消瘀通列汤治疗慢性盆腔疼痛综合征临床研究

目的：观察“消瘀通列汤”治疗慢性疼痛综合征（CPPS）的疗效及NIH—CPSI评分。方法：据NIH前列腺炎综合征分类标准，选择CPPS病例186例，根据EPSRT分成Ⅲa和Ⅲb两组。给予“消瘀通列汤”治疗，治疗前及治疗后每月作EPSRT常规及NIH—CPSI评分进行疗效评价。结果：3个疗程后Ⅲa组显效率41．1％，总有效率82．2％；Ⅲb组显效率51．9％，总有效率86．1％。经统计分析，两组疗效差异有显著性意义（P〈0．05）。每个疗程结束后，两组NIH—CPSI各类得分均有明显改善（P〈0．001或P〈0．01）。Ⅲa组WBC计数评分，除第1、2疗程有明显减少外，第3疗程开始无明显变化。结论：“消瘀通列汤”能有效改善慢性盆腔疼痛综合征临床症状，提高生活质量。可能减轻盆腔内静脉充血。     

加味枸橘汤治疗慢性盆腔疼痛综合征的临床研究

目的:观察加味枸橘汤治疗慢性盆腔疼痛综合征(CPPS)的临床疗效。方法:通过对75例CPPS患者口服加味枸橘汤治疗前、后临床症状与客观指标的测定,总结其疗效。结果:75例CPPS患者口服加味枸橘汤治疗前及治疗1~2个月后,按美国国立卫生研究所提出的前列腺炎分类及症状评分标准(NIH-CPSI)进行评分,其总均分、疼痛、排尿症状影响生活质量的平均分分别由(26.4±5.0)、(10.2±2.5)、(5.1±1.1)和(9.7±1.4)分下降至(14.5±5.1)、(6.0±3.2)、(2.5±1.2)和(5.6±3.0)分,经统计学处理,差异均有显著性意义(P<0.05),总有效率达81.3%(61/75)。结论:加味枸橘汤对CPPS有明显的临床疗效,是一种有效的治疗药物。     

前列舒通胶囊治疗湿热瘀阻型慢性前列腺炎临床观察

目的观察前列舒通胶囊治疗湿热瘀阻型慢性前列腺炎的疗效。方法选取150例湿热瘀阻型慢性前列腺炎患者随机分为治疗组（前列舒通胶囊＋氟哌酸胶囊）和对照组（氟哌酸胶囊）。结果治疗组与对照组的总有效率分别为183.33%、68.33%（“P〈0.05”）,两组间中医证候积分及前列腺液白细胞计数均有显著性差异（“P〈0.05”）。结论前列舒通胶囊可有效治疗湿热瘀阻型慢性前列腺炎,并能提高抗生素的疗效。     

自拟消炎汤治疗慢性盆腔炎湿热瘀阻型65例疗效观察

目的：观察中药消炎汤加减治疗慢性盆腔炎湿热瘀阻型的临床疗效。方法：将120例湿热瘀阻型慢性盆腔炎患者随机分为两组。治疗组65例，口服自拟方消炎汤（丹参、丹皮、赤芍、薏苡仁、桃仁、蒲公英、红藤、败酱草、泽泻、甘草）；对照组55例，西药常规治疗。连续治疗2个月。结果：总有效率治疗组为95．4％。对照组为69．1％．两组比较，差异有显著性（P〈0.05）。结论：运用消炎汤加减治疗慢性盆腔炎湿热瘀阻型有较好疗效，能明显改善临床症状、体征，值得临床推荐使用。     

前列桂黄片治疗慢性盆腔疼痛综合征260例疗效观察

目的:探讨中成药前列桂黄片治疗慢性盆腔疼痛综合征的疗效.方法:选取符合慢性盆腔疼痛综合征诊断标准的患者260例,随机分为中成药治疗组132例和西药对照组128例.分别口服前列桂黄片和左氧氟沙星胶囊治疗.两组均15 d为1个疗程,共两个疗程,然后进行NIH-CPSI评分和前列腺液常规检查.结果:前列桂黄片组痊愈52例,显...     

督脉灸治疗慢性盆腔疼痛综合征寒凝血瘀证

目的:观察督脉灸治疗慢性盆腔疼痛综合征寒凝血瘀证的临床疗效。方法:选择80例慢性盆腔疼痛综合征患者,辨证为寒凝血瘀证,随机数字表法分为治疗组和对照组。治疗组采用督脉灸治疗,对照组口服少腹逐瘀颗粒,每次1袋,每天3次。比较两组患者治疗前后中医证候评分、美国国立卫生研究院慢性前列腺炎症状指数评分(National Institutes of health chronic prostatitis symptom index,NIH-CPSI)、卵磷脂小体数、焦虑及抑郁自评量表评分等指标的变化,并评定两组疗效。结果:①治疗组有效率为90.0%(36/40),对照组为72.5%(29/40),治疗组优于对照组(P<0.05)。②治疗后两组中医证候积分均显著降低(均P<0.01),且治疗组优于对照组(8.56±3.17 vs 11.09±3.49,P<0.01)。③治疗后两组卵磷脂小体均明显增加(均P<0.01),且治疗组优于对照组(32.58±6.07 vs 28.45±7.32,P<0.05)。④治疗后两组NIH-CPSI总评分及疼痛、焦虑、抑郁评分均明显改善(均P<0.01),且治疗组均优于对照组(P<0.01,P<0.05)。结论:督脉灸治疗慢性盆腔疼痛综合征寒凝血瘀证临床疗效满意。     

督脉灸治疗慢性盆腔疼痛综合征寒凝血瘀证

目的:观察督脉灸治疗慢性盆腔疼痛综合征寒凝血瘀证的临床疗效。方法:选择80例慢性盆腔疼痛综合征患者,辨证为寒凝血瘀证,随机数字表法分为治疗组和对照组。治疗组采用督脉灸治疗,对照组口服少腹逐瘀颗粒,每次1袋,每天3次。比较两组患者治疗前后中医证候评分、美国国立卫生研究院慢性前列腺炎症状指数评分(National Institutes of health chronic prostatitis symptom index,NIH-CPSI)、卵磷脂小体数、焦虑及抑郁自评量表评分等指标的变化,并评定两组疗效。结果:①治疗组有效率为90.0%(36/40),对照组为72.5%(29/40),治疗组优于对照组(P0.05)。②治疗后两组中医证候积分均显著降低(均P0.01),且治疗组优于对照组(8.56±3.17 vs 11.09±3.49,P0.01)。③治疗后两组卵磷脂小体均明显增加(均P0.01),且治疗组优于对照组(32.58±6.07 vs 28.45±7.32,P0.05)。④治疗后两组NIH-CPSI总评分及疼痛、焦虑、抑郁评分均明显改善(均P0.01),且治疗组均优于对照组(P0.01,P0.05)。结论:督脉灸治疗慢性盆腔疼痛综合征寒凝血瘀证临床疗效满意。     

前列炎清颗粒治疗炎症性慢性盆腔疼痛综合征疗效观察

目的：观察前列炎清颗粒治疗炎症性慢性盆腔疼痛综合征（CPPS）的疗效。方法：102例患者随机分成2组。治疗组68例予前列炎清颗粒；对照组34例口服特拉唑嗪均治疗4周。根据美国国立卫生研究院慢性前列腺炎症状评分（NIH-CPSI）、前列腺按摩液（EPS）常规、最大尿流率（MFR）及平均尿流率（AFR）比较2组疗效。结果：2组总有效率分别为92．6％、55．9％（P〈0．01）。治疗组NIH-CPSI总分降低71．6％，EPS中白细胞减少72．0％，卵磷脂小体增加87．0％，MFR、AFR分别增加54．7％与51．6％，均优于对照组（P〈0．01），试验中未发现明显不良反应。结论：前列炎清颗粒治疗炎症性慢性盆腔疼痛综合征安全有效。     

慢性前列腺炎/慢性盆腔疼痛综合征诱发因素的临床研究

2004年1月2008年1月随机抽取了160例慢性前列腺炎／慢性盆腔疼痛综合征（CP／CPPS）在门诊治疗后症状缓解的患者,对几种常见的CP／CPPS诱发因素如饮酒、吃辣椒、骑自行车、过频性生活等进行临床对照研究,对诱发因素引起相应症状的程度、时间和转归等进行探讨。现报告如下。     

活血化瘀法治疗慢性盆腔疼痛综合征临床研究

活血化瘀法治疗慢性盆腔疼痛综合征(Ⅲ型前列腺炎),主要包括清热利湿活血化瘀法、疏肝理气活血化瘀法以及补肾温阳活血化瘀法3类.中药化瘀法能使前列腺内血管扩张,血液循环加速,组织供氧加强,并使活血化瘀药物直接作用于前列腺局部改善微循环,畅通前列腺管,具有抑制炎性介质释放,抗纤维化,调节免疫功能的作用.     

慢性盆腔疼痛综合征对精液质量的影响

目的探讨慢性盆腔疼痛综合症对精液质量的影响。方法分析25例慢性盆腔疼痛综合症患者及25例年龄匹配的正常男性的精液常规及分析资料,将这些资料进行对比,观察他们之间的区别。同时,分析慢性盆腔疼痛综合症患者精液参数与症状持续时间的关系。结果慢性盆腔疼痛综合症组和正常对照组之间在射精量、精子活力及果糖浓度之间差别显著;其他参数差别不显著。慢性盆腔疼痛综合症组有2例无精子,对照组没有发现无精子患者。前列腺痛持续时间与精液参数无关。结论慢性盆腔疼痛综合症患者精子活力及果糖浓度较对照组显著下降,此结论支持慢性盆腔综合症是器质性病变,而不是心理性病因所致。     

Fluoxetine ameliorates symptoms of refractory chronic prostatitis/chronic pelvic pain syndrome

Background  Category III chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common syndrome of unclear etiology with significant impact on quality of life. Because the outcomes of multiple therapies for CP/CPPS have been far from approving, the possible psychological factors have been considered to play an important role in CP/CPPS. Based on this, we investigated the role of antidepressant drug (fluoxetine) in men with refractory CP/CPPS.

Methods  In this study, 42 men diagnosed with refractory CP/CPPS without response to standard therapy (include multiple antibiotic courses and α-blockers) were referred for fluoxetine therapy. All patients received fluoxetine (20 mg/d) for three months and were clinically evaluated before (baseline), and after 4, 8 and 12 weeks of therapy. The evaluation included a National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI) and a Beck depression inventory (BDI) questionnaire. Moreover, the subjective global assessment (SGA) was assessed at the 4th, 8th and 12th week of therapy.

Results  Significant decreases were observed for total NIH-CPSI (28.55 to 9.29), NIH-CPSI pain (14.69 to 5.19), NIH-CPSI urinary (4.95 to 1.88 ), NIH-CPSI quality of life (8.83 to 2.20), and BDI (34.67 to 13.95) scores compared with baseline, all P values <0.05. Twenty-nine (69.05%) reported marked improvement on the subjective global assessment and 33 (78.57%) had a greater than 50% decrease in NIH-CPSI at the end of therapy (12th week). At the same time, the Pearson correlation coefficient analysis demonstrated a positive correlation between BDI score and each CPSI score. No adverse events were reported in this study.

Conclusions  Fluoxetine appears to be a safe and effective treatment in improving symptoms in, and the quality of life of, men with difficult CP/CPPS. Moreover, amelioration of difficult CP/CPPS-related symptoms could be related to a decrease in depressive symptoms.

     

Management of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）： an evidence-based approach

Objective：To evaluate the efficacy and safety of the treatment of chronic prostatitis/chronic pelvic pain syndrome （CP/CPPS）. Methods- The randomized controlled trials （RCTs） about the treatment for CP/CPPS all over the world were searched. MEDLINE （January 1966 to June 2007）, EMBASE （January 1988 to June 2007）, and 4 Chinese databases were electronically searched. The studies included in the refer- ences of eligible studies were additionally searched. Two reviewers independently screened the studies for eli- gibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross- checking. Divergences of opinion were settled by discussion or consulted by the experts. Meta-analysis was performed by using RevMan 4.2 software. Results： Twelve original studies involving 1 003 participants met inclusion criteria. Compared with placebo, alpha-blockers could improve the symptoms of CP/CPPS obvious- ly with WMD of NIH-CPSI, total score and pain score were -4.10 （95%CI： -6. 92 to -1.28） and -1.68 （95 %CI： -2.54 to -0. 82）. Antibiotics could not improve the symptoms obviously with WMD of NIH-CP- SI; total score and pain score were -2.71 （95%CI： -4. 78 to -0. 64） and -0.86 （95%CI： -2.07 to 0.36）. Flavoxate could not improve the NIH-CPSI total score obviously, but could relieve the pain, with WMD of NIH-CPSI total score and pain score being -2.96 （95%CI： -5.17 to -0. 74） and --2.31 （95%CI.. -4.05 to 0.03）. Prostat could improve the NIH-CPSI total score obviously, but could not relieve the pain, with WMD of NIH-CPSI total score and pain score being --7. 60 （95%CI.. -9. 97 to -5.23） and -2. 02 （95%CI： -4.07 to 0. 04）. Conclusion： Drug intervention could improve total symptoms of CP/CPPS in some degree, but no universally effective treatment is available that can prove significant lasting benefit for all the symptoms of CP/CPPS. Future RCT must use an appropriate sample size and optimal duration and fol- low-up of participants. It is important to improve the quality of internal original studies.     

NIH慢性骨盆疼痛综合征分型法的临床价值探讨

目的 探讨美国国立卫生研究院（NIH）的慢性骨盆疼痛综合征（CPPS）分型法的临床价值。方法 选择167名CPPS患者,首诊时采用慢性前列腺炎症状评分（CPSI）问卷调查,同时行前列腺液pH值测定。予以口服氟喹诺酮治疗4周后随访,再次行CPSI问卷调查。结果 比较首诊时CPSI评分、前列腺液pH值以及各部位疼痛不适发生率,IIIa型与IIIb型的差异无统计学意义（P〉0.05）。治疗后IIIa型与IIIb型CPSI下降幅度的差异无统计学意义（P〉0.05）。结论 尚不能认为CPPS中IIIa型与IIIb型的病情及对治疗的反应存在差异,NIH的CPPS分型法的临床价值尚不能得到证实。     

Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

Objective:To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome (CPPS). Methods: A total of 36 men with recalcitrant CPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl (10 ml of 0. 125% Bupivacaine, 0. 05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12) into sacral space once a week for 4 weeks. The National Institute of Health Chronic Proslatitis Symptom Index (NIH-CPSI), maximum and average flow rate were performed at the start and the end of 4 weeks' therapy. Results :Mean NIH-CPSI total score was decreased from 26. 5±1. 6 to 13. 4±2. 0 (P<0. 001). Significant improvement was seen in each subscore domain. A total of 32 patients (89%) had at least 25% improvement on NIH-CPSI and 22 (61 %) had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3. 8 to 23. 6±4. 2 and 10. 9±2. 6 to 14. 3±2. 4 respectively. Conclusion: Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacral spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.     

A preliminary evaluation of the psychometric profiles in Chinese men with chronic prostatitis/chronic pelvic pain syndrome

Background  As one of the most commonly diagnosed diseases, chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is characterized by a variety of complex symptoms. Anxiety and depression are two of the most prevalent clinical manifestations of patients with CP/CPPS, and have adverse effects on the health of the subjects and prognosis of comorbidities. Such psychological disorders, however, have not been deeply and thoroughly studied in China. The aim of this study was to investigate the prevalence and severity of psychological disorders in Chinese adults with CP/CPPS.

Methods  From April 2008 to June 2009, 80 patients and 40 age-matched healthy men participating in a voluntary health examination were recruited. The majority of the subjects completed the questionnaires on the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) as well as the hospital anxiety and depression scale (HADS).

Results  Of all the participants, 77 (96.3%) patients and 37 (92.5%) healthy controls completed the questionnaires. The average NIH-CPSI total score was 21.0±9.5 for the patients and 2.2±1.5 for the controls (P=0.03). Of the 77 patients with CP/CPPS, 48 (62.3%), 5 (6.5%), and 1 (1.2%) had anxiety symptoms, depression symptoms, or both anxiety and depression symptoms, respectively. For the controls, the average HADS anxiety and depression scores in patients were 14.5±6.8 and 5.2±4.5, which were both significantly higher than in controls. Moreover, the prevalence and the symptom scores of both the HADS anxiety and depression were higher for the younger age group (<35 years) than for the older age group (<35 years).

Conclusions  This preliminary study revealed that male patients with CP/CPPS had a higher prevalence of psychological disorders than in the control subjects. Moreover, the differences of the prevalence and severity of the psychological symptoms between the two different age groups may imply that psychological disorders related to CP/CPPS may be relieved with increasing age. The present study indicated that psychological evaluation is important in men with CP/CPPS, especially in younger men.

     

Ⅲ型慢性前列腺炎合并勃起功能障碍的中西结合治疗临床观察

目的 探讨花粉芪奴汤结合伐地那非治疗Ⅲ型慢性前列腺炎(CP/CPPS)合并勃起功能障碍(ED)的疗效.方法 CP/CPPS合并ED患者138例,随机分为两组:治疗组70例,使用花粉芪奴汤4周后加用伐地那非治疗;对照组68例持续使用花粉芪奴汤8周.分别于第4和第8周末进行NIH-CPSI评分和IIEF-5评分观察疗效.结果 4周末治疗组和对照组NIH-CPSI分别为13.1±4.7和13.3±4.5,较治疗前均显著下降(P＜0.01),两组间比较差异无统计学意义(P＞0.05),两组IIEF-5评分分别为14.1±3.3和14.3±5.0,较治疗前有所上升(P＜0.01),但两组间比较差异无统计学意义(P＞0.05).8周后治疗组NIH-CPSI评分7.8±2.8、IIEF-5评分20.1±4.4与4周末比较差异均有统计学意义(P＜0.01);对照组NIH-CPSI评分12.7±2.3、IIEF-5评分14.3±4.5、与4周末比较差异均无统计学意义(P＞0.05);两组间NIH-CPSI与IIEF-5评分比较差异均有统计学意义(P＜0.01),治疗组IIEF-5评分值与NIH-CPSI值呈负相关关系.结论 对CP/CPPS合并ED患者在使用花粉芪奴汤加用伐地那非能有效治疗ED,同时使NIH-CPSI评分降低,促进CP/CPPS恢复.     

从心论治盆腔炎性疾病后遗症之慢性盆腔痛

盆腔炎性疾病因治疗不彻底或不及时所遗留的慢性盆腔痛在临床中较多见,医家多以清热解毒,化瘀止痛法治之。但在临床中多见疼痛与情志心理变化关系密切,故试通过从心论治盆腔炎性疾病所遗留的慢性盆腔痛的理论依据、临床遣方用药特点及病案举例,阐述本病的发生与心关系密切,临证中应注重从心论治,在给予药物治疗的同时,还应加强对患者的情绪管理并给予人文关怀。     

穿刺治疗慢性盆腔疼痛综合征的研究

目的 探讨穿刺治疗慢性盆腔疼痛综合征的临床疗效.方法 临床上对42例慢性盆腔疼痛综合征患者的前列腺液,常规进行细菌培养,以排除其它类型的前列腺炎.根据经验选择一种敏感抗生素,加上地塞米松和利多卡因的混合液行经会阴前列腺注射,隔7天注射一次,4次为一疗程.治疗后1月评价其治疗效果并追踪观察6月.结果 42例慢性盆腔疼痛综合征的患者中,治愈22例(52.38%),有效16例(38.10%),无效4例(9.52%),总有效率达90.48%.其中31例获6月追踪观察,无1例复发.结论 经会阴穿刺注射药物治疗慢性盆腔疼痛综合征是一种有效的、治愈率较高的治疗方法.     

特异性环氧化酶Ⅱ抑制剂治疗慢性盆腔疼痛综合征的临床研究

目的从治疗学的角度探讨慢性盆腔疼痛综合征的可能病因及治疗选择.方法112例门诊诊断为慢性盆腔疼痛综合征的患者根据前列腺液中白细胞数量大于或小于等于10个/高倍视野,分为Ⅲa(炎症性)组和Ⅲb(非炎症性)组;两组患者接受相同的治疗,口服塞来昔布,治疗随访6周;比较两组患者治疗前后慢性前列腺炎症状评分及前列腺液中卵磷脂小体数量的变化.结果每组患者治疗前后及两组患者治疗后的症状评分和前列腺液中卵磷脂小体数量的变化均有统计学意义.结论炎症反应能导致慢性盆腔疼痛综合征;特异性环氧化酶Ⅱ抑制剂对慢性盆腔疼痛综合征有较好的疗效,其对Ⅲa型(炎症性)的疗效优于Ⅲb型(非炎症性).