通淋固本方防治输尿管支架管综合征的临床观察

Clinical Observation of Tonglin Guben Recipe in Preventing and Treating Ureteral Stent-related Symptoms

【目的】评价通淋固本方对尿路结石术后留置输尿管支架管患者输尿管支架管综合征(USS)的防治疗效。【方法】采用前瞻性随机对照研究,将100例上尿路结石术后留置输尿管支架管并兼有脾肾两虚证型的患者随机分成试验组和对照组,每组各50例。试验组在置管术后第1天开始给予通淋固本方汤剂口服联合行为指导治疗,对照组只给予行为指导治疗,治疗周期为2周,观察期为4周。通过观察2组患者治疗前后输尿管支架症状问卷(USSQ)评分表中的下尿路症状、身体疼痛情况、一般情况、工作能力、性生活满意度和生活质量指数等各维度评分的变化情况,评价通淋固本方防治尿路结石术后留置输尿管支架管患者输尿管支架管综合征的疗效及安全性。【结果】(1)重复测量方差分析及多变量方差分析结果显示:时间对2组患者的各项评分变化均有影响(P<0.05),表现为术后第2周和第4周,2组患者的USSQ各维度评分均较术后第1天明显改善(P<0.05)。组间比较,术后第2周,试验组对下尿路症状、身体疼痛情况和生活质量指数评分的改善作用均优于对照组(P<0.05),而在性生活满意度、工作能力和一般情况评分方面,差异均无统计学意义(P>0.05);术后第4周,试验组仅对下尿路症状评分的改善作用优于对照组(P<0.05),而在身体疼痛情况、性生活满意度、工作能力、一般情况和生活质量指数评分方面,差异均无统计学意义(P>0.05)。(2)2组患者在用药过程中均未诉不适,也未报告局部皮肤过敏、胃肠反应、眩晕等不良反应。【结论】排除行为指导疗法及自身耐受性等因素对评分的影响,通淋固本方可改善留置输尿管支架管患者的下尿路症状、身体疼痛情况和生活质量指数评分,但停药2周后,疗效有所减退,输尿管支架管综合征的部分症状再次出现反弹。

Objective To evaluate the effect of Tonglin Guben Recipe in preventing and treating ureteral stentrelated symptoms of the patients with the indwelled ureteral stent after surgery for the removal of urinary tract stones. Methods A prospective randomized controlled trial was carried out in a total of 100 patients with the indwelled ureteral stent after surgery for the removal of upper urinary tract stones. The qualified patients with the syndrome of spleen and kidney deficiency were randomly assigned to the trial group and the control group,50 cases in each group. The trial group was given oral use of Tonglin Guben Recipe combined with behavioral guidance therapy on the first day after indwelling the ureteral stent,and the control group was given behavioral guidance therapy. The course of treatment for the two groups lasted two weeks,and the observation period covered 4 weeks.Before and after treatment, the scores of various items of lower urinary tract symptoms, body pain, general status, working capacity, sexual life satisfaction, and the quality of life(QOL)index of the Ureteral Stentrelated Symptoms Questionnaire(USSQ)were observed in the two groups. After treatment, we evaluated the clinical efficacy and safety of Tonglin Guben Recipe in preventing and treating ureteral stent-related symptoms of the patients with the indwelled ureteral stent after surgery for the removal of urinary stones. Results(1)The results of the repeated measurement analysis of variance and multivariate analysis of variance showed that the time had an effect on the change of scores in both groups(P<0.05),manifesting as the scores of various items of USSQ in the two groups on the second and fourth week after the surgery were much improved in comparison with those on the first day after the surgery(P<0.05). The intergroup comparison showed that the trial group had stronger effect on improving the scores of lower urinary tract symptoms, body pain and QOL index than the control group on postoperative week 2(P<0.05),but the differences of the scores of sexual life satisfaction,working capacity,and general status in both groups were insignificant(P>0.05). On the fourth week after the surgery,the trial group had stronger effect on improving the scores of lower urinary tract symptoms(P<0.05),but the differences of the scores of body pain,sexual satisfaction,work capacity,general status,and QOL index were insignificant between the two groups(P>0.05).(2)During the medication,no discomforts or adverse reaction of local skin allergy,gastrointestinal reaction,or dizziness was found in the two groups. Conclusion Excluding the influence of behavioral guidance therapy and self-tolerance on the scores,Tonglin Guben Recipe can improve the scores of lower urinary tract symptoms,body pain and QOL index in patients with the indwelled ureteral stent after surgery for the removal of urinary tract stones. But 2 weeks after the suspension of medication, the clinical efficacy of Tonglin Guben Recipe weakens,and partial symptoms of ureteral stenting will rise up again.