05）. Conclusion Hydrochlorothiazide combined with tamsulosin treating post-ESWL patients can promote stone expelling, prevent steinstrasse formation, and reduce renal colic attack, use of analgesics and complications.