肾输尿管结石体外冲击波碎石术后联合α受体阻滞剂的辅助药物治疗：一项荟萃分析
Adjunctive medical therapy with α-blocker after extracorporeal shock wave lithotripsy of renal and ureteral stones: a meta-analysis.
作者信息
Li Mingchao, Wang Zhengyun, Yang Jun, Guo Xiaolin, Wang Tao, Wang Shaogang, Yin Chunping, Liu Jihong, Ye Zhangqun
机构信息
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, P. R. China.
Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
出版信息
PLoS One. 2015 Apr 10;10(4):e0122497. doi: 10.1371/journal.pone.0122497. eCollection 2015.
BACKGROUND
Although some trials assessed the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after extracorporeal shock wave lithotripsy (ESWL), the role of the α-blocker in facilitating upper urinary calculi expulsion after ESWL remain controversial.
AIMS
To determine the efficacy and safety of the α-blocker in facilitating renal and ureteral stones expulsion after ESWL.
METHODS
A literature search was carried out using the PubMed database, EMBASE and the Cochrane Library database to identify relevant studies. Two reviewers independently extracted data and assessed methodological quality. Pooled effect estimates were obtained using a fixed- and random-effects meta-analysis.
RESULTS
The meta-analysis included 23 RCTs, α-blocker significantly enhanced expulsion rate of upper urinary tract calculi after ESWL (P<0.00001; RR 1.21; 95% CI 1.12-1.31), significantly promoted steinstrasse expulsion (P=0.03; RR 1.25; 95% CI 1.03-1.53), significantly shortened the discharge time of upper urinary tract calculi (P=0.0001; MD -2.12; 95% CI -3.20--1.04), significantly reduced the patient's pain VAS score (P=0.001; RR -1.0; 95% CI -1.61--0.39). Compared with the control group, dizziness (P=0.002; RR 5.48; 95% CI 1.91-15.77), anejaculation (P=0.02; RR 12.17; 95% CI 1.61-91.99) and headache (P=0.04; RR 4.03; 95% CI 1.04-15.72) in the α-blocker group was associated with a higher incidence.
CONCLUSIONS
Treatment with α-blocker after ESWL appears to be effective in enhancing expulsion rate of upper urinary tract calculi, shortening the discharge time of upper urinary tract calculi, reducing the patient's pain. The side effects of α-blocker were light and few.
背景
尽管一些试验评估了α受体阻滞剂在体外冲击波碎石术（ESWL）后促进肾和输尿管结石排出方面的疗效和安全性，但α受体阻滞剂在ESWL后促进上尿路结石排出中的作用仍存在争议。
目的
确定α受体阻滞剂在ESWL后促进肾和输尿管结石排出方面的疗效和安全性。
方法
使用PubMed数据库、EMBASE和Cochrane图书馆数据库进行文献检索，以识别相关研究。两名评价者独立提取数据并评估方法学质量。采用固定效应和随机效应荟萃分析获得合并效应估计值。
结果
荟萃分析纳入23项随机对照试验，α受体阻滞剂显著提高了ESWL后上尿路结石的排出率（P<0.00001；RR 1.21；95%CI 1.12-1.31），显著促进了石街排出（P=0.03；RR 1.25；95%CI 1.03-1.53），显著缩短了上尿路结石的排出时间（P=0.0001；MD -2.12；95%CI -3.20--1.04），显著降低了患者的疼痛视觉模拟评分（P=0.001；RR -1.0；95%CI -1.61--0.39）。与对照组相比，α受体阻滞剂组的头晕（P=0.002；RR 5.48；95%CI 1.91-15.77）、射精障碍（P=0.02；RR 12.17；95%CI 1.61-91.99）和头痛（P=0.04；RR 4.03；95%CI 1.04-15.72）发生率较高。
结论
ESWL后使用α受体阻滞剂治疗似乎能有效提高上尿路结石的排出率，缩短上尿路结石的排出时间，减轻患者疼痛。α受体阻滞剂的副作用轻微且较少。
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