Engeler D S, Schmid S, Schmid H P
Klinik für Urologie, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Scand J Urol Nephrol. 2008;42(2):137-42. doi: 10.1080/00365590701673716.
With an annual incidence of 0.1-0.4%, renal colic is certainly a frequent disorder. Thanks to recent findings, the approach to treatment is changing. This prompted us to conduct a survey amongst all urologists in Switzerland regarding the analgesic measures they use in patients suffering from acute renal colic.
In March 2005, we sent a total of 170 questionnaires to all practising urologists who are also members of the Swiss Urology Society. The questions covered the types of drugs used for first- and second-line analgesic therapy in acute renal colic and the approach to acute and follow-up analgesic therapy. Dosage adjustments in patients with renal failure were also included. The responses were compared with recent literature findings and international guidelines.
The response rate was 58%. Non-opioid analgesics are used for first-line therapy by 81% of respondents, with metamizol being used in 64% of cases. First-line therapy is given intravenously in 65% of cases. An opioid (pethidine) is used most frequently as acute second-line therapy (74% of cases). In the presence of renal failure, half of the respondents make a dose adjustment to the analgesic. Follow-up therapy consists mainly of non-steroidal anti-inflammatory drugs (75%). This complies with the literature and with the recommendations of the European Association of Urology.
First-line therapy for acute renal colic should consist of a non-opioid analgesic, and only if the response to this is inadequate should opioids then be used.
肾绞痛的年发病率为0.1 - 0.4%，无疑是一种常见疾病。由于最近的研究发现，治疗方法正在发生变化。这促使我们对瑞士所有泌尿外科医生进行一项关于他们在急性肾绞痛患者中使用的镇痛措施的调查。
2005年3月，我们向所有也是瑞士泌尿外科学会成员的执业泌尿外科医生共发送了170份问卷。问题涵盖了急性肾绞痛一线和二线镇痛治疗所用药物的类型以及急性和后续镇痛治疗的方法。还包括了肾衰竭患者的剂量调整。将这些回答与最近的文献研究结果和国际指南进行了比较。
回复率为58%。81%的受访者将非阿片类镇痛药用于一线治疗，其中64%的病例使用了安乃近。65%的病例一线治疗采用静脉给药。阿片类药物（哌替啶）最常被用作急性二线治疗（74%的病例）。在存在肾衰竭的情况下，一半的受访者会对镇痛药进行剂量调整。后续治疗主要由非甾体抗炎药组成（75%）。这与文献以及欧洲泌尿外科学会的建议相符。
急性肾绞痛的一线治疗应采用非阿片类镇痛药，只有在对此反应不足时才应使用阿片类药物。
