间苯三酚联合非甾体抗炎药治疗肾绞痛的荟萃分析
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摘要
目的系统评价间苯三酚联合非甾体抗炎药(NSAIDs)治疗肾绞痛的临床价值。方法电子检索中英文数据库中关于间苯三酚联合NSAIDs对比山莨菪碱联合NSAIDs治疗肾绞痛的随机或半随机对照研究,采用Rev Man 5.2软件对数据进行分析。结果共纳入6篇研究,共1437名患者,其中间苯三酚组765例,山莨菪碱组672例。Meta分析结果显示:2组在治疗肾绞痛30 min疼痛缓解率上差异无统计学意义(P=0.07),但结果稳健性欠佳。间苯三酚联合NSAIDs比山莨菪碱联合NSAIDs治疗肾绞痛的疼痛缓解速度更快(P=0.0002),总不良反应发生率更低(P=0.0003),其中口干、皮肤潮红、排尿困难、尿潴留等常见不良反应发生率也明显更低(P<0.05)。结论与山莨菪碱联合NSAIDs相比,间苯三酚联合NSAIDs治疗肾绞痛的起效速度更快,不良反应更少。该结论仍需更多高质量大样本的随机对照研究予以论证。
Objective To evaluate the efficacy and safety of phloroglucinol combined with NSAIDs in the treatment of renal colic by meta-analysis. Methods According to the cochrane review, randomized controlled trials(RCTs) and semi-randomized controlled trials of phloroglucinol combined with NSAIDs vs anisodamine combined with NSAIDs in the treatment of renal colic were acquired by a comprehensive search in both Chinese and English databases. Rev Man 5.2 software was used for data analysis. Results Six pieces of literatures and 1437 patients were identified. The meta-analysis showed: Patients in the phloroglucinol group compared with anisodamine group had similar pain relief rate(at 30 min)(P = 0.07). However, the robustness of the meta-analysis result of pain relief rate(at 30 min) was poor. The pain relief time of patients in the phloroglucinol group was shorter than that of patients in the anisodamine group(P = 0.0002). The total adverse reaction incidence of patients in phloroglucinol group was lower than that of patients in anisodamine group(P = 0.0003), and dry mouth, erubescence, dysuria and uroschesis of patients in the phloroglucinol group were scarce(P < 0.05). Conclusion Compared with the anisodamine group, phloroglucinol combined with NSAIDs can be a safer and faster medication in relieving renal colic. More RCTs with high quality and large sample are needed for further verification.
Objective To evaluate the efficacy and safety of phloroglucinol combined with NSAIDs in the treatment of renal colic by meta-analysis. Methods According to the cochrane review, randomized controlled trials(RCTs) and semi-randomized controlled trials of phloroglucinol combined with NSAIDs vs anisodamine combined with NSAIDs in the treatment of renal colic were acquired by a comprehensive search in both Chinese and English databases. Rev Man 5.2 software was used for data analysis. Results Six pieces of literatures and 1437 patients were identified. The meta-analysis showed: Patients in the phloroglucinol group compared with anisodamine group had similar pain relief rate(at 30 min)(P = 0.07). However, the robustness of the meta-analysis result of pain relief rate(at 30 min) was poor. The pain relief time of patients in the phloroglucinol group was shorter than that of patients in the anisodamine group(P = 0.0002). The total adverse reaction incidence of patients in phloroglucinol group was lower than that of patients in anisodamine group(P = 0.0003), and dry mouth, erubescence, dysuria and uroschesis of patients in the phloroglucinol group were scarce(P < 0.05). Conclusion Compared with the anisodamine group, phloroglucinol combined with NSAIDs can be a safer and faster medication in relieving renal colic. More RCTs with high quality and large sample are needed for further verification.
引文
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[20]曾衍亮,徐婉媚.间苯三酚,山莨宕碱和哌替啶治疗肾绞痛的临床观察[J].岭南急诊医学杂志,2011,16(6):466-467.
[21]陈冠群,朱丽鹏,瞿幼雅.间苯三酚治疗结石性肾绞痛的疗效观察及护理[J].海峡药学,2013,25(6):217-218.
[22]李健和,易利丹,彭六保,等.间苯三酚的药理作用与临床应用[J].中国新药与临床杂志,2011,30(7):494-499.
[23]彭辉强,陈曼佳,陈小华,等.氯诺昔康联合间苯三酚治疗肾绞痛疗效观察[J].广东医学,2010,31(8):1042-1044.
[2]Afshar K,Jafari S,Marks AJ,et al.Nonsteroidal antiinflammatory drugs(NSAIDs)and non-opioids for acute renal colic[J].The Cochrane Library,2015,29(6):CD006027.
[3]Kanda Swamy GV,Dhanasekaran AK,Elangovan A,et al.Randomized double blinded placebo controlled trial comparing diclofenac and piroxicam in management of acute renal colic and its clinical implications[J].Urol J,2015,12(2):2069-2073.
[4]Boubaker H,Boukef R,Claessens YE,et al.Phloroglucinol as an adjuvant analgesic to treat renal colic[J].Am J Emerg Med,2010,28(6):720-723.
[5]章传华,刘双林,陈志强,等.间苯三酚治疗肾绞痛的多中心随机对照临床研究[J].中华泌尿外科杂志,2015,36(4):257-260.
[6]王发祥,王忠祥,刘军.间苯三酚联合双氯芬酸钠治疗急性肾绞痛的疗效[J].江苏医药,2015,41(4):418-419.
[7]高永祺,陈勇坚,王福权,等.山莨菪碱,间苯三酚分别联合双氯芬酸钠利多卡因,异丙嗪治疗肾绞痛的效果比较[J].中国医药指南,2013,11(7):410-411.
[8]欧永健.间苯三酚联合吲哚美辛栓治疗肾绞痛的疗效观察[J].中国医药指南,2013,11(33):346-347.
[9]李春芳,夏剑,王秋娣,等.山莨菪碱,间苯三酚单独和联合双氯酚酸钠治疗肾绞痛镇痛效果比较[J].临床急诊杂志,2011,12(3):149-150.
[10]张方毅,张奕荣,练鑫,等.间苯三酚联合吲哚美辛治疗肾绞痛临床观察[J].中国初级卫生保健,2011,25(7):128-129.
[11]Furlan AD,Pennick V,Bombardier C,et al.2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group[J].Spine,2009,34(18):1929-1941.
[12]Leong M,Mackie S.The management of renal colic[J].J R Nav Med Serv,2014,100(2):179-185.
[13]Bultitude M,Rees J.Management of renal colic[J].BMJ,2012,345(5499):129.
[14]Manjunath A,Skinner R,Probert J.Assessment and management of renal colic[J].BMJ,2013,346:f985.
[15]Fu W,Yao J,Li Q,et al.Efficacy and safety of parecoxib/phloroglucinol combination therapy versus parecoxib monotherapy for acute renal colic:a randomized,double-blind clinical trial[J].Cell Biochem Biophys,2014,69(1):157-161.
[16]曾斌,刘修恒,陈志远.间苯三酚治疗肾绞痛30例[J].医药导报,2006,25(6):542-543.
[17]刘小燕.间苯三酚联合吲哚美辛栓治疗肾绞痛31例[J].浙江实用医学,2008,13(3):179-180.
[18]胡勇朝.间苯三酚注射液治疗肾绞痛,胆石症疼痛疗效观察[J].当代医学,2010,16(16):132-133.
[19]孙琼,顾铭忠,冯平.间苯三酚治疗肾绞痛50例临床观察[J].中国医学工程,2011,19(2):70-71.
[20]曾衍亮,徐婉媚.间苯三酚,山莨宕碱和哌替啶治疗肾绞痛的临床观察[J].岭南急诊医学杂志,2011,16(6):466-467.
[21]陈冠群,朱丽鹏,瞿幼雅.间苯三酚治疗结石性肾绞痛的疗效观察及护理[J].海峡药学,2013,25(6):217-218.
[22]李健和,易利丹,彭六保,等.间苯三酚的药理作用与临床应用[J].中国新药与临床杂志,2011,30(7):494-499.
[23]彭辉强,陈曼佳,陈小华,等.氯诺昔康联合间苯三酚治疗肾绞痛疗效观察[J].广东医学,2010,31(8):1042-1044.