癃清片联合抗生素改善输尿管支架管相关症状和尿路感染的临床效果

Clinical effect of Longqing tablets combined with antibiotics on improving stent-related symptoms and urinary tract infections in patients with indwelling ureteral stent

目的评估在接受经尿道输尿管镜碎石取石术(URL)并留置输尿管支架管的患者中,单独应用抗生素与联合应用癃清片和抗生素对于支架管相关症状(SRS)、尿路感染(UTI)以及生活质量的影响。方法回顾性分析2022年1月—2023年12月于首都医科大学宣武医院泌尿外科行URL并留置输尿管支架管的160例患者的临床资料。根据术后应用抗生素和癃清片情况分为两组:对照组和观察组,每组各80例。对照组患者口服左氧氟沙星片,观察组患者口服癃清片联合左氧氟沙星片。根据尿路刺激症状、腰痛和尿痛的程度来比较两组患者的SRS。通过发热发生率、血尿发生率、脓尿发生率、尿培养阳性率和具体细菌类别评估UTI情况。评估两组患者的中文版输尿管支架管症状问卷评分(USSQ)和生活质量评分。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用t检验;非正态分布的计量资料以中位数(四分位间距)[M(Q_(1),Q_(3))]表示,组间比较采用非参数检验。计数资料以例数和百分比[例(%)]表示,组间比较采用χ^(2)检验。结果160例患者中,141例(88.13%)出现SRS,包括对照组71例(88.75%),观察组70例(87.50%),两组比较差异无统计学意义(P=0.724)。在SRS方面,观察组患者的尿路刺激症状评分[3.0(1.0,5.0)分比5.0(3.0,7.0)]、腰痛评分[1.5(1.0,2.0)分比2.5(2.0,3.0)分]以及尿痛程度[1.5(1.0,2.0)分比3.5(2.5,4.0)分]均明显低于对照组,差异均有统计学意义(P<0.05)。中文版USSQ结果显示,观察组患者的尿路症状相比对照组显著缓解[15(12,19)分比22(15,28)分],差异具有统计学意义(P=0.037)。在UTI方面,观察组和对照组患者的发热发生率(6.25%比7.50%)、血尿发生率(20.00%比22.50%)、脓尿发生率(30.00%比33.75%)和尿培养阳性率(11.25%比15.00%)比较,差异虽无统计学意义(P>0.05),但数量上有一定程度地减少。两组患者术前的生理功能、情感职能和社会功能评分差异无统计学意义(P>0.05);但两组患者术后2周的上述3项评分均有所提高,且观察组的提高幅度明显高于对照组,差异均有统计学意义(P<0.01)。结论接受URL并留置输尿管支架管的患者采用癃清片联合抗生素治疗对改善SRS较单用抗生素效果更佳,并可在一定程度上起到预防UTI、提高生活质量的作用。

ObjectiveTo evaluate the effects of antibiotics alone and combined with Longqing tablets and antibiotics on stent-related symptoms(SRS),urinary tract infection(UTI),and quality of life in patients who underwent ureteroscopic lithotripsy(URL)with indwelling ureteral stents.MethodsThe clinical data of 160 patients who underwent URL with indwelling ureteral stents in the Department of Urology,Xuanwu Hospital,Capital Medical University from January 2022 to December 2023 were retrospectively analyzed.According to the postoperative application of antibiotics and Longqing tablets,they were divided into two groups:control group and observation group,with 80 cases in each group.The control group took Levofloxacin tablets orally,and the observation group took Longqing tablets combined with Levofloxacin tablets orally.The SRS of the two groups was compared according to the degree of urinary tract irritation symptoms,low back pain,and dysuria.UTI was evaluated by the incidence of fever,hematuria,pyuria,positive rate of urine culture,and specific bacterial classes.The Chinese version of the ureteral stent symptom questionnaire(USSQ)and the quality of life score were evaluated in the two groups.Normally distributed quantitative data were expressed as mean±standard deviation(±s),and the t-test was used for comparison between groups;non-normally distributed quantitative data were expressed as median(interquartile range)[M(Q 1,Q 3)],and the non-parametric test was used for comparison between groups.Count data were expressed as the number of cases and percentage,and the Chi-square test was used for comparison between groups.ResultsAmong the 160 patients,141(88.13%)developed SRS,including 71 cases(88.75%)in the control group,and 70 cases(87.50%)in the observation group,there was no significant difference between the two groups(P=0.724).In terms of SRS,the urinary tract irritation symptom scores[3.0(1.0,5.0)points vs 5.0(3.0,7.0)points],low back pain scores[1.5(1.0,2.0)points vs 2.5(2.0,3.0)points]and dysuria scores[1.5(1.0,2.0)points vs 3.5(2.5,4.0)points]of the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05).The Chinese version of USSQ showed that the urinary tract symptoms of the observation group were significantly relieved compared with the control group[15(12,19)points vs 22(15,28)points],and the difference was statistically significant(P=0.037).In terms of UTI,the incidence of fever(6.25%vs 7.50%),the incidence of hematuria(20.00%vs 22.50%),the incidence of pyuria(30.00%vs 33.75%),and positive rate of urine culture(11.25%vs 15.00%)between the two groups were not statistically significant(P>0.05),but the number was reduced to a certain extent.There was no statistically significant difference in the scores of physiological function,emotional function and social function between the two groups before surgery(P>0.05);however,the scores of the above three items in both groups were improved 2 weeks after surgery,and the improvement of the observation group was significantly higher than that of the control group,with statistical significance(P<0.01).ConclusionLongqing tablets combined with antibiotics are more effective in improving SRS in patients who receive URL and have indwelling ureteral stents than antibiotics alone,and can prevent UTI and improve the quality of life to a certain extent.