托特罗定和索利那新改善输尿管支架管导致的下尿路症状效果比较
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摘要
目的比较分析托特罗定和索利那新在改善输尿管支架管(双J管)导致的下尿路症状中的效果,以期为临床治疗提供循证依据。方法选取2015年1月-2016年12月成都市某医院收治的96例输尿管镜碎石取石术后留置双J管患者为研究对象。采用随机数字表法将患者分为对照组、托特罗定组和索利那新组,每组32例。对照组患者给予左氧氟沙星片(0.5g/次,1次/d)口服治疗,托特罗定组患者在对照组治疗基础上加用酒石酸托特罗定片(4mg/次,1次/d)治疗,索利那新组患者在对照组治疗基础上加用琥珀酸索利那新(5 mg/次,1次/d)治疗。治疗4周时,采用输尿管支架症状问卷评分表(USSQ)和世界卫生组织生存质量简表(WHOQOLBREF)分别评估2组患者的下尿路症状及生活质量,同时观察用药过程中发生的不良反应。结果关于USSQ中尿频、尿急、尿失禁、腰痛、腹痛和尿道痛的评分,对照组分别为(3.15±1.82)分、(3.52±1.37)分、(0.68±0.25)分、(2.38±1.58)分、(2.63±1.47)分、(1.45±1.36)分;托特罗定组分别为(2.08±1.89)分、(1.26±1.31)分、(0.16±0.19)分、(0.87±1.43)分、(0.59±1.38)分、(0.96±1.38)分;索利那新组分别为(2.14±1.87)分、(1.35±1.25)分、(0.18±0.21)分、(0.98±1.68)分、(0.67±1.27)分、(0.94±1.31)分。托特罗定组、索利那新组患者USSQ中尿频、尿急、尿失禁、腰痛、腹痛和尿道痛评分均低于对照组,差异均有统计学意义(P<0.05),而托特罗定组、索利那新组患者以上相关评分比较,差异无统计学意义(P>0.05)。关于WHOQOL-BREF中生理领域、心理维度领域评分,对照组分别为(14.91±2.65)分、(14.85±2.45)分;托特罗定组分别为(16.47±2.58)分、(16.78±2.98)分;索利那新组分别为(16.24±2.47)分、(16.98±2.34)分。托特罗定组、索利那新组患者WHOQOL-BREF中生理领域、心理领域维度评分均高于对照组,差异均有统计学意义(P<0.05),而托特罗定组、索利那新组患者以上相关评分比较,差异无统计学意义(P>0.05)。结论托特罗定、索利那新分别联合左氧氟沙星在改善由双J管导致的尿频、尿急、尿失禁、腰痛、腹痛、尿道痛等临床症状中的效果优于单用左氧氟沙星,极大地提高了患者的生活质量,而二者的临床效果相当,临床应用时可根据实际情况灵活选用。
Objective To compare the efficacy of tolterodine versus solifenacin in relieving lower urinary tract symptoms(LUTS)caused by ureteral stents(double J tube),so as to provide evidence for clinical management.Methods Ninety-six patients with indwelling double J tube after ureteroscopic lithotripsy who were treated at a Chengdu hospital between January 2015 and December 2016 were included in this study.Based on a random number table,these patients were divided into the control group,tolterodine group,and solifenacin group,32 patients in each group.All Patients received oral levofolxacin(0.5 g,once daily),those in the tolterodine group also received tolterodine tartrate(4 mg,once daily),and those in the solifenacin group were treated with solifenacin succinate(5 mg,once daily)in addition to levofolxacin.At 4 weeks,the Ureteral Stent Symptom Questionnaire(USSQ)and WHO Quality of Life-Brief Scale(WHOQOL-BREF)were used to assess the LUTS and QOL,respectively.Meanwhile,adverse events were monitored during the study.Results The urinary frequency,urgency,incontinence,lumbago,abdominal pain,and urethralgia scores in USSQ were 3.15±1.82,3.52±1.37,0.68±0.25,2.38±1.58,2.63±1.47,and 1.45±1.36 in the control group,respectively;2.08±1.89,1.26±1.31,0.16±0.19,0.87±1.43,0.59±1.38,and 0.96±1.38 in the tolterodine group,respectively;and 2.14±1.87,1.35±1.25,0.18±0.21,0.98±1.68,0.67±1.27,and 0.94±1.31 in the solifenacin group,respectively.All of these scores were significantly lower in both the tolterodine group and the solifenacin group as compared with the control group(all P<0.05);but these scores were comparable between the tolterodine group and the solifenacin group(P>0.05).The scores of the physical and psychological domains in WHOQOL-BREF were14.91±2.65 and 14.85±2.45 in the control group,respectively;16.47±2.58 and 16.78±2.98 in the tolterodine group,respectively;and 16.24±2.47 and 16.98±2.34 in the solifenacin group,respectively.Both scores were significantly higher in the tolterodine group and the solifenacin group as compared with the control group(both P<0.05),but similar between the tolterodine group and the solifenacin group(P>0.05).Conclusion Compared with levofolxacin alone,tolterodine or solifenacin combined with levofolxacin seems to be more effective in relieving LUTS caused by double J tube,such as urinary frequency,urgency,incontinence,lumbago,abdominal pain,and urethralgia,which may substantially improve the quality of life of these patients.When added to levofolxacin,tolterodine and solifenacin have comparable efficacy,both of which may be selected according to the specific clinical conditions.
Objective To compare the efficacy of tolterodine versus solifenacin in relieving lower urinary tract symptoms(LUTS)caused by ureteral stents(double J tube),so as to provide evidence for clinical management.Methods Ninety-six patients with indwelling double J tube after ureteroscopic lithotripsy who were treated at a Chengdu hospital between January 2015 and December 2016 were included in this study.Based on a random number table,these patients were divided into the control group,tolterodine group,and solifenacin group,32 patients in each group.All Patients received oral levofolxacin(0.5 g,once daily),those in the tolterodine group also received tolterodine tartrate(4 mg,once daily),and those in the solifenacin group were treated with solifenacin succinate(5 mg,once daily)in addition to levofolxacin.At 4 weeks,the Ureteral Stent Symptom Questionnaire(USSQ)and WHO Quality of Life-Brief Scale(WHOQOL-BREF)were used to assess the LUTS and QOL,respectively.Meanwhile,adverse events were monitored during the study.Results The urinary frequency,urgency,incontinence,lumbago,abdominal pain,and urethralgia scores in USSQ were 3.15±1.82,3.52±1.37,0.68±0.25,2.38±1.58,2.63±1.47,and 1.45±1.36 in the control group,respectively;2.08±1.89,1.26±1.31,0.16±0.19,0.87±1.43,0.59±1.38,and 0.96±1.38 in the tolterodine group,respectively;and 2.14±1.87,1.35±1.25,0.18±0.21,0.98±1.68,0.67±1.27,and 0.94±1.31 in the solifenacin group,respectively.All of these scores were significantly lower in both the tolterodine group and the solifenacin group as compared with the control group(all P<0.05);but these scores were comparable between the tolterodine group and the solifenacin group(P>0.05).The scores of the physical and psychological domains in WHOQOL-BREF were14.91±2.65 and 14.85±2.45 in the control group,respectively;16.47±2.58 and 16.78±2.98 in the tolterodine group,respectively;and 16.24±2.47 and 16.98±2.34 in the solifenacin group,respectively.Both scores were significantly higher in the tolterodine group and the solifenacin group as compared with the control group(both P<0.05),but similar between the tolterodine group and the solifenacin group(P>0.05).Conclusion Compared with levofolxacin alone,tolterodine or solifenacin combined with levofolxacin seems to be more effective in relieving LUTS caused by double J tube,such as urinary frequency,urgency,incontinence,lumbago,abdominal pain,and urethralgia,which may substantially improve the quality of life of these patients.When added to levofolxacin,tolterodine and solifenacin have comparable efficacy,both of which may be selected according to the specific clinical conditions.
引文
[1]周练兴,张雄伟,陈强文,等.托特罗定干预输尿管双J管留置术后膀胱过度活动症疗效分析[J].海南医学,2015,26(19):2916-2918.DOI:10.3969/j.issn.1003-6350.2015.19.1061.
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[8]王涛,潘铁军,杨家荣,等.酒石酸托特罗定缓释片改善留置双J管患者相关的临床症状及生活质量的疗效观察[J].临床泌尿外科杂志,2011,26(2):106-107.DOI:S10.3969/j.issn.1001-1420.2011.02.011.
[9]张家模,张翾,刘家骥,等.索利那新对输尿管支架置入患者相关症状及生活质量的影响[J].临床泌尿外科杂志,2015,30(4):362-364.
[10]张涛,耿和,吴宗林,等.托特罗定对于改善留置输尿管支架管引起的下尿路症状的作用[J].现代泌尿外科杂志,2015,20(3):181-184.DOI:10.3969/j.issn.1009-8291.2015-03-014.
[11]徐遵礼,窦维龙,马丽英,等.双J管在妊娠合并输尿管结石患者中的应用[J].国际生殖健康/计划生育杂志,2015,34(2):126-128.
[12]李国来,杨立新,唐桂良,等.置双J管行ESWL治疗较大肾结石疗效分析[J].浙江创伤外科,2014,4:562-563.DOI:10.3969/j.issn.1009-7147.2014.04.027.
[13]王太华,孟召余,陈建军.双J管置入在输尿管梗阻中的临床疗效观察[J].中外医学研究,2014(4):113-114.
[14]呙林杰,李成龙,汪涛,等.琥珀酸索利那新片治疗和预防双J管患者下尿路症状[J].长江大学学报(自科版),2013(21):12-13.
[15]GUPTA M,PATEL T,XAVIER K,et al.Prospective randomized evaluation of periureteral botulinum toxin type A injection for ureteral stent pain reduction[J].Journal of Urology,2010,183(2):598-602.DOI:10.1016/j.juro.2009.10.021.
[16]DELLIS AF,KEELEY FX,MANOLAS VI,et al.Role ofα-blockers in the treatment of stent-related symptoms:a prospective randomized control study[J].Urology,2014,83(1):56-61.DOI:10.1016/j.urology.2013.08.067.
[17]朱剑勇,童炎岳,雷樟明,等.酒石酸托特罗定治疗输尿管结石术后留置双J管患者下尿路症状效果评价[J].中国现代医生,2013,51(27):67-69.
[18]王毓斌,邵晋凯,吕永安,等.索利那新联合坦索罗辛治疗男性下尿路症状伴膀胱过度活动症疗效观察[J].临床医学工程,2010,17(10):38-40.DOI:10.3969/j.issn.1674-4659.2010.10.038.
[2]张明芳,蒋晏英,戴红春,等.宫颈癌放疗前预置双J管防治肾积水的临床研究[J].江西医药,2014,19(11):362-364.DOI:10.3969/j.issn.1006-2238.2014.11.013.
[3]夏朝晖.输尿管镜钬激光碎石术后留置双J管并发症危险因素分析[J].医学综述,2014,20(24):4568-4569.DOI:10.3969/j.issn.1006-2084.2014.24.062.
[4]王晓庆,陈岐辉,侯宇川,等.纳米梯度可降解输尿管支架的制备及生物相容性[J].中华实验外科杂志,2012,29(5):864.DOI:10.3760/cma.j.issn.1001-9030.2012.05.030.
[5] CEVIK I,DILLIOGLUGIL O,AKDAS A,et al.Is stent place-ment necessary after uncomplicated ureteroscopy for removal of impacted ureteral stones[J].J Endourol,2010,24(8):1263-1267.DOI:10.1089/end.2009.0153.
[6]邱智,孙玉成,朱丽珍,等.输尿管留置双J管患者生活质量的初步调查[J].中华泌尿外科杂志,2010,31(12):828-830.DOI:10.3760/cma.j.issn.1000-6702.2010.12.013.
[7] BEDDINGFIELD R,PEDRO RN,HINCK B,et al.Alfuzosin to relieve ure-teral stent discomfort:a prospective,randomized,placebo con-trolled study[J].J Urol,2009,181(1):170-176.DOI:10.1016/j.juro.2008.09.026.
[8]王涛,潘铁军,杨家荣,等.酒石酸托特罗定缓释片改善留置双J管患者相关的临床症状及生活质量的疗效观察[J].临床泌尿外科杂志,2011,26(2):106-107.DOI:S10.3969/j.issn.1001-1420.2011.02.011.
[9]张家模,张翾,刘家骥,等.索利那新对输尿管支架置入患者相关症状及生活质量的影响[J].临床泌尿外科杂志,2015,30(4):362-364.
[10]张涛,耿和,吴宗林,等.托特罗定对于改善留置输尿管支架管引起的下尿路症状的作用[J].现代泌尿外科杂志,2015,20(3):181-184.DOI:10.3969/j.issn.1009-8291.2015-03-014.
[11]徐遵礼,窦维龙,马丽英,等.双J管在妊娠合并输尿管结石患者中的应用[J].国际生殖健康/计划生育杂志,2015,34(2):126-128.
[12]李国来,杨立新,唐桂良,等.置双J管行ESWL治疗较大肾结石疗效分析[J].浙江创伤外科,2014,4:562-563.DOI:10.3969/j.issn.1009-7147.2014.04.027.
[13]王太华,孟召余,陈建军.双J管置入在输尿管梗阻中的临床疗效观察[J].中外医学研究,2014(4):113-114.
[14]呙林杰,李成龙,汪涛,等.琥珀酸索利那新片治疗和预防双J管患者下尿路症状[J].长江大学学报(自科版),2013(21):12-13.
[15]GUPTA M,PATEL T,XAVIER K,et al.Prospective randomized evaluation of periureteral botulinum toxin type A injection for ureteral stent pain reduction[J].Journal of Urology,2010,183(2):598-602.DOI:10.1016/j.juro.2009.10.021.
[16]DELLIS AF,KEELEY FX,MANOLAS VI,et al.Role ofα-blockers in the treatment of stent-related symptoms:a prospective randomized control study[J].Urology,2014,83(1):56-61.DOI:10.1016/j.urology.2013.08.067.
[17]朱剑勇,童炎岳,雷樟明,等.酒石酸托特罗定治疗输尿管结石术后留置双J管患者下尿路症状效果评价[J].中国现代医生,2013,51(27):67-69.
[18]王毓斌,邵晋凯,吕永安,等.索利那新联合坦索罗辛治疗男性下尿路症状伴膀胱过度活动症疗效观察[J].临床医学工程,2010,17(10):38-40.DOI:10.3969/j.issn.1674-4659.2010.10.038.