排石汤联合盐酸坦洛新辅助体外冲击波碎石术治疗上尿路结石的临床疗效分析

目的:探讨排石汤联合盐酸坦洛新辅助体外冲击波碎石术(ESWL)治疗上尿路结石的临床疗效。方法:选择我院2015年1月~2016年9月收治的120例上尿路结石患者,采取随机数字表将其分成两组,每组60例。两组患者均行ESWL治疗,并于术后辅助使用盐酸坦洛新,观察组在上述治疗基础上联合排石汤治疗,对比两组的临床疗效以及治疗前后血清肌酐(Scr)、中性粒细胞明胶酶相关载脂蛋白(NGAL)、半胱氨酸蛋白酶抑制剂C(Cys-C)、肾小球滤过率(GFR)水平的变化情况。结果:观察组总有效率为96.60%,对照组为86.67%,观察组总有效率明显高于对照组(P0.05)。观察组结石排净率为95.00%,明显高于对照组(P0.05);肾绞痛发生率为6.67%,明显低于对照组(P0.05),结石排出时间、血尿持续时间均显著短于对照组(P0.01)。两组1年复发率对比差异无统计学意义(P0.05)。两组患者术后2 h、1 d血清NGAL、Cys-C水平逐渐升高,GFR逐渐下降,术后3 d上述指标逐渐恢复。观察组术后1 d、3 d NGAL、Cys-C水平明显低于对照组,GFR明显高于对照组(P0.01)。两组术前术后各时点Scr比较差异均无明显统计学意义(P0.05)。结论:排石汤联合盐酸坦洛新辅助ESWL治疗上尿路结石的临床疗效显著,并可有效改善ESWL引起的肾损伤。

Effect of Paishitang Combined with Tamsulosin Hydrochloride on Upper Urinary Calculi after Extracorporeal Shock Wave Lithotripsy

ABSTRACT Objective: To explore the clinical effect of paishitang combined with tamsulosin hydrochloride on the patient with up- per urinary calculi after extracorporeal shock wave lithotripsy (ESWL). Methods: 120 cases with upper urinary calculi in our hospital from January 2015 to September 2016 were selected and divided into two groups according to the random number table, 60 cases in each group. ESWL was given to both groups of patients and provided with tamsulosin hydrochloride postoperation, then paishitang were addi- tionally given to the patients in the observation group. The clinical effect and changes of serum creatinine (Scr), neutrophil gelatinase as- sociated lipocalin (NGAL), cystatin C (Cys-C) and glomerular filtration rate (GFR) levels before and after treatment were compared be- tween two groups. Results: The total effective rate of observation group was 96.67%, which was 86.67% in the control group, no signifi- cant difference was found in the total effective rate between the two groups(P<0.05). The stone discharge rate was 95.00% in the observa- tion group, which was significantly higher than that of the control group (P<0.05); the incidence rate of renal colic was 6.67%, which was significantly lower than that of the control group(P<0.05), the stone discharge time and the duration of hematuria were significantly short- er than those in the control group (P<0.01). There was no significant difference in the recurrence rate between the two groups within one year (P>0.05). The serum NGAL and Cys-C levels of both groups were gradually increased while the GFR levels were gradually de- creased on the 1st, 2nd day postoperation, but all the index mentioned above gradually recovered on the 3rd day postoperation. The levels of NGAL and Cys-C in the observation group were significantly lower than those in the control group on the 1st, 3rd day postoperation while the GFR was significantly higher in the observation group than those of control group on the 1st, 3rd day postoperation(P<0.01). No signifi- cant difference was found in the Scr at different time points postoperation between two groups(P>0.05). Conclusion: Paishitang combined with tamsulosin hydrochloride had significant clinical effect on thpatient with upper urinary calculus after ESWL and could effectively improve the renal injury induced by ESWL.