氟比洛芬酯联合诺仕帕治疗肾绞痛48例临床分析

目的:观察氟比洛芬酯联合诺仕帕治疗肾绞痛的临床疗效和不良反应.方法:将96例肾绞痛患者随机分成观察组和对照组各48例,两组均静脉注射诺仕帕40 mg,观察组和对照组分别静脉注射氟比洛芬酯50 mg和肌注度冷丁100 mg,比较两组用药后30 min、60 min的疗效和6h复发情况.结果:两组30 min 、60 min的总有效率无统计学差异(P＞0.05),观察组不良反应率和再发率均明显低于对照组(P＜0.05).结论:氟比洛芬酯联合诺仕帕治疗肾绞痛疗效确切,不良反应率及肾绞痛再发率低,值得临床推广应用.     

急性肾绞痛458例不同止痛方法疗效分析

目的:通过对急性肾绞痛458例治疗的回顾性分析,对常用的几种缓解疼痛的方法进行比较,探寻治疗重度肾绞痛的最佳方案.方法:确诊重度肾绞痛458例资料(口诉评分法判定疼痛的严重程度),针对我院常用的3种止痛方法:(1)弱阿片类药(曲马多)+M受体阻滞剂(654-2);(2)非甾体类抗炎药(蒙洛英)+M受体阻滞剂(654-2);(3)强阿片类药物(度冷丁),评价给药40 min内疼痛缓解的效果并进行分析.结果:弱阿片类显效率为58%(完全缓解),非甾体类抗炎药显效率为81%,强阿片类显效率为88%,后两者的疗效明显优于前者(χ2=27.22和χ2=16.94,均P＜0.005);强阿片类组与NSAIDs+M受体阻滞剂组无差异.结论:NSAIDs+M受体阻滞剂可代替强阿片类药物治疗重度肾绞痛.     

莫比可联合间苯三酚治疗中老年急性肾绞痛疗效观察

目的:观察莫比可联合间苯三酚治疗中老年人急性肾绞痛的临床疗效和不良反应.方法:84例中老年急性肾绞痛患者随机分成实验组和对照组各42例,两组均静滴间苯三酚120 mg,实验组和对照组分别肌注莫比可15 mg和度冷丁80 mg,观察治疗后疗效和不良反应.结果:实验组与对照组的有效率无统计学差异(P＞0.05),实验组不良反应、6 h再发肾绞痛例数均明显低于对照组(P ＜0.01).结论:莫比可联合间苯三酚治疗中老年急性肾绞痛安全有效,值得临床推广应用.     

地塞米松联合解痉镇痛药治疗急性肾绞痛疗效观察

目的:观察地塞米松联合解痉镇痛药治疗急性肾绞痛的临床疗效.方法:将急性肾绞痛患者108例随机分为对照组(n=53)和观察组(n=55),对照组予双氯灭痛及阿托品肌肉注射,观察组在对照组治疗基础上加用地塞米松静脉滴注,比较两组镇痛效果.结果:观察组较对照组镇痛效果显著(P<0.05),且3小时内复发率明显降低(P<0.01).结论:地塞米松联合解痉止痛药治疗急性肾绞痛疗效确切,建议临床推广应用.     

山莨菪碱与酮咯酸氨丁三醇对肾绞痛止痛疗效的对照研究

目的：比较山莨菪碱（654-2）与酮咯酸氨丁三醇（尼松）对肾绞痛的止痛疗效和不良反应.方法：将2012年5月-2013年5月在福建省宁德市闽东医院急诊外科确诊的421例肾绞痛患者随机分为研究组（n=211）和对照组（n=210）,分别应用654-2注射液静脉滴注和尼松注射液肌肉注射治疗,比较两组对肾绞痛的止痛效果及不良反应.结果：研究组与对照组的止痛有效率分别为92.42％和93.33％,差异无统计学意义（P＞0.05）,而研究组的不良反应较尼松组少且轻微.结论：654-2与尼松对肾绞痛的止痛效率均在90％以上,且无明显差异,但654-2的副作用少且轻;654-2治疗肾绞痛较尼松更安全,建议临床推广应用.     

心痛定,度冷丁治疗肾绞痛疗效的对比观察：（380例报告）

本文报告用心痛定、度冷丁随机分组治疗肾绞痛共380例的疗效对比观察结果。心痛定组的总有效率为83.2%,与度冷丁组(88.4%)相前,无显著性差异(P>0.05),但度冷丁的药物副作用(嗜睡、头晕、口干等)则明显高于心痛定组(P<0.01),且有成瘾之虞。作者认为,用心痛定治疗肾绞痛简便、安全、价廉、副作用少,无成瘾性。心痛定不失为治疗肾绞痛的一种较理想的药物。     

黄体酮联合小冬眠治疗肾绞痛临床观察

肾绞痛属临床急症,其中以结石梗阻引起者居多。笔者自2000年12月～2001年7月,选择因输尿管结石梗阻而致肾绞痛患者82例。随机分为两组,对照组选用阿托品、度冷丁肌注,静滴平衡盐;观察组以黄体酮肌注、静滴氯丙嗪、异丙嗪混合液(亦即小冬眠疗法)。结果显示,观察组与对照组2小时镇痛疗效相仿,但观察组疼痛缓解速度明显快于对照组,且观察     

双氯芬酸钠治疗肾绞痛的临床观察

目的观察双氯芬酸钠治疗肾绞痛的疗效及安全性。方法将236例肾绞痛患者随机分为双氯芬酸钠组118例和度冷丁组118例进行对照研究观察。结果治疗组有效率为93．22％，对照组有效率为94．92％，两组间差异无统计学意义（P〉0．05）。结论双氯芬酸钠对肾绞痛止痛效果有效可靠，毒副作用少，其作用可替代度冷丁，是一种对肾绞痛有效的镇痛药，值得临床推广应用。     

酮咯酸氨丁三醇联合间苯三酚治疗急性肾绞痛52例疗效观察

目的:观察酮咯酸氨丁三醇联合间苯三酚治疗急性.肾绞痛的疗效及不良反应.方法:将急性肾绞痛表现患者151例按不平衡指数最小的分配原则分成A、B、C三组,A组49例静滴间苯三酚120 mg,B组50例肌注酮咯酸氨丁三醇30 mg.C组52例在静滴间苯三酚120 mg的同时肌注酮咯酸氨丁三醇30 mg.观察三组在用药30 min时的止痛效果及不良反应.结果:C组疗效显著高于A组、B组(P＜0.05),三组在治疗剂量时均无明显不良反应.结论:当单用间苯三酚或酮咯酸氨丁三醇治疗急性肾绞痛疗效欠佳时,可考虑二者联用,以提高疗效.     

心痛定、黄体酮、曲马多治疗肾绞痛的临床体会

目的 :探讨心痛定、黄体酮、曲马多联合用药治疗肾、输尿管结石引起的肾绞痛的临床疗效。方法 :采用心痛定、黄体酮、曲马多联合用药治疗肾绞痛 5 9例 ,与度冷丁、阿托品治疗肾绞痛随机对照观察。结果 :治疗组与对照组比较 ,总有效率无差异 (P >0 0 5 ) ,复发率减少 (P <0 0 5 ) ,差异有显著性 ,同时 ,药物副作用发生率也明显减少。结论 :心痛定、黄体酮通过不同的作用机制协同解除输尿管平滑肌剧烈收缩痉挛 ,加用中枢镇痛药物曲马多治疗肾绞痛 ,不仅止痛效果好 ,药物副作用少 ,且可减少肾绞痛的复发率。     

硝苯地平治疗肾输尿管绞痛42例疗效观察

目的 观察硝苯地平治疗肾绞痛的疗效和不良反应.方法 肾或输尿管绞痛患者42例分为硝苯地平组(n=22)和阿托品加盐酸哌替啶组(n=20),观察比较硝苯地平和阿托品加盐酸哌替啶缓解肾、输尿管绞痛的效果及不良反应.结果 两组显效率和总有效率比较差异均无统计学意义(P＞0.05);硝苯地平组出现嗜睡、头痛、口干、心悸等不良反应均低于阿托品联用盐酸哌替啶组(P＜0.05).结论 硝苯地平有较强的缓解肾、输尿管绞痛的作用,且见效快、安全性较高、不良反应少.     

吗啡分次注射联合间苯三酚治疗肾绞痛的疗效观察

目的:评价吗啡分次注射联合间苯三酚治疗肾绞痛的疗效及安全性。方法:患者100例,随机分为2组,每组50例。实验组给予生理盐水100ml+间苯三酚80mg静脉滴注+吗啡9mg静脉分3次推注,对照组给予生理盐水100ml+山莨菪碱10mg静脉滴注+肌注哌替啶50mg。于注射后40min、6h2个时间段观察解痉镇痛效果及其不良反应。结果:治疗40min后,实验组和对照组的显效率分别为46%和38%,两组比较差异无统计学意义(P>0.05)。实验组总有效率和6h内疼痛再发率分别为94%、16%,对照组为80%、34%,两组比较差异有统计学意义(P<0.05);实验组、对照组的不良反应发生率分别为18%、68%,两组比较差异有统计学意义(P<0.01)。结论:吗啡分次注射联合间苯三酚用治疗肾绞痛疗效好,不良反应少,值得临床推广应用。     

孕期输尿管结石并肾绞痛的输尿管镜腔内置双J管疗效分析

目的：评估输尿管镜腔内置双 J 管术治疗孕期输尿管结石并肾绞痛的疗效及安全性。方法对58例经保守治疗无效的孕期输尿管结石并肾绞痛患者行输尿管镜腔内置双 J 管术,观察手术疗效及安全性。结果所有患者置入双 J 管后肾绞痛症状均缓解;58例双 J 管留置时间3～8个月,术后复查泌尿系彩色多普勒超声检查发现结石自行排出后拔除双 J 管14例;留置双 J 管至分娩后1个月行输尿管镜碎石取石术26例、行体外震波碎石术18例。58例均顺利足月分娩,新生儿均健康,无因肾绞痛而发生流产、早产等不良事件。结论输尿管镜腔内置双 J 管术治疗孕期输尿管结石并肾绞痛疗效好,且安全。     

输尿管镜下碎石术治疗输尿管结石并发肾绞痛80例

目的探讨输尿管镜下碎石术治疗输尿管结石并发肾绞痛的疗效。方法对80例因输尿管结石并发肾绞痛患者，采用输尿管镜下碎石术。结果1例因结石上移至肾盂，1例因输尿管下段狭窄使输尿管镜无法到达结石部位手术失败，其余78例均碎石成功，术后当天肾绞痛缓解，碎石手术成功率和术后肾绞痛缓解率均为97．5％。结论输尿管镜下碎石术治疗输尿管结石及其引起的肾绞痛，是一种安全、有效的方法。     

Does computed tomographic scan affect diagnosis and management of patients with suspected renal colic?

Background

Patients with renal colic commonly present to the emergency department (ED) and are usually treated with analgesics, antiemetics and hydration. Computed tomographic (CT) scan is commonly utilized in evaluating patients with suspected renal colic.

Objectives

We compared diagnosis and treatment plans before and after CT in patients with suspected renal colic with the aim to evaluate how often changes in diagnosis, treatment and disposition are made.

Methods

In this prospective observational study, we enrolled a convenience sample of clinically Stable ED patients older than 17 with suspected renal colic for whom CT was planned. Exclusion criteria were: chronic kidney disease, urinary tract infection, recent CT and history of previous kidney stone. Pre-CT and Post-CT surveys were completed by the treating provider.

Results

The discharge diagnosis was renal colic in 62 of 93 enrolled patients (67%). Urinalysis showed blood in 52 of these patients (84%). CT confirmed obstructing kidney or bladder stone in 50 patients. There were five cases of alternative diagnoses noted on CT scan. After CT scan, 7 patients had changes in disposition. Sixteen providers felt that CT would not change management. In these cases, CT offered no alternative diagnosis and didn't change disposition.

Conclusion

CT scan didn't change management when providers did not expect it would. This indicates that providers who are confident with the diagnosis of renal colic should consider forgoing a CT scan. CT scan did occasionally find important alternative diagnoses and should be utilized when providers are considering other concerning pathology.     

妊娠合并输尿管结石致顽固性肾绞痛的腔内处理

【目的】探讨妊娠合并输尿管结石致顽固性肾绞痛安全有效的腔内处理方法。【方法】妊娠合并输尿管结石致肾绞痛经保守治疗无效患者14例,孕7~34周,平均27周。结石最大径5~12mm。输尿管上段结石8例,中段3例,下段3例。上段结石中6例单纯留置双J管,2例将结石推回肾盂后留置双J管。中下段结石中3例采用输尿管镜下气压弹道碎石术击碎结石,3例应用输尿管镜下双频激光碎石。【结果】12例术后肾绞痛消失;2例单纯放置双J管者仍有间断轻微肾绞痛,服用解痉药物可以缓解。8例未碎石在结石排出前每3个月更换双J管。14例孕妇均顺利生产,婴儿健康。【结论】妊娠合并输尿管结石致顽固性肾绞痛患者采用逆行输尿管插管或输尿管镜取石术安全有效。     

输尿管中下段结石并急性肾绞痛急诊输尿管镜钬激光碎石治疗

目的探讨急诊输尿管镜钬激光治疗输尿管中下段结石并肾绞痛的效果。方法对25例输尿管中下段结石致急性肾绞痛患者行急诊输尿管镜钬激光碎石治疗。结果 25例手术均获成功,肾绞痛缓解率100%,碎石成功率96%,4周后结石排净率92%。结论输尿管中下段结石导致的急性肾绞痛患者行急诊输尿管镜钬激光碎石术安全有效,排石率高。     

间苯三酚治疗妊娠期肾绞痛疗效观察

目的:评价间苯三酚在妊娠期肾绞痛中的应用。方法:将21例妊娠期结石性肾绞痛患者随机分成两组,治疗组静脉滴注间苯三酚,对照组静脉滴注山莨菪碱。同时联合硫酸镁,黄体酮治疗。观察组间止痛效果,复发率及不良反应。结果:止痛效果:治疗组(间苯三酚)总有效率为90.90%,对照组(山莨菪碱)为70.00%;复发率:前者18.18%,后者50.00%。组间比较止痛总有效率及复发率差异均有统计学意义(P<0.05)。治疗组(间苯三酚)未见不良反应。2例肾绞痛频繁发作者予输尿管镜下弹道碎石术渐缓解。结论:相比山莨菪碱,静脉应用间苯三酚治疗妊娠期肾绞痛镇痛效果肯定、能有效安胎且无明显不良反应。     

The analgesic effect of ketorolac addition for renal colic pain: A meta-analysis of randomized controlled studies

IntroductionThe effect of ketorolac addition for the pain control of renal colic remains controversial. We conduct a systematic review and meta-analysis to explore the analgesic efficacy of ketorolac addition for renal colic.MethodsWe search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs) assessing the analgesic efficacy of ketorolac addition for renal colic. This meta-analysis is performed using the random-effect model.ResultsFour RCTs are included in the meta-analysis. In patients with renal colic pain, ketorolac addition is associated with significantly lower pain scores at 10–20 min (SMD=-2.50; 95% CI=-4.31 to −0.68; P=0.007) and analgesic rescue (RR=0.68; 95% CI=0.52 to 0.89; P=0.006), but reveals no notable effect on nausea (RR=0.36; 95% CI=0.12 to 1.12; P=0.08), vomiting (RR=0.50; 95% CI=0.13 to 1.95; P=0.31), or dizziness (RR=0.68; 95% CI=0.05 to 0.60; P=0.007).ConclusionsKetorolac addition may improve the analgesic efficacy for renal colic pain.     

A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting

OBJECTIVES: The aim of this study was to compare morphine and pethidine in patients with clinically suspected renal colic with regard to analgesic efficacy, patient satisfaction and side effects. METHODS: double blinded, randomised controlled trial. RESULTS: There was no significant difference between morphine and pethidine with respect to any of the parameters measured. CONCLUSION: Because of the well known adverse effects that may be associated with pethidine use, the authors recommend that morphine should be the preferred agent in suspected renal colic, when an opioid analgesic is to be used.