Springhart W Patrick, Marguet Charles G, Sur Roger L, Norris Regina D, Delvecchio Fernando C, Young Matthew D, Sprague Paula, Gerardo Charles A, Albala David M, Preminger Glenn M
Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, North Carolina, USA.
J Endourol. 2006 Oct;20(10):713-6. doi: 10.1089/end.2006.20.713.
The management of acute renal colic is a problem commonly encountered by both urologists and emergency medicine physicians. The classic approach to managing uncomplicated acute renal colic involves hydration, along with imaging and pain control. Previous studies have suggested that hydration has a significant impact on patient comfort, as well as spontaneous stone passage. This study evaluated the effects of maintenance v forced hydration and its effect on the pain experienced from renal colic.
Forty male and 18 female patients with a mean age of 41 years suspected to have acute renal colic were identified in the emergency department. After screening and informed consent, the patients were enrolled in the study, and 43 patients were eventually available for analysis. Patients received intravenous (IV) analgesia, imaging with a noncontrast CT scan of abdomen and pelvis, and assignment to either forced IV hydration with 2 L of normal saline over 2 hours (N = 20) or minimal IV hydration at 20 mL of normal saline per hour (N = 23). A visual analog pain scale was completed hourly for a total of 4 hours. Demographic information, laboratory and imaging results, narcotic use in morphine equivalents (ME), and pain scores were recorded and compared. Spontaneous stone passage rates were also calculated by careful patient follow-up. Results were considered statistically significant at p < 0.05.
Stone size was equivalent in the two treatment groups (p > 0.05). There was no difference in the narcotic requirement in ME (p = 0.644) between the two groups. Similarly, there was no difference in hourly pain score or stone-passage rates between the groups (p > 0.05).
Treatment of uncomplicated renal colic has traditionally included vigorous intravenous hydration, as well as medications for the control of pain and nausea. Our data suggest that maintenance intravenous fluids are as efficacious as forced hydration with regard to patient pain perception and narcotic use. Moreover, it appears the state of hydration has little impact on stone passage.
急性肾绞痛的处理是泌尿外科医生和急诊医学医生都常遇到的问题。处理单纯性急性肾绞痛的经典方法包括补液、影像学检查和疼痛控制。既往研究表明，补液对患者舒适度以及结石自然排出有显著影响。本研究评估了维持性补液与强制性补液的效果及其对肾绞痛所致疼痛的影响。
在急诊科识别出40例男性和18例女性患者，平均年龄41岁，怀疑患有急性肾绞痛。经过筛查并获得知情同意后，患者被纳入研究，最终43例患者可供分析。患者接受静脉镇痛、腹部和盆腔非增强CT扫描成像，并被分配至两组之一，一组在2小时内静脉输注2L生理盐水进行强制性补液（N = 20），另一组以每小时20mL生理盐水进行最小量静脉补液（N = 23）。每小时完成一次视觉模拟疼痛量表，共持续4小时。记录并比较人口统计学信息、实验室和影像学结果、吗啡等效剂量（ME）的麻醉药物使用情况以及疼痛评分。通过仔细随访患者还计算了结石自然排出率。当p < 0.05时，结果被认为具有统计学意义。
两个治疗组的结石大小相当（p > 0.05）。两组之间在ME的麻醉药物需求量方面无差异（p = 0.644）。同样，两组之间每小时疼痛评分或结石排出率也无差异（p > 0.05）。
传统上，单纯性肾绞痛的治疗包括积极的静脉补液以及控制疼痛和恶心的药物。我们的数据表明，就患者的疼痛感知和麻醉药物使用而言，维持性静脉补液与强制性补液同样有效。此外，似乎补液状态对结石排出影响很小。
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