【作者】 王志刚；

【导师】 谢建兴；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2009， 硕士

【摘要】 目的:评价活血化瘀法合α受体阻滞剂(坦索罗辛)治疗输尿管下段结石的临床作用。方法:研究病例均来源于2008年1月—2009年3月就治于广州中医药大学第一附属医院泌尿外科的门诊患者。将52例符合条件的受试对象按照数字随机表分为三组,其中坦索罗辛治疗组男性10例,女性8例,平均年龄40.8±10.3岁,结石最大直径平均6.6±2.1mm;活血化瘀方治疗组男性9例,女性9例,平均年龄38.9±9.6岁,结石最大直径平均6.9±2.3mm;合并用药治疗组(盐酸坦索罗辛缓释胶囊+活血化瘀方)男性9例,女性7例,平均年龄39.7±10.5岁,结石最大直径平均6.5±2.3mm;三组患者的性别、年龄、结石最大直径经两独立样本t检验,p＞0.05,具有可比性。①坦索罗辛组:盐酸坦索罗辛缓释胶囊0.2mg,1次/天,口服。②活血化瘀方组:金钱草30g、小蓟15g、冬葵子15g、三棱10g、莪术10g、大黄10g、虎杖20g、赤芍15g、丹参15g、白茅根20g、三七10g、牛膝15g、甘草6g、海金沙20g(包煎)、内金10g、车前子20g、王不留行15g日一剂,水煎服。③合并用药组:盐酸坦索罗辛缓释胶囊0.2mg,1次/天,口服。加活血化瘀方:金钱草30g、小蓟15g、冬葵子15g、三棱10g、莪术10g、大黄10g、虎杖20g、赤芍15g、丹参15g、白茅根20g、三七10g、牛膝15g、甘草6g、海金沙20g(包煎)、内金10g、车前子20g、王不留行15g日一剂,水煎服。三组患者均鼓励多饮水及运动,疗程6周。每周复诊一次,复查X线摄片,记录排石时间,有无药物的副作用,能否耐受。结石排出即停止治疗。对6周后仍没有排石的患者,根据病情和患者意愿决定继续保守治疗或选择输尿管镜碎石取石。结果:合并用药组对输尿管下段结石的治愈率高达81.3%(13/16),明显高于坦索罗辛组50.0%(9/18)和活血化瘀方组55.6%(10/18),统计学分析差异具有统计学意义(P＜0.05)。三组治愈病例排石时间比较,合并用药组中输尿管下段结石的排石时间6.23±1.21天,明显短于坦索罗辛组9.87±1.55天和活血化瘀方组10.06±1.93天,统计学分析差异有显著意义(P＜0.01)。所有52例对象均完成临床研究。三组患者经临床观察,活血化瘀方组在治疗过程中出现2例轻度腹泻患者,大便约4次/日,质烂,无腹痛,但经对症治疗后均能坚持至试验结束。其余入组病例均未出现眩晕、鼻炎、腹泻、腹痛、心悸、皮疹等不良反应。结论:运用活血化瘀法合α受体阻滞剂(坦索罗辛)治疗输尿管下段结石,可明显缩短排石时间,提高治愈率,使患者避免了手术的痛苦,从而减轻了患者的经济负担,是一种行之有效的治疗方法,此方法在泌尿外科临床中的运用,更好地凸显了中西医结合治疗优势。更多还原

【Abstract】 Objective:To evaluate the combined method huoxuehuayuα-blocker(tamsulosin) in the treatment of lower ureteral stones in clinical role.Methods:Study patients were from January 2008 -2009 onthe rule in March in Guangzhou University of Traditional Chinese Medicine First Affiliated Hospital of outpatient urology.52 cases will be eligible in accordance with the number of subjects were randomly divided into three groups form,in which men tamsulosin treatment group 10 cases,eight cases of women,average age 40.8±10.3 years old,the average maximum diameter of stone 6.6±2.1mm; promoting blood circulation to the treatment group 9 cases of men,9 women, average age 38.9±9.6 years old,the average maximum diameter of stone 6.9±2.3mm;Combined drug treatment group(Tamsulosin hydrochloride sustained-release capsules+huoxuehuayu side),nine cases of men and 7 women with mean age 39.7±10.5 years old,the average maximum diameter of stone 6.5±2.3mm;Three groups of patients with gender,age,the largest stone diameter by two independent samples t test,p＞0.05,comparable.①Tamsulosin group:Tamsulosin hydrochloride sustained-release capsules 0.2mg,1 times/day,oral.②huoxuehuayu side group:Jinqiancao 30g,Xiaoji 15g,Dongkuizi 15g, Trigonobalanus 10g,Ezhu 10g,rhubarb 10g,Reynoutria 20g,Radix Paeoniae Rubra 15g,Salvia miltiorrhiza 15g,Baimaogen 20g,Notoginseng 10g,cattle knee 15g,Radix Glycyrrhizae 6g,Lygodium 20g(pack fried),Neijin 10g,Plantago 20g,Wangbuliuxing 15g,decoction and taking.③Combined treatment group: Tamsulosin hydrochloride sustained-release capsules 0.2mg,ltimes/day, oral.Plus huoxuehuayu side groups:Jinqiancao 30g,Xiaoji 15g,Dongkuizi 15g, Trigonobalanus 10g,Ezhu 10g,rhubarb 10g,Reynoutria 20g,Radix Paeoniae Rubra 15g,Salvia miltiorrhiza 15g,Baimaogen 20g,Notoginseng 10g,cattle knee 15g,Radix Glycyrrhizae 6g,Lygodium 20g(pack fried),Neijin 10g,Plantago 20g,Wangbuliuxing 15g,decoction and taking. Three groups of patients are to encourage more drinking water and exercise, treatment for 6 weeks.Once a week follow-up visits,review of X-ray,Paishi record time,with or without the side effects of drugs,can tolerate.Stones from which to stop the treatment.After six weeks of no Paishi patients, according to the wishes of patients and patients decided to continue conservative treatment or ureteroscopy stone rubble.Results:The combined treatment group on the lower ureteral stones cure rate as high as 81.3%(13/16),Tamsulosin group was significantly higher than 50.0% (9/18) and blood group to 55.6%(10/18),statistical analysis with a statistically significant difference(P＜0.05).Three cases were cured Paishi time,thecombined treatment group in the lower ureteral calculi Paishi time of 6.23±1.21 days,Significantly shorter than tamsulosin group 9.87±1.55 days and blood group to 10.06±1.93 days,statistical analysis of significant difference(P＜0.01).All objects were 52 cases of clinical studies completed. Three groups of patients with clinical observations,blood circulation to group process in the treatment of two cases of patients with mild diarrhea, stool about 4 times/day,bad quality,no pain,but symptoms can persist after treatment to the end of the trial.The remaining patients did not appear to dizziness,rhinitis,diarrhea,abdominal pain,palpitations,skin rashes and other adverse reactions.Conclusion:The combined method huoxuehuayuα-blocker(tamsulosin) in the treatment of lower ureteral stones,can significantly shorten the waiting time stone to improve the cure rate,to enable patients to avoid the pain of surgery, thereby reducing the financial burden on patients,is an effective method of treatment,this method in the use of clinical urology,and better highlight the advantages of traditional Chinese and western medicine.更多还原