丁溴东莨菪碱联合坦索罗辛辅助体外冲击波碎石治疗泌尿系结石的疗效及对血清炎性因子的影响

Effect of scopolamine butylbromide injection combined with tamsulosin oral auxiliary extracorporeal shock wave lithotripsy in the treatment of urinary calculi and influence on serum inflammatory factors

目的研究丁溴东莨菪碱静脉滴注联合坦索罗辛口服辅助体外冲击波碎石(ESWL)治疗泌尿系结石的疗效,并探讨其对患者血清炎性因子的影响。方法选择2016年1月至2017年5月兰溪市人民医院收治的泌尿系结石患者96例,采用随机数字表法分为对照组(n=42)与观察组(n=54),对照组行丁溴东莨菪碱辅助ESWL治疗,观察组在对照组的基础上加用坦索罗辛治疗,比较两组治疗前后VAS评分、临床效果、不良反应及血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)等炎性因子的影响。结果治疗前,两组VAS评分差异无统计学意义(t=0.274,P>0.05);治疗后,观察组VAS评分为(2.21±0.28)分,明显低于对照组VAS评分(4.75±0.63)分(t=7.935,P<0.05)。观察组结石清除率96.30%(52/54)明显高于对照组结石清除率71.43%(30/42)(χ^2=6.712,P<0.05);观察组疼痛消失时间为(10.86±1.54)d,明显低于对照组疼痛消失时间(7.02±1.25)d(t=7.468,P<0.05);观察组结石排出时间为(9.01±1.53)h,明显低于对照组结石排出时间(13.25±2.21)h(t=8.035,P<0.05)。治疗前,两组血清CRP、TNF-α水平差异无统计学意义(t=0.152、0.185,P>0.05);治疗后,观察组血清CRP水平为(11.64±1.75)mg/L,明显低于对照组CRP水平(18.94±2.03)mg/L(t=7.008,P<0.05);治疗后,观察组血清TNF-α水平为(13.95±2.01)mg/L,明显低于对照组TNF-α水平(20.76±3.18)mg/L(t=7.008,P<0.05)。观察组不良反应总发生率为5.56%,明显低于对照组不良反应总发生率26.19%(χ^2=9.572,P<0.05)。结论泌尿系结石行丁溴东莨菪碱静脉滴注联合坦索罗辛口服辅助ESWL治疗,可有效减轻患者疼痛,有效降低血清炎性因子水平,提高结石清除率,并发症少,值得临床推广及应用。

Objective To study the effect of scopolamine butylbromide injection combined with tamsulosin oral auxiliary extracorporeal shock wave lithotripsy(ESWL)in the treatment of urinary calculi,and to investigate its effect on serum inflammatory factors.MethodsFrom January 2016 to May 2017,96 patients with urinary calculi in the People's Hospital of Lanxi were selected and randomly divided into control group(n=42)and observation group(n=54).The control group received scopolamine butylbromide assisted ESWL treatment,the observation group treated with tamsulosin on the basis of the control group.The VAS score,clinical efficacy,adverse reactions and serum C reactive protein(CRP),tumor necrosis factor alpha(TNF-alpha)and other inflammatory factors were compared between the two groups.ResultsBefore treatment,no statistically significant difference in VAS score was found between the two groups(t=0.274,P>0.05).After treatment,the VAS score of the observation group was(2.21±0.28)points,which was significantly lower than that of the control group[(4.75±0.63)points](t=7.935,P<0.05).The stone clearance rate in the observation group was 96.30%(52/54),which was significantly higher than that in the control group[71.43%(30/42)](χ^2=6.712,P<0.05).The time of disappearance of pain in the observation group was(10.86±1.54)d,which was significantly lower than that in the control group[(7.02±1.25)d](t=7.468,P<0.05).The lithecbole time of the observation group was(9.01±1.53)h,which was significantly shorter than that of the control group[(13.25±2.21)h](t=8.035,P<0.05).Before treatment,there were no statistically significant differences in serum CRP and TNF-levels between the two groups(t=0.152,0.185,all P>0.05).After treatment,the serum level of CRP in the observation group was(11.64±1.75)mg/L,which was significantly lower than that in the control group[(18.94±2.03)mg/L](t=7.008,P<0.05).After treatment,the serum TNF-level in the observation group was(13.95±2.01)mg/L,which was significantly lower than that in the control group[(20.76±3.18)mg/L](t=7.008,P<0.05).The incidence rate of adverse reactions of the observation group was 5.56%,which was significantly lower than 26.19%of the control group(χ^2=9.572,P<0.05).ConclusionUrinary calculi underwent intravenous infusion of scopolamine butylbromide combined with tamsulosin oral adjuvant ESWL therapy,can effectively reduce the pain of patients,reduce the serum levels of inflammatory cytokines,improve the stone clearance rate,and with less complications,it is worthy of clinical popularization and application.