米拉贝隆联合索利那新防治前列腺电切术后导尿管相关膀胱刺激症的疗效分析

Add to Favorite Efficacy and safety of mirabegron combined with solifenacin for catheter related bladder discomfort in patients undergoing transurethral resection of the prostate:A prospective case-control study

目的论证米拉贝隆联合索利那新防治经尿道前列腺电切术(TURP)术后导尿管相关膀胱刺激症(CRBD)的有效性和安全性。方法将符合标准的108例接受TURP手术的前列腺增生患者随机分为三组,每组36例;术前1天开始M+S组给予口服米拉贝隆50 mg/d联合索利那新5 mg/d;S组服用单药索利那新5 mg/d;C组仅接受TURP手术。对术后出现中度以上CRBD的患者进行自制综合量表评分,达到设定标准的予静脉滴注间苯三酚处理。观察各组术后第1、3、5天CRBD发生情况,术后5天内静脉给药量,持续膀胱冲洗时间及药物不良反应。结果共有106例患者纳入最终的分析,M+S组除了术后第1天在中度和重度CRBD的发生率上与S组相当外,在其他时间节点的CRBD总发生率、中度和重度CRBD发生率及静脉给药量上均明显优于S组及C组(P<0.05);S组与C组相比在任何时间节点均没有降低CRBD总发生率(P>0.05),但在中度和重度CRBD的发生率及静脉用药量上优于C组(P<0.05)。3组术前及术后第1、3、5天的心率、收缩压、舒张压值均无统计学意义(P>0.05);M+S组和S组中新发口干、便秘的例数略多于C组,但是差异无统计学意义(P>0.05);M+S组额外报告1例新发皮疹。结论米拉贝隆联合索利那新可降低TURP术后CRBD的发生率,减少患者静脉解痉药物的应用,较单药索利那新效果更优且不增加药物不良反应。

Objective To investigate the safety and efficacy of mirabegron combined with solifenacin in the treatment of CRBD after TURP.Methods A total of 108 patients with BPH who underwent TURP were randomly divided into three groups,36 cases in each group.Patients in M+S group were given oral mirabegron 50 mg/d combined with solifenacin 5 mg/d from one day before surgery;S group was given solifenacin 5 mg/d;C group received surgical treatment only.Patients with more than moderate degree of CRBD after operation were scored,and those who met the indications were given intravenous spasmodic and analgesic treatment.The occurrence of CRBD in each group at the 1st,3rd and 5th day after surgery and the amount of intravenous fluids within the 5th day after surgery were recorded,the time of continuous catheter washout and adverse drug reactions were also recorded.Results A total of 106 patients were included in the final analysis.On postoperative day 1,the probability of more than moderate CRBD was not significantly different between the M+S and S groups(P>0.05),in addition,the incidence of overall CRBD,the incidence of more than moderate CRBD,and the amount of intravenous fluids in the M+S group were significantly less than those in the S and C groups at any time point(P<0.05).Compared with C group,S group did not reduce the overall incidence of CRBD(P>0.05),but the incidence of CRBD above moderate degree and the amount of intravenous infusion were better than those in C group(P<0.05).There was no difference in heart rate,systolic blood pressure and diastolic blood pressure between the three groups before surgery and 1,3 and 5 days after surgery(P>0.05).There was no difference in the incidence of dry mouth,constipation,too(P>0.05).One additional case of rash was reported in the M+S group.Conclusion Mirabegron combined with solifenacin can reduce the incidence of CRBD after TURP,reduce the intravenous use of spasmolytics,and has a more significant effect than solifenacin alone without increasing adverse drug reactions.