行为心理疗法配合药物在救灾军人早泄治疗中的应用

目的 针对抗震救灾部队所处的特殊环境,探讨综合心理行为配合药物治疗对早泄(premature ejaculation,PE)患者的治疗效果.方法 通过调查,确诊84例PE患者,随机分为心理行为干预组和对照组,每组42例.两组均给予药物盐酸氟西汀治疗,干预组同时配合综合性心理行为治疗,共4周,治疗前后应用阴道内射精潜伏期、患者及其配偶性交满意度评分、焦虑自评量表(SAS)进行评定,并比较两组治疗效果.结果 两组患者平均阴道内射精潜伏期和患者及其配偶性交满意度评分在治疗后较治疗前均显著增加(P<0.01),治疗后干预组患者平均阴道内射精潜伏期和患者及其配偶性交满意度评分显著高于对照组(P<0.01).而两组患者的SAS评分在治疗后显著低于治疗前,治疗后干预组患者SAS评分显著低于对照组(P<0.01).结论 对经历特殊环境的救灾军人,综合心理行为干预可改善传统药物治疗早泄的疗效.     

疏肝益阳胶囊联合舍曲林治疗早泄临床观察

目的:观察疏肝益阳胶囊联合盐酸舍曲林治疗早泄(PE)的临床疗效。方法:192例早泄患者随机分为盐酸舍曲林联合疏肝益阳胶囊治疗组和单用盐酸舍曲林对照组,对照组口服盐酸舍曲林片,50 mg/次,每晚1次。治疗组在对照组基础上,予疏肝益阳胶囊,4粒/次,3次/日口服。两组均连续治疗6周。评定治疗前、治疗6周后、停药6周后中国早泄患者性功能评价表(CIPE-5)评分及阴道内射精潜伏期(IELT)。结果:治疗组IELT:治疗前为(1.41±0.53)min,治疗6周后为(6.69±3.56)min;CIPE-5评分:治疗前(9.80±2.06)分,治疗6周后为(21.62±4.76)分。对照组IELT:治疗前为(1.43±0.48)min,治疗6周后为(5.37±2.91)min;CIPE-5评分:治疗前(9.41±1.97)分,治疗6周后为(20.85±4.83)分。两组患者各指标治疗6周后较治疗前均显著改善(P均0.05)。对照组停药6周后IELT时间[(1.19±1.34)min]与CIPE-5评分[(10.59±2.38)分]与治疗前相比较均无显著差异(P0.05);治疗组在停药6周后IELT时间[(3.77±1.63)min]、CIPE-5评分[(16.92±3.37)分],与治疗前相比较,差异均有显著性(P均0.05)。结论:疏肝益阳胶囊联合舍曲林治疗早泄疗效确切,效果持久。     

口服帕罗西汀治疗早泄的随机对照研究

目的:验证帕罗西汀对早泄的治疗效果。方法:将符合纳入标准的80例早泄患者随机分为试验组和对照组,每组40例。所有患者进入为期4周的基线水平观察期,记录治疗前的阴道内射精潜伏时间(IELT)和性交满意度分值。试验组每天口服帕罗西汀20 mg,对照组口服安慰剂。治疗30 d后记录每个患者治疗后的IELT值和性交满意度分值。结果:试验组治疗后平均IELT与治疗前比较明显延长(5.75±1.24 min vs 0.89±0.21min,P<0.01),性交满意度与治疗前比较明显提高(6.4±1.2分vs 2.7±0.9分,P<0.01)。对照组治疗后平均IELT和性交满意度与治疗前比较均无显著性差异(1.06±0.28 min vs 0.97±0.18 min,3.6±1.3分vs 3.1±1.1分,P>0.05)。结论:早泄患者每天口服帕罗西汀20 mg,30 d后IELT和性交满意度均有明显改善。     

舍曲林治疗无效的早泄患者应用达泊西汀的疗效观察

目的观察达泊西汀用于舍曲林治疗无效的早泄患者的疗效。方法收集2017年10月至2020年10月应用舍曲林(50mg)治疗早泄的患者,按照治疗早泄的疗效分为舍曲林治疗有效组(有效组)和舍曲林治疗无效组(无效组),洗脱后两组均改用达泊西汀30mg按需口服,观察两组阴道内射精潜伏时间(IELT)、早泄评估量表(PEP)、临床总体印象评分(CGIC)及不良反应发生情况。结果 106例患者中,97例患者完成随访。有效组(56例)与无效组(41例)患者治疗前各项指标无统计学差异(P0.05),治疗后4、12周两组患者IELT、PEP、CGIC均较基线值明显改善,两组疗效相似,无明显的统计学差异(P0.05)。两组不良反应发生率无明显差别。结论口服舍曲林无效的患者改服达泊西汀仍然有较好的效果;达泊西汀治疗早泄的效果与舍曲林是否有效无关。     

盐酸曲马多联合行为疗法治疗早泄的安全性、有效性临床观察

目的:评价盐酸曲马多联合行为疗法治疗早泄的安全性、有效性。方法:按随机原则将72例早泄患者分为治疗组和对照组,治疗组(n=36)性生活前2 h口服盐酸曲马多50 mg联合行为疗法,对照组(n=36)予以单纯行为疗法,两组疗程均为8周,记录治疗前后阴道内射精潜伏期(IELT)、配偶性生活满意度评分、临床总有效率、不良反应和肝、肾功能。结果:两组治疗前后在IELT和改善配偶性交满意度评分方面有显著性差异(P<0.01),两组治疗效果的总有效率,治疗组为72.2%,对照组为47.2%,治疗组较对照组治疗后IELT、改善配偶性交满意度评分和临床总有效率方面有显著性差异(P<0.05),10例(27.8%)患者出现不良反应,治疗组治疗前后肝肾功能无统计学差异(P>0.05)。结论:盐酸曲马多联合行为疗法在延长IELT及改善配偶性交满意度评分、临床总有效率和肝、肾功能方面,其安全性和有效性值得肯定。但盐酸曲马多为阿片类药物,成瘾性还有待评估,是否作为国内治疗早泄的常规治疗药物尚需进行多中心、双盲临床安全性及有效性的进一步研究。     

中西药联合治疗早泄合并轻中度勃起功能障碍的多中心、随机对照临床研究

目的评价盐酸达泊西汀联合枸橼酸西地那非及乌灵胶囊联合运用治疗早泄(PE)合并轻中度勃起功能障碍(ED)的安全性和有效性。方法 140例PE合并轻中度ED患者随机分为对照组和治疗组各70例,对照组给予枸橼酸西地那非与乌灵胶囊治疗,治疗组在对照组基础上加用盐酸达泊西汀进行治疗,疗程4周。以国际勃起功能问卷调查表-5(IIEF-5)、阴道内射精潜伏时间(IELT)、早泄诊断量表(PEDT)分别评价患者的勃起功能障碍和早泄的临床疗效,并应用PHQ-9、GAD-7量表评估患者治疗前后的抑郁、焦虑程度。结果治疗过程中治疗组脱落2例,对照组脱落3例,最终有效病例135例,治疗组68例,对照组67例。治疗组、对照组在治疗后IELT、IIEF-5评分较治疗前均明显增加,差异具统计学意义(P0.05);PEDT、PHQ-9、GAD-7评分较治疗前均明显下降,差异具统计学意义(P0.05);组间相比,治疗组与对照组在治疗IIEF-5评分改善方面无显著差异(P0.05),在IELT、PEDT、PHQ-9、GAD-7评分的改善方面,差异具统计学意义(P0.05);不良反应方面,对照组头痛2例,治疗组背部肌肉酸痛1例,头痛2例,均为轻度,可耐受,自行缓解,未做特殊处理。结论盐酸达泊西汀联合枸橼酸西地那非及乌灵胶囊治疗PE合并轻中度ED,可以安全有效地改善患者勃起功能,并进一步改善患者IELT以及缓解其焦虑抑郁情绪。     

盐酸达泊西汀联合小剂量他达拉非治疗原发性早泄的前瞻性随机对照临床研究

目的:评价盐酸达泊西汀联合小剂量他达拉非治疗原发性早泄(PE)的临床疗效。方法:收集原发性PE患者97例,随机分成对照组(n=46)和治疗组(n=51),对照组性交前按需口服盐酸达泊西汀30mg;治疗组性交前按需口服盐酸达泊西汀片30mg,同时每日服用(OAD)小剂量他达拉非片5mg,疗程12周。嘱患者在治疗期间规律性生活,每月性生活≥4次,治疗前后行中国早泄患者性功能评价表5(CIPE-5)评分及阴道内射精潜伏期(IELT)测评并做好相关记录。结果:与治疗前比较,治疗后两组CIPE-5评分及IELT均明显提高,差异有统计学意义(P0.05)。与对照组比较,治疗后治疗组的CIPE-5评分及IELT改善更为明显,差异有统计学意义(P0.05)。两组患者治疗期间不良事件发生率差异无统计学意义(P0.05),不良事件可自行缓解。结论:盐酸达泊西汀联合小剂量他达拉非治疗原发性PE安全有效。     

西酞普兰治疗早泄的临床观察

目的:探讨西酞普兰治疗早泄的临床疗效和安全性。方法:将2011年5月至2012年5月男科门诊就诊的80例早泄患者随机分为治疗组和对照组,每组40例。治疗组每天口服西酞普兰20 mg,对照组口服安慰剂,记录治疗前、治疗2周和4周后患者阴道内射精潜伏时间(IELT)和性交满意度分值。结果:治疗组治疗2、4周后IELT分别为(5.64±1.31)min和(7.12±1.56)min,均比治疗前[(0.91±0.18)min]明显延长(P均<0.01),且西酞普兰治疗4周后的IELT明显高于2周后(P<0.01);治疗组治疗2、4周后性交满意度分别为(6.1±1.3)分和(6.3±1.1)分,与治疗前[(2.5±0.8)分]相比有明显提高(P<0.01),而治疗2周和4周后性交满意度无显著性差异(P>0.05)。对照组治疗2、4周后IELT和性交满意度分别为(1.02±0.24)min、1.01±0.21 min和(3.0±1.1)分、(3.1±1.3)分,与治疗前[(0.95±0.17)min和(3.2±1.2)分]比较,均无显著性差异(P均>0.05)。结论:每天口服西酞普兰20 mg,对早泄患者IELT和性交满意度均有明显改善,西酞普兰治疗早泄具有较好的临床疗效和安全性。     

早泄诊断和治疗

早泄(premature ejaculation,PE)是临床上最常见的主诉之一,其共同特征为:射精潜伏期缩短、延迟或控制射精的能力下降、并引起患者痛苦/烦恼。目前尚无一致公认的PE定义。不同定义之间争论的焦点是如何设定射精潜伏期(intravaginal ejaculatory latency time,IELT)。新的分类方法将PE分为:原发性、继发性、自然变异性和早泄样射精障碍。不同类型PE发生的病理生理和病因学不同,决定了治疗方案的差异。     

赛乐特治疗早泄的临床研究

目的 :观察抗抑郁剂赛乐特 (盐酸帕罗西汀 )治疗早泄的疗效及副反应。　方法 :每日中午口服赛乐特 2 0mg ,疗程 4周 ;采用《抗抑郁剂治疗早泄疗效评定问卷》并进行修订 ,在治疗前后由病人填写调查问卷和疗效、副作用评价问卷。　结果 :4 3例门诊早泄病人纳入临床研究 ,治疗后病人射精潜伏期、性生活满意度及配偶性生活满意度均有较大改善 ,与治疗前比较 ,差异有极显著性 (P <0 .0 0 1) ;早泄改善起效时间平均为服药后 (11.2 6± 5 .79)d ;32例在停药后平均 (2 0 .94± 8.0 4 )d ,早泄反复到治疗前状态 ;7例病人性欲及性高潮程度升高 ,2例性欲降低 ;少数病人出现便秘、口干、失眠及皮肤瘙痒等不适。　结论 :抗抑郁剂赛乐特对早泄有较好的治疗作用。     

Premature ejaculation in patients with ankylosing spondylitis

We aimed to evaluate the premature ejaculation (PE) among ankylosing spondylitis (AS) patients. Fifty male patients with AS who were diagnosed according to the modified New York criteria and fifty normal healthy controls (NHC) were included in this study. The details of patient age, disease duration, morning stiffness, laboratory activity, disease severity and medication use were obtained by reviewing the medical record. The Bath AS Functional Index (BASFI) was used to measure the functional status of the patients with AS. By taking a careful medical and sexual history, patients were classified as lifelong, natural variable, acquired PE or premature ejaculatory dysfunction. In addition to medical and sexual history, self-estimated intravaginal ejaculatory latency times (IELT) of patients were used in the classification of patients. To our knowledge, this is the first study of frequency of PE in men with AS. The prevalence rates of PE in patient and healthy controls were 32 and 30%, respectively (p = 0.331). The prevalence of PE was not significantly different between AS patients and NHC groups as regards the four PE syndromes. Average estimated IELT was 10,009 ± 51.9 sec in the PE group and 145.26 ± 43.01 sec in the non-PE group (p = 0.000). Patients with lifelong PE had a significantly lower mean estimated IELT than the other group (p = 0.000). Patients with premature-like ejaculatory dysfunction had the highest estimated IELT (p = 0.000). There was a significant association between self-estimated IELT and distribution of the patients according to the four PE syndromes (p = 0.01). Both AS patients and NHC groups have the same results. The present study demonstrates that PE in men with AS is as prevalent as it is in the general population. Although this study is restricted in terms of the number of patients, it is the first study ever conducted. For more meaningful results, multi centred studies with more patients are required.     

持续小剂量伐地那非联合曲唑酮治疗早泄疗效观察

目的 探讨持续小剂量伐地那非联合曲唑酮并配合心理行为治疗早泄的临床疗效.方法 136例早泄患者随机分为实验组(小剂量伐地那非+曲唑酮+行为疗法)和对照组(曲唑酮+行为疗法),记录治疗前后阴道内射精潜伏期(IELT)并进行组内和组间比较,同时记录夫妻对性生活的满意情况.结果 治疗前,实验组和对照组IELT分别为(0.87±0.29)min、(0.93±0.35)min,治疗后分别为(4.62±2.31)min、(2.35±1.25)min,差异有统计学意义(P＜0.01),且实验组IELT较对照组相比差异有统计学意义(P＜0.01).夫妻双方对性生活的情况:实验组满意率(62.3%)和总满意率(满意加基本满意)(89.8%)分别优于对照组满意率(37.3%)和总满意率(67.2%),差异均有统计学意义(P＜0.01).结论 持续小剂量伐地那非联合曲唑酮并配合心理行为治疗早泄在延长IELT,改善夫妻双方性生活满意度方面明显优于盐酸曲唑酮配合心理行为疗法组,持续小剂量给药可以起到增强疗效和降低副作用,两药合用在治疗早泄方面有一定的应用前景.     

西地那非治疗合并勃起功能障碍的早泄病人的临床观察

目的 :评价枸橼酸西地那非对合并勃起功能障碍 (ED)的早泄病人的临床疗效和安全性。　方法 :45例诊断为合并ED早泄病人 ,以西地那非片可调整用药方案治疗 1～ 3个月。以阴道内射精潜伏期及配偶性交满意度来评价早泄治疗效果 ,并评估ED的总体疗效和治疗满意度 ,比较治疗前后的国际勃起功能指数评分 5 (IIEF 5 )。　结果 :早泄改善者共 2 7例 ,有效率为 6 0 %。勃起功能改善者共 40例 ,改善率为 88.88%。 2 7例早泄有效者均为 5 0mg西地那非改善了勃起功能的病人 ,且满意率为81.48%;18例早泄无效者中ED治疗满意率仅为 5 .5 6 %。在早泄有效者和无效者间比较其治疗前、后IIEF 5评分及增加值 ,差异均有显著性 (P <0 .0 0 1)。不良反应共 9例(2 0 %) ,均为轻度或中度 ,未经特殊处理即自行缓解。　结论 :对合并ED的早泄病人 ,枸橼酸西地那非片能安全有效地改善其勃起功能 ,如获得满意疗效多能使病人早泄得到改善。     

Premature ejaculation: results from a five-country European observational study

OBJECTIVES: To characterize premature ejaculation (PE) in five European countries using intravaginal ejaculatory latency time (IELT) and the Premature Ejaculation Profile (PEP). METHODS: This 8-wk, multicenter, observational study enrolled men >or=18 yr of age and their female partners. Clinicians diagnosed PE using the DSM-IV-TR criteria and at least moderate, subject-reported, ejaculation-related personal distress or interpersonal difficulty. The PEP was administered at baseline and weeks 4 and 8. Partners measured IELT; the average stopwatch-measured IELT for each 4-wk period was calculated and compared with the man's screening-estimated IELT. Relationships between individual PEP measures and IELT were assessed with path analysis. RESULTS: PE was diagnosed in 201 of 1115 men. Findings were similar to those in a similarly conducted US study. Mean IELT was lower in the PE versus the non-PE group (3.3 vs. 10.0min, respectively), but substantial overlap was observed. Men with PE and their partners reported significantly worse control over ejaculation, ejaculation-related personal distress, satisfaction with sexual intercourse, and ejaculation-related interpersonal difficulty than men without PE and their partners. Path analysis showed that perceived control over ejaculation had a significant effect on ejaculation-related personal distress and satisfaction with sexual intercourse; IELT had an effect on control over ejaculation, no direct effect on satisfaction with sexual intercourse, and a small direct effect on ejaculation-related personal distress. CONCLUSIONS: No major cultural differences existed between EU and US men with and without PE and their female partners. These results emphasize the importance of the PEP measures, especially perceived control over ejaculation, in characterizing PE.     

口服万艾可结合行为疗法治疗早泄

目的 :探讨万艾可 (枸橼酸西地那非 )结合行为疗法治疗早泄 (PE)的临床效果。　方法 :6 0例PE患者随机均分为单纯行为疗法组和万艾可 +行为疗法组 ,记录患者治疗前后阴道内射精潜伏期并进行组内和组间比较 ,同时记录夫妻对性生活的满意程度。　结果 :治疗前 ,单纯行为疗法组和万艾可 +行为疗法组阴道内射精潜伏期分别为(0 .80± 0 .2 0 )、(0 .73± 0 .2 4 )min ,治疗后分别为 (1.82± 0 .5 4 )、(3.6 3± 0 .5 5 )min ,差异有显著性 (P <0 .0 1)。在夫妻对性生活满意度方面 ,万艾可 +行为疗法组优于单纯行为疗法组。　结论 :万艾可结合行为疗法可延长射精潜伏期 ,提示万艾可在治疗PE方面也有一定的应用前景。     

Impact of physical activity on patient self‐reported outcomes of lifelong premature ejaculation patients: Results of a prospective,randomised, sham‐controlled trial

Previous studies have investigated whether physical activity increases serotonin hormone levels. Serotonin receptor dysfunction is one of the frequently accused factors of premature ejaculation (PE). Nevertheless, no studies up to date have demonstrated that the association between physical activity and premature ejaculation. We aimed to investigate the relationship between physical activity and PE and determine whether moderate physical activity might delay ejaculation time or be an alternative treatment for PE. A total of 105 patients diagnosed with PE were enrolled in this study. Of the patients, 35 were treated with dapoxetine, (30 mg) on demand (Group 1), 35 performed moderate physical activities (Group 2), and 35 performed minimal physical activity (Group 3‐sham). Demographic characteristics, metabolic equivalents (MET), premature ejaculation diagnostic tool (PEDT) and intravaginal ejaculatory latency time (IELT) were recorded. There were no significant differences among three groups in terms of age, BMI, MET, PEDT or IELT before treatment. At the end of the study, there was significant decrease in PEDT scores, and increase in IELT in groups 1 and 2 as compared to Group 3. In conclusion, a moderate physical activity longer than 30 min at least 5 times a week leads to ejaculation delay, and appears as an alternative to dapoxetine on demand for the treatment of PE.     

Does lidocaine ointment addition increase fluoxetine efficacy in the same group of patients with premature ejaculation?

PURPOSE: To evaluate the efficacy of fluoxetine alone and fluoxetine+lidocaine ointment in the same patient group with premature ejaculation (PE). MATERIAL AND METHODS: 78 patients with PE were given 20 mg fluoxetine by an 'as-needed treatment' 4 h before planned sexual activity for a period of 3 months. They were then told to add local lidocaine ointment to fluoxetine 30 min before sexual activity for an additional 3 months for most of their sexual attempts. They were asked to note their PE grades and intravaginal ejaculatory latency time (IELT) scores by stopwatch technique before and after each treatment modality; the results were compared statistically afterwards. RESULTS: Of 46 patients who completed the study, the mean pretreatment, fluoxetine alone and fluoxetine+lidocaine ointment treatment PE grades and IELT scores were found to be 6.52+/-1.42 and 2.58+/-0.49, 3.21+/-1.86 and 1.28+/-0.71, 2.17+/-1.56 and 1.04+/-0.72, respectively, showing a decrease in PE grades and IELT scores in combined therapy. On an individual patient basis, the total significant and moderate improvement rate of combined therapy was found to be 86.9%. Failure was observed in 6 (13.1%) patients. CONCLUSION: The effective treatment with fluoxetine+lidocaine ointment offers the advantage of an 'as-needed treatment' in PE with minimal side effects and can be used as one of the first-line alternatives in the treatment of PE.     

选择性显微阴茎背神经切断术治疗原发性早泄的临床观察

目的:评价显微镜下选择性阴茎背神经切断术治疗原发性早泄(PPE)的效果。方法:2010年9月至2012年10月,选择原发性早泄78例,行显微镜下选择性阴茎背神经切断术,切除分支5支9例,6支17例,7支15例,8支14例,9支8例,10支6例,11支6例,12支3例。术后随访12月。记录治疗前、治疗后患者阴道内射精潜伏时间(IELT)和性交满意度分值。结果:治疗前后IELT分别为(0.86±0.32)min和(6.65±3.9)min,有显著性差异(P<0.01)。治疗前后患者性交满意度分值分别为(7.32±2.52)分和(12.32±3.76)分,有显著性差异(P<0.01)。治疗前后配偶性交满意度分值分别为(4.46±1.36)分和(12.73±1.45)分,有显著性差异(P<0.01)。结论:显微镜下选择性阴茎背神经切断术治疗原发性早泄安全、有效。