双“J”管留置治疗顽固性肾绞痛的效果

目的探讨留置双"J"管治疗上尿路疾病引起顽固性肾绞痛的价值。方法顽固性肾绞痛患者118例(A组),采用输尿管镜下留置双"J"管急诊治疗成功;选择同期各种原因未置双"J"管而仅予对症处理的顽固性肾绞痛患者57例作为对照(B组)。比较两组的疼痛转归及肾功能恢复情况。结果 A组患者疼痛程度明显减轻,治疗有效率高于B组(98.3%vs.66.7%)(P<0.05)。同时,急性梗阻性肾功能不全患者置双"J"管后肾功能明显好转,尿量>400ml/d。结论顽固性肾绞痛患者急诊输尿管镜下留置双"J"管,能迅速缓解肾绞痛,改善肾功能。     

维拉帕米与山莨菪碱治疗肾绞痛的比较

目的：比较维拉帕米与山莨菪碱治疗肾绞痛的疗效。方法：１５３例肾绞痛病人随机分为３组。Ａ组５４例（男性３５例，女性１９例；年龄３５±ｓ９ａ）采用维拉帕米２０ｍｇ；Ｂ组４８例（男性３０例，女性１８例；年龄３４±７旬采用维拉帕米８０ｍｇ；Ｃ组５１例（男性３２例，女性１９例；年龄３７±１０ａ）采用山莨菪碱２０ｍｇ。以上３个药分别加入５％葡萄糖液２５０ｍＬ，静脉滴注，且于１ｈ滴完。结果：Ａ组总有效率８９％，Ｂ组９２％，Ｃ组７３％；Ａ，Ｂ２组分别与Ｃ组比较，差别均有显著意义（Ｐ＜０．０５）。Ｂ组显效率明显优于Ａ或Ｃ组（Ｐ＜０．０５）。结论：Ｂ（维拉帕米８０ｍｇ）组疗效最佳。     

妊娠合并肾绞痛的诊治研究

目的：探讨妊娠合并肾绞痛的诊断和治疗方法。方法：回顾性分析妊娠并发肾绞痛患者36例,19例采用超声诊断和保守治疗,17例采用输尿管镜诊断和治疗。结果：19例保守治疗患者中15例治疗有效,1例因病情反复,多次治疗效果不明显而选择流产,1例由于症状反复且加重导致流产,2例因诊断不明确且病情反复而选择流产。输尿管镜诊治17例,证实输尿管结石14例,肾绞痛3例,碎石或放置双J管,17例患者均顺利度过围生期,并产健康婴儿。两组疗效间差异有统计学意义。结论：输尿管镜检术对诊治妊娠合并肾绞痛是安全、有效的。     

预先留置双“J”管再行ESWL处理孤立肾肾结石35例分析

目的 探讨预先留置双"J"管再行ESWL术处理孤立肾肾结石的治疗效果.方法 回顾性分析我院2000年12月～2008年11月行预先留置双"J"管再行ESWL术处理孤立肾肾结石共35例,所有患者均为孤立肾肾结石,先在膀胱镜F留置该侧输尿管之双"J"管,再行ESWL术.结果 21例1次ESWL成功,8例行2次ESWL成功,6例行3次ESWL成功,无并发症发生.结论 预先留置双"J"管再行ESWL术处理孤立肾肾结石具有安全、高效、结石清除率高、并发症少的特点,可作为孤立肾肾结石的常规治疗方法 .     

急诊内镜治疗输尿管结石并肾绞痛疗效观察

目的　评价输尿管镜术急诊治疗输尿管结石并肾绞痛的疗效。方法　总结应用输尿管镜取石、碎石术治疗 1 0 7例输尿管结石并肾绞痛患者的资料 ,并对提高单次取石和碎石成功率进行讨论。结果　 86例输尿管结石原位 1次取石、碎石成功 ,1 6例结石被冲入肾盂 (有 2例继在肾盂内行钬激光碎石术获成功 ) ,2例发生输尿管穿孔改行开放手术 ,3例因输尿管下段特别细小经输尿管扩张 1周后再行内镜治疗成功。术后结石梗阻解除率为 95.3% (1 0 2 /1 0 7) ,单次取石或碎石成功率为 82 .2 % (88/1 0 7)。术后残石排净时间平均 2 .1周 ,术后无明显血尿、梗阻性脓肾等并发症发生。结论　输尿管镜术可作为输尿管结石并肾绞痛治疗的有效方法之一。     

生长抑素治疗颈淋巴结清扫术后难治性乳糜漏的疗效

目的观察生长抑素治疗颈淋巴结清扫术后难治性乳糜漏的临床疗效。方法颈淋巴结清扫术后难治性乳糜漏16例分为两组:B组,10例,采用局部加压、负压引流和低脂饮食;A组,6例,加用生长抑素6mg,溶于500ml生理盐水中静脉泵维持24h治疗,比较两组疗效。结果 A组乳糜漏闭合率为100%,明显高于B组的50%(P<0.05)。A组住院时间为(11.2±4.4)d,明显短于B组的(16.7±4.8)d(P<0.05)。结论生长抑素可有效提高颈淋巴结清扫术后难治性乳糜漏的闭合率,缩短住院时间。     

双氯芬酸钠利多卡因和哌替啶治疗肾绞痛的对比研究

目的 观察并比较双氯芬酸钠利多卡因和哌替啶各联合山莨菪碱治疗肾绞痛的疗效及安全性.方法 280例肾绞痛患者随机分为观察组和对照组各140例,观察组:一次性同时肌内注射双氯芬酸钠利多卡因2 ml(含双氯芬酸钠75 mg,利多卡因20 mg)和山莨菪碱10 mg;对照组一次性同时肌内注射哌替啶75 mg和山莨菪碱10 mg.观察比较两种方法给药后1h内的镇痛效果及不良反应.结果 两组的镇痛效果无明显差异(P＞0.05),但不良反应比较差异具有统计学意义(P＜0.01).结论 双氯芬酸钠利多卡因与哌替啶用于肾绞痛疗效相似,但不良反应少,无成瘾性,临床应用方便,值得推广.     

氯诺昔康治疗肾绞痛的疗效分析

目的:评价氯诺昔康治疗肾绞痛的临床疗效和安全性.方法:肾痛患者80例,随机分为治疗组和对照组各40例,治疗组用氯诺昔康8mg,肌注;对照组给予盐酸哌替啶50～75mg,肌注.两组均以用药后30min为判断疗效的时限.结果:治疗组和对照组显著有效率分别为65%和75%,有效率分别为30%和22.5%,无效率分别为5%和2.5%,两组比较差异无显著性(P>0.05),不良反应发生率分别为7.5%和2.5%(P<0.05).结论:氯诺昔康治疗肾绞痛具有与度冷丁相同的疗效,安全性高.     

Nifedipine in the treatment of renal colic

A double-blind randomized, clinical trial was conducted in 43 patients to evaluate the efficacy of sublingual nifedipine in the treatment of pain in renal colic. Comparison was made with a combination of dipyrone, pitofenone and fenpipramide, which is usually administered intravenously in Spain. With nifedipine, pain completely disappeared in 44% of the cases, and with the combination of drugs, in 89% (p less than 0.005). More adverse effects were noted with the combination than with nifedipine. Both treatments brought about a slight drop in arterial pressure without leading to hypotension in any case. There was no change in heart rate. The possible causes of the relatively low level of success with nifedipine were analyzed. The possibility of using nifedipine under certain circumstances in which other drugs are contraindicated or when their administration is unfeasible is suggested.     

经鼻肠梗阻导管置入术治疗老年患者术后粘连性肠梗阻的临床效果

目的：探析经鼻肠梗阻导管置入术治疗老年患者术后粘连性肠梗阻的临床效果。方法入选本院2012年2月∽2014年2月收治的术后粘连性肠梗阻老年患者102例,按照入院先后顺序分为两组,对照组50例行常规鼻胃管胃肠减压术治疗,观察组52例行经鼻肠梗阻导管置入术治疗,比较两组的临床效果。结果观察组的总有效率为94.2%（49/52）,显著高于对照组的78.0%（39/50）,且胃肠减压量显著多于对照组,气液平面消失时间、腹部症状缓解时间及恢复排气、排便时间均显著短于对照组（P均〈0.05）。结论经鼻肠梗阻导管置入术治疗老年患者术后粘连性肠梗阻可全面改善临床症状和各项指标,提高治疗效果。     

肾绞痛的社区治疗对策探讨

Object To investigate the effective therapeutic to control nephric colic without anesthetics by comparing the different drugs. Methods 512 patients with moderate or severe nephric colic (the severity of pain was scored by verbal report) were randomized into three groups, including (1) group pethidine +654-2, (2) group lornoxicam + 654-2,and (3) group rotundine +654-2. The effects on alleviation of pain were evaluated among three groups within 40 minutes after drug administration.Results The excellence rate iss 86% and effective rate is 90% in group pethidine + 654-2. The excellence rate are 70% and 65%, respectively,in group lornoxicam + 654-2 and group rotundine +654-2, which are both lower than that in group pethidine +654-2 (both P＜ 0.05), however, the effective rates were 92% and 89%, respectively, which are not significantly different from that in group pethidin + 654-2 (both P＞ 0.05). Comclusion Lornoxicam and rotundine can be widely used to replace pethidine to alleviate nephric colic.     

肾绞痛的社区治疗对策探讨

目的 通过对512例急性肾绞痛治疗效果的回顾性分析,对常用的几种药物缓解疼痛的方法进行比较,寻找毒麻药外的有效治疗肾绞痛方法,为社区急性肾绞痛药物治疗提供对策.方法 对512例中重度肾绞痛患者（口述评分法制定疼痛的严重程度）,按照我院常用的3种治疗方法随机分为三组：（1）哌替啶＋654-2;（2）氯诺昔康＋654-2;（3）罗通定＋654-2,评价给药40分钟内疼痛缓解的效果并进行组间比较分析.结果 哌替啶组显效率86%,有效率90%,氯诺昔康组显效率70%,有效率92%,罗通定组显效率65%,有效率率89%,后两组的显效不及哌替啶（P＜0.05）,而三组的有效率差异无显著性（P＞0.05）.结论 氯诺昔康、罗通定可以替代哌替啶治疗中重度肾绞痛,可在社区推广应用.     

妊娠期肾绞痛治疗方法的选择

目的探讨妊娠期肾绞痛中不同治疗方法的效果和顽固性肾绞痛输尿管镜应用的价值。方法42例妊娠期肾绞痛患者，首先选择休息、大量补充水、止痛、解痉、抗感染等保守治疗；无效者应用输尿管镜检查和治疗16例，放置D-J管；如置管失败，再行榆尿管镜探查和碎石。结果保守治疗26例；输尿管镜留置D—J管成功10例，并定期更换D-J管8例；妊娠期气压弹道碎石并留置D-J管6例，其中5例成功。1—2周后拔出D-J管。产后输尿管镜碎石和体外震波碎石8例。结论保守治疗多数病例疼痛可完全缓解作为首选，应严密随访；对反复发作和顽固性肾绞痛患者，先考虑留置D—J管，尽量减少对患者刺激，以避免流产和先兆流产；必要时再行输尿管镜检查和气压弹道碎石。     

Intravenous indoprofen in the management of renal colic

Recent reports imply that the prostaglandin system is involved in the pathogenesis of pain due to renal colic, and prostaglandin-synthetase inhibitors have been proposed in the management of this condition. A dose-response study has therefore been performed in patients with renal colic, using two intravenous non-steroidal antiinflammatory drugs, indoprofen and lysine acetylsalicylate (ASA). Seventy-five inpatients (15 per group) were treated with three dose levels of indoprofen (100, 200 and 400 mg) or two dose levels of ASA (500 and 1500 mg) according to a double-blind, randomized, parallel-group design. The patients scored their pain at 15, 30, 60, 120 and 180 minutes after treatment; they also assessed the overall efficacy of treatment by means of a visual analogue scale. The results showed that, in terms of mean pain score, there was a prompt analgesic response in each treatment group, higher effects being obtained with increasing dose levels of both drugs. However, the statistical prerequisites for calculating a potency ratio between the drugs under study were satisfied only for a few variables, in which cases the relative potency of indoprofen to ASA varied between 7.1 and 8.8. The analysis of the frequencies of response, on the other hand, revealed for indoprofen a significant dose-effect regression, the higher dose of this drug giving a complete or nearly complete relief of pain in the majority of patients.     

利培酮治疗难治性精神分裂症

目的 :观察利培酮对难治性精神分裂症病人的疗效。方法 :10 6例难治性精神分裂症病人给利培酮 ,开始 1mg·d- 1,2wk内加至 4～ 6mg·d- 1,分 2次服 ,共用 12wk ,用BPRS ,SANS ,SDSS ,CGI和TESS量表评定 ,观察其疗效和不良反应。结果 :治疗后经上述量表评定利培酮治疗难治性精神分裂症有效率 34%。不良反应轻 ,以震颤、急性肌张力增高、静坐不能为主。结论 :利培酮治疗难治性精神分裂症较文献报道的传统的抗精神病药的疗效要高     

桂美辛和山莨菪碱治疗胆绞痛的比较

桂美辛组(男性21例,女性35例;年龄44±12a)治疗胆绞痛56例,剂量300mg, po, tid,显效32例,有效21例,总有效率95％。山茛菪碱组52例(男性18例,女性34例;年龄46±13a),剂量10mg, im, tid,显效、有效分别为9与20例,总有效率56％。2组比较,P<0.01。桂美辛治疗胆绞痛有疗效高、不良反应少的优点。     

The use of flavoxate in cystitis and renal colic

Summary

Two double-blind trials and one open study were carried out to assess the efficacy of the spasmolytic, flavoxate, in relieving the pain and discomfort associated with various urological conditions. In the first two studies, 24 patients with renal colic and 34 with cystitis or urethrotrigonitis were treated orally with either 0.2?g. flavoxate t.d.s. or placebo. In the open study, 25 patients with acute renal colic were given a single i/v injection of flavoxate (0–1?g.).

Thirty-four (68 %) of the 54 patients receiving flavoxate showed a good or moderate response in terms of symptom relief compared with only 8 (28%) of the patients on placebo. The results of cystometrography in 7 patients on flavoxate and 7 on placebo showed that the increase in bladder capacity and the reduction in pressure after flavoxate treatment were statistically significant but not so in the case of placebo. No side-effects or adverse reactions were noted in any of the patients treated.     

Pharmacological management of renal colic in the older patient

Renal colic affects up to 12% of the population. Initial management of most patients is expectant. Acute symptom management of renal colic is best accomplished with a combination of parenteral opioids and NSAIDs. The elderly patient with a kidney stone should be screened for contraindications to NSAID therapy, such as renal failure or previous peptic ulcer disease. Use of parenteral opioids is often necessary during the acute setting, and downward-adjusted doses and monitoring are necessary to prevent associated confusion and respiratory depression. Novel therapy with desmopressin may also be effective for symptom control at the initial presentation, without the adverse effects of opioids or NSAIDs. However, use of desmopressin in the elderly must be undertaken cautiously, given the potential adverse effects of this agent. Many small, distal ureteral stones are treated initially with watchful waiting for the first 2-4 weeks after presentation. The patient should have effective, non-parenteral analgesics for use at home. Included in these agents are oral or suppository NSAIDs and oral opioids. Medical expulsion therapy with alpha-adrenoceptor antagonists or calcium channel antagonists is efficacious. alpha-Adrenoceptor antagonists such as the alpha(1A/)(1)(D)-selective tamsulosin are well tolerated in the elderly and increase the rate of spontaneous stone passage by approximately 50% for small distal stones. These agents also appear to decrease the severity of renal colic. Corticosteroids and calcium channel antagonists are also effective but their use in the elderly is not recommended as first-line therapy.