布美他尼对体外冲击波碎石术治疗输尿管结石的影响

The Effect of Bumetanide on Extracorporeal Shock Wave Lithotripsy of Ureteral Calculus

目的 观察布美他尼注射液利尿剂在体外冲击波碎石术(ESWL)治疗输尿管结石的效果。方法 收集2020年1月至2021年12月我院收治的389例输尿管结石的患者,排除禁忌证和失访等因素,采用随机数表抽取法,分为布美他尼注射液利尿剂+ESWL(观察组)128例,ESWL组(对照组)90例,观察组ESWL术前30 min给予布美他尼1 mg静脉注射至术后第3天。比较两组患者术中、术后参数和结石清除率,根据术前参数,分段比较两组结石清除率。多因素Logistic回归分析影响结石清除率独立危险因素。结果 观察组和对照组碎石清除率(79.7%vs.76.7%)和并发症差异无统计学意义(P>0.05)。当结石直径>1 cm,观察组结石清除率明显高于对照组(75.9%vs.45.0%,P=0.028);平均CT密度值>850 Hu时,观察组结石清除率高于对照组(87.5%vs.56.5%,P=0.009)。结石直径是预测结石清除率的单独因素(OR=0.229)。结论 ESWL治疗输尿管结石时,当结石直径超过1 cm或者结石平均CT密度值超过850 Hu,使用利尿剂可能提高结石清除率。

Objective To assess the effect of diuretics(bumetanide injection)with extracorporeal shock wave lithotripsy(ESWL)on the treatment of ureteric calculi.Methods 389 patients with ureteral calculus were enrolled in Taiyuan People′s Hospital from January 2020 to December 2021,who were excluded contraindications or loss of follow-up,were divided into bumetanide injection diuretic+ESWL(observation group,n=128)and ESWL group(control group,n=90)by random number table extraction.The observation group was given 1 mg bumetanide by intravenous injection 30 minutes before ESWL until the third day.The intraoperative and postoperative of lithotripsy parameters and the stone clearance rates of the two groups were compared.According to the parameters before lithotripsy,the stone clearance rates were compared by sections.Multivariate Logistic regression analysis of the independent risk factors was used for the stone clearance rates.Results There were no statistically significant differences in the stone clearance rates(79.7%vs.76.7%)or postoperative complications between the observation group and the control group(P>0.05).When the stone diameter was larger than 1 cm,the stone clearance rate of diuretic+ESWL group(75.9%)was significantly higher than that of ESWL group(45.0%),and the difference was statistically significant(P=0.028).When the average CT density value of stones was more than 850 Hu,the stone clearance rate of observation group was 87.5%higher than that of the control group 56.5%(P=0.009).Multivariate logistic regression analysis showed that the stone diameter was a single factor in predicting stone clearance rate(OR=0.229).Conclusion In the treatment of ureteral calculi with ESWL,when the stone diameter is larger than 1 cm or the average CT density value is more than 850 Hu,diuretics may be considered for improving the stone clearance rate.