心痛定,度冷丁治疗肾绞痛疗效的对比观察：（380例报告）

本文报告用心痛定、度冷丁随机分组治疗肾绞痛共380例的疗效对比观察结果。心痛定组的总有效率为83.2%,与度冷丁组(88.4%)相前,无显著性差异(P>0.05),但度冷丁的药物副作用(嗜睡、头晕、口干等)则明显高于心痛定组(P<0.01),且有成瘾之虞。作者认为,用心痛定治疗肾绞痛简便、安全、价廉、副作用少,无成瘾性。心痛定不失为治疗肾绞痛的一种较理想的药物。     

度冷丁、山莨菪碱联合双氯酚酸钠栓治疗顽固性肾绞痛的疗效观察

目的 探讨度冷丁、山莨菪碱联合双氯酚酸钠栓治疗顽固性肾绞痛的效果.方法 87例顽固性肾绞痛患者随机分为2组,对照组45例使用传统方法治疗,即常规静脉点滴中加入654-2 10 mg、度冷丁50 nag或75 mg肌肉注射;治疗组42例在使用上述药物30～40 min后疼痛仍然剧烈者再加双氯酚酸钠栓50 mg或100 mg肛门塞入.结果 对照组度冷丁和654-2应用30 min内无一例疼痛完全消失或仅有轻微胀痛者,30 min后显效者占22.5%,有效者占26.5%,无效者占51%.治疗组给予双氯酚酸钠栓肛门塞人后30 min内显效者占88.1%,有效者占11.9%.两组有效率比较,差异有统计学意义(P＜0.01).结论 度冷丁、山莨菪碱联合双氯酚酸钠栓应用治疗顽固性肾绞痛的效果良好.     

电针治疗肾绞痛43例疗效观察

我们近年来采用电针治疗肾绞痛43例，并设立度冷丁组进行对比观察，现报告如下：     

几种肾绞痛治疗方法的比较

几种肾绞痛治疗方法的比较湖北医科大学附属第一医院泌尿外科（４３００６０）刘修恒，詹炳炎，刘运初肾绞痛发病急、疼痛剧烈、发病率高，需尽快处理。目前临床上治疗肾绞痛方法较多，各有优劣，为此我们对几种常用的方法进行观察比较，以探讨一种镇痛效果好、起效快、毒...     

硫酸镁静滴治疗肾绞痛疗效分析

目的 探讨肾绞痛的治疗方法及其疗效.方法 2000年8月至2005年8月收治肾绞痛患者220例,随机分为常规组:108例,应用杜冷丁50mg和阿托品0.5mg肌注治疗;硫酸镁组:112例,用25%硫酸镁10ml+10%葡萄糖100ml缓慢静推,用时20min,再用25%硫酸镁20ml+10%葡萄糖500ml持续静点,速度控制在30-40 gtt/min.单盲对照观察疗效.结果 硫酸镁组治疗肾绞痛缓解时间为17±7 min,治愈时间为25±9 min,无效3例,再发作2例;常规组分别为28 4-10 min、42±12 min、18例、28例.结论 硫酸镁治疗肾绞痛临床效果满意,值得推广.     

硝苯地平治疗肾及输尿管绞痛的疗效比较

目的：比较硝苯地平与常用解痉镇痛药缓解肾、输尿管绞痛的疗效及副作用，方法：顺序随机分组观察比较硝苯地平，阿托品、维生素K3和．阿托品加度冷丁缓解肾、输尿管经绞痛的疗效及副作用。结果硝苯地平组的显效率和总有效率与托品加度冷丁组无显著性差异，但均显著高于阿托品组和维生素K3组（P＜0．05，P＜0．01），所有病例均未见严重副作用，硝苯地平组出现嗜睡、头晕、口干等症状均低于其他组，结论：硝 地平确有较强的解除肾、输尿管绞痛的作用，且见效快，安全，副作用少。     

急性肾绞痛458例不同止痛方法疗效分析

目的:通过对急性肾绞痛458例治疗的回顾性分析,对常用的几种缓解疼痛的方法进行比较,探寻治疗重度肾绞痛的最佳方案.方法:确诊重度肾绞痛458例资料(口诉评分法判定疼痛的严重程度),针对我院常用的3种止痛方法:(1)弱阿片类药(曲马多)+M受体阻滞剂(654-2);(2)非甾体类抗炎药(蒙洛英)+M受体阻滞剂(654-2);(3)强阿片类药物(度冷丁),评价给药40 min内疼痛缓解的效果并进行分析.结果:弱阿片类显效率为58%(完全缓解),非甾体类抗炎药显效率为81%,强阿片类显效率为88%,后两者的疗效明显优于前者(χ2=27.22和χ2=16.94,均P＜0.005);强阿片类组与NSAIDs+M受体阻滞剂组无差异.结论:NSAIDs+M受体阻滞剂可代替强阿片类药物治疗重度肾绞痛.     

定痉灵和间苯三酚治疗急性肾绞痛临床研究

目的:观察定痉灵和间苯三酚治疗急性肾绞痛的临床疗效.方法:将2009年1月至2010年12月收治的急性肾绞痛68例随机分为对照组和观察组各34例.其中对照组应用间苯三酚治疗,观察组应用定痉灵治疗,比较两组的临床疗效和不良反应.结果:对照组和观察组肾绞痛缓解的总有效率分别为88%(30/34)和91%(31/34),疗效和不良反应均无明显差异(P>0.05).结论:定痉灵和间苯三酚治疗急性肾绞痛均有较好的临床疗效,且副作用少.     

针刺和杜冷丁对输尿管结石绞痛镇痛和排石作用121例临床分析

目的观察电针与药物对输尿管结石绞痛的镇痛作用和排石效果。方法121例输尿管结石绞痛患者随机分成电针组和药物组（用杜冷丁、解痉药治疗）。结果电针疗法能促进排石和缓解绞痛的作用。两组对绞痛缓解时间和镇痛持续时间作用相似，电针组治疗后绞痛缓解时间和镇痛作用的持续时间分别为（16．33±6．37）min、（4．60±1．42）h，药物组分别为（15．44±6．01）min、（4．54±1．40）h。两组比较，差异无显著性意义（P〉O．05）。电针组2周内排石率为60．32％，药物组（43．10％），电针组排石率高于药物组，两组比较，差异无显著性意义（P〈0．05）。结论电针疗法有明显的排石和镇痛作用。     

Comparison of Hydromorphone and Meperidine for Ureteral Colic

Objective: To compare the efficacies of meperidine and hydromorphone in the treatment for ureteral colic in the emergency department (ED).
Methods: A prospective, double-blind, randomized clinical trial was conducted over six months at a tertiary referral center with 93,000 annual ED visits. Seventy-three patients completed the study. The patients received either 1 mg of hydromorphone or 50 mg of meperidine IV at t = 0. Pain intensity was determined using a 10-cm visual analog scale at t = 0, 15, 30, 60, and 120 minutes. A second dose of the study drug could be given between t = 15 and t = 120 minutes when the clinician believed the initial dose was ineffective. Patients requiring more than one additional dose of analgesia were treated as nonresponders and were removed from the study.
Results: Thirty-six patients received hydromorphone and 37 received meperidine. The initial pain intensities (hydromorphone group = 8.4 ± 1.5; meperidine group = 8.5 ± 2.1), age distributions, sex distributions, and side effects of the two groups were comparable. Pain relief was better (p < 0.05) with hydromorphone at t = 15, 30, 60, and 120 minutes. The hydromorphone group required rescue analgesia less often (31% vs 68%, p < 0.01), had fewer IV pyelographies (IVPs) (28% vs 54%, p < 0.05), and had a lower proportion of hospital admissions (25% vs 49%, p = 0.08).
Conclusions: For the fixed doses used in this study, the adult ureteral colic patients receiving hydromorphone achieved more pain relief, required less rescue medication, underwent fewer IVPs, and avoided hospital admission more frequently than did those receiving meperidine.     

莫比可联合间苯三酚治疗中老年急性肾绞痛疗效观察

目的:观察莫比可联合间苯三酚治疗中老年人急性肾绞痛的临床疗效和不良反应.方法:84例中老年急性肾绞痛患者随机分成实验组和对照组各42例,两组均静滴间苯三酚120 mg,实验组和对照组分别肌注莫比可15 mg和度冷丁80 mg,观察治疗后疗效和不良反应.结果:实验组与对照组的有效率无统计学差异(P＞0.05),实验组不良反应、6 h再发肾绞痛例数均明显低于对照组(P ＜0.01).结论:莫比可联合间苯三酚治疗中老年急性肾绞痛安全有效,值得临床推广应用.     

双氯芬酸钠利多卡因联合消旋山莨菪碱治疗肾绞痛298例临床分析

目的:探讨双氯芬酸钠利多卡因联合消旋山莨菪碱治疗肾绞痛的临床疗效和不良反应.方法:回顾性分析2010年10月至2012年6月我科收治的肾绞痛298例患者的临床资料,肾绞痛均为临床诊断病例,均应用双氯芬酸钠利多卡因2 ml肌注联合消旋山莨菪碱10 mg静脉滴注,用药45 min后进行疗效和副作用的判断.结果:本组298例肾绞痛患者中,显效201例(67.45％),有效92例(30.87％),总有效率98.32％,无效5例(1.68％);未见明显副作用.结论:双氯芬酸钠利多卡因联合消旋山莨菪碱治疗肾绞痛疗效显著,且无明显副作用,值得临床进一步推广应用.     

Bedside Emergency Department Ultrasonography plus Radiography of the Kidneys, Ureters, and Bladder vs Intravenous Pyelography in the Evaluation of Suspected Ureteral Colic

Abstract. Objective : To determine the role of bedside renal ultrasonography (US) and plain radiography of the kidneys, ureters, and bladder (KUB) as the initial investigative modality for those patients presenting to the ED with unilateral flank pain and he-maturia. The hypothesis was that the renal US + KUB may obviate the need for emergent IV pyelography (IVP) in a majority of patients. Methods : Prospective study over an 8-month period of all consecutive adult patients between the ages of 18 and 65 years presenting with unilateral flank pain and he-maturia to the ED at LAC + USC Medical Center. Patients received KUB followed by a 500-mL bolus of normal saline. Bedside US was then performed by emergency physicians (EPs). Hydronephrosis of the kidney was graded as mild, moderate, or severe. All patients then underwent IVP. The results of the bedside US + KUB were then compared with those of IVP (the criterion standard). Results : Of a total of 139 eligible patients, 108 were enrolled. The combination of US and KUB correctly identified pathology consistent with nephroureterolithiasis with a sensitivity of 97.1% (95% CI = 93.1–100%) when compared with IVP. The KUB + US results were falsely positive in 16 patients, resulting in a specificity of 58.9% (95% CI = 43.5–74.3%). The positive predictive value of the combined modality was 80.7%, the negative predictive value was 92.0%, and the overall accuracy was 83.3%. Conclusion : The bedside US + KUB has a high sensitivity and can be performed rapidly at the bedside by the EP when compared with IVP. This combined modality is an effective screening tool in the initial evaluation of ureteral colic.     

妊娠合并输尿管结石致顽固性肾绞痛的腔内处理

【目的】探讨妊娠合并输尿管结石致顽固性肾绞痛安全有效的腔内处理方法。【方法】妊娠合并输尿管结石致肾绞痛经保守治疗无效患者14例,孕7~34周,平均27周。结石最大径5~12mm。输尿管上段结石8例,中段3例,下段3例。上段结石中6例单纯留置双J管,2例将结石推回肾盂后留置双J管。中下段结石中3例采用输尿管镜下气压弹道碎石术击碎结石,3例应用输尿管镜下双频激光碎石。【结果】12例术后肾绞痛消失;2例单纯放置双J管者仍有间断轻微肾绞痛,服用解痉药物可以缓解。8例未碎石在结石排出前每3个月更换双J管。14例孕妇均顺利生产,婴儿健康。【结论】妊娠合并输尿管结石致顽固性肾绞痛患者采用逆行输尿管插管或输尿管镜取石术安全有效。     

Effectiveness of Selective Use of Intravenous Pyelography in Patients Presenting to the Emergency Department with Ureteral Colic

Objective: To determine whether IV pyelography (IVP) is required routinely for all patients presenting to the ED with ureteral colic.
Methods: A randomized prospective study was conducted with 2 patient groups—a routine IVP group, in which all patients underwent IVP, and a selective IVP group, in which patients were treated, observed, and released without undergoing IVP unless they experienced continued symptoms. The study was performed in a large university-affiliated, community hospital ED. Participants were patients aged 18–65 years with signs and symptoms consistent with ureteral colic.
Results: Among the 40 patients enrolled in the routine IVP group, 26 had positive studies, 8 of which necessitated hospitalization. Among the 41 patients randomized to the selective IVP group, there were only 19 IVPs performed, of which 6 were positive and 4 necessitated hospitalization. Compared with the routine IVP group, there were 54% fewer FVPs performed and a 51 % lower admission rate in the selective IVP group.
Despite the fact that fewer IVPs were performed in the selective IVP group, clinical outcomes in the 2 groups were similar, without significant complication in either group.
Conclusions: IVPs do not need to be routinely performed for all patients presenting to the ED with ureteral colic. The decision to perform an IVP may be dictated by symptoms that persist after initial evaluation and treatment.     

Renal effects of i.v. adenosine infusion in humans

Summary. The effects of systemic intravenous (i.v.) infusion of adenosine on renal blood flow and glomerular filtration in eight healthy, awake females have been examined. In conclusion, i.v. infusion of adenosine in healthy, awake subjects causes a minor increase in total renal blood flow and a marked reduction in glomerular filtration. This shows that adenosine also exerts a vasodilatory effect in the renal circulation, primarily on postglomerular arterioles. In addition, adenosine may produce an aldosterone-like effect on salt excretion, and a reduction in renal oxygen consumption. Renal blood flow and glomerular filtration rate were measured as the clearance of para-aminohippuric acid (PAH) and inulin, respectively. Following basal sampling adenosine was infused i.v. at successive rates of 60 and 80 μg kg^-1 min^-1 for 30 min at each rate. Plasma clearance of PAH showed a minor, but non-significant, increase from 697 ±41 to 775 ±97 ml min^-1. However, the arterial plasma concentration of PAH decreased by 17±4% (P < 00.1), indicating that there was a small increase in renal blood flow. Inulin clearance was reduced from 123±14 to 88±11 ml min^-1 1.73 m^-2 (P < 0.01). The resulting filtration fraction was reduced from 18±1 to 11±1 (P < 0.001). The K⁺/Na⁺ excretion ratio increased from a basal value of 10±1 to 42±11 (P < 0.01) at the highest dose of adenosine, and renal oxygen consumption decreased from 17±2 to 9± 1 ml min^-x (P <0.001).     

孕妇输尿管结石合并肾绞痛28例的诊治

目的探讨孕妇输尿管结石并肾绞痛有效的诊断和治疗方法。方法总结28例输尿管结石合并。肾绞痛孕妇,保守治疗好转25例,3例保守治疗无效者置放输尿管双J管。结果28例孕妇症状均缓解,均顺利度过围产期。分娩后结石自行排出25例,体外冲击波碎石（ESWL）治愈3例。结论黄体酮、硫酸镁注射液具解痉止痛和保胎双重功效,保守治疗无效者置放输尿管双J管具操作简单、创伤小、疗效确切的优点。