Department of Urology, Pellegrin University Hospital, Bordeaux, France.
J Endourol. 2009 Dec;23(12):2021-7. doi: 10.1089/end.2009.0111.
Extracorporeal shockwave lithotripsy (SWL) is a noninvasive but painful procedure. The aim of this study was to identify predictive risk factors for pain during SWL.
Two hundred twenty-two SWL treatments with the Lithostar lithotripter (Siemens) were included in a monocentric study. Patient and stone characteristics were prospectively collected in a database, and a standardized pain control protocol was administered 1 hour before treatment: paracetamol, nefopam, ketoprofen, and alprazolam. Subjective pain level was assessed with visual analog scale (VAS, 0-10). If VAS was >or=3, tramadol was added. If VAS was still >or=3, shockwave intensity was decreased or treatment was interrupted. The efficacy on stone fragmentation was evaluated 1 month after treatment. The need for adjuvant analgesia was compared with patient and stone characteristics to find out predictive risk factors for pain.
The average subjective pain was 3.1. The need for supplementary analgesia was more frequent in women (p = 0.035), younger patients (p < 0.001), anxious and depressed patients (p = 0.018), in patients with previous SWL (p = 0.0185), in patients with a rib projected stone (p < 0.001), in patients with renal stones (p = 0.0535), and finally in patients with homogeneous stones (p = 0.02). Multivariate analysis revealed two independent risk factors for pain: young age (odds ratio = 5; p < 0.001) and rib projected stone (odds ratio = 5.23; p < 0.001). Stone fragmentation was worse in patients with an adjuvant analgesia requirement (p = 0.0311).
Predictive risk factors for pain during SWL treatments were found: young age, rib projected stones, anxious and depressed patients, previous SWL treatment, and homogeneous stones. A higher analgesic requirement is necessary for these preselected patients to perform SWL and optimize its efficacy.
体外冲击波碎石术（SWL）是一种非侵入性但疼痛的程序。本研究的目的是确定 SWL 过程中疼痛的预测风险因素。
纳入了一项单中心研究中的 222 例 SWL 治疗。患者和结石特征被前瞻性地收集在数据库中，并在治疗前 1 小时给予标准化的疼痛控制方案：扑热息痛、奈福泮、酮洛芬和阿普唑仑。主观疼痛程度采用视觉模拟评分法（VAS，0-10）评估。如果 VAS>3，则加用曲马多。如果 VAS 仍然>3，则降低冲击波强度或中断治疗。治疗 1 个月后评估结石碎裂效果。比较患者和结石特征与辅助镇痛需求，找出疼痛的预测风险因素。
平均主观疼痛为 3.1。女性（p=0.035）、年轻患者（p<0.001）、焦虑和抑郁患者（p=0.018）、有过 SWL 治疗史的患者（p=0.0185）、肋骨投影结石的患者（p<0.001）、肾结石患者（p=0.0535）和最后是同质结石患者（p=0.02）更需要辅助镇痛。多变量分析显示，疼痛的两个独立风险因素是年轻年龄（优势比=5；p<0.001）和肋骨投影结石（优势比=5.23；p<0.001）。需要辅助镇痛的患者结石碎裂效果更差（p=0.0311）。
发现了 SWL 治疗过程中疼痛的预测风险因素：年轻年龄、肋骨投影结石、焦虑和抑郁患者、之前的 SWL 治疗和同质结石。对于这些预选患者，需要更高的镇痛要求才能进行 SWL 并优化其疗效。
