el-Sherif A E, Salem M, Yahia H, al-Sharkawy W A, al-Sayrafi M
Department of Urology, Hamad Medical Corporation, Doha, Qatar, Arabian Gulf.
J Urol. 1995 May;153(5):1395-8.
The vasopressin analogue, 1-desamino-8-arginine vasopressin (desmopressin), is a potent antidiuretic without the pressor effects of vasopressin. A total of 18 patients with acute renal colic due to stone disease received 40 microgramsf1p4mopressin intranasal spray with encouraging results. There was a significant decrease in the colic pain intensity from an initial mean visual analogue score of 67 +/- 17 mm. to 39 +/- 36 mm. within 30 minutes (p < 0.001). Eight patients (44.4%) had complete pain relief within 30 minutes of administering intranasal desmopressin spray. Nine of 10 patients who required intramuscular diclofenac sodium achieved complete pain relief within another 30 minutes. In other words, when intranasal desmopressin spray was administered before diclofenac sodium, 94.4% of the patients achieved complete pain relief and were discharged home. The mechanism of analgesic action of desmopressin in renal colic is uncertain. At the peripheral level, desmopressin may alleviate the acute renal colic through its potent antidiuretic effect or by relaxing the renal pelvic and ureteral smooth muscles. The central analgesic effect of desmopressin by stimulating the release of the hypothalamic beta-endorphin is proposed. We conclude that intranasal desmopressin spray can be used successfully in the treatment of renal colic. It may also replace prostaglandin synthetase inhibitors in treating renal colic with the advantage of avoiding the potential side effects. Further studies are needed to investigate whether the combination of desmopressin with analgesics or spasmolytic drugs offers competitive results compared with those achieved by prostaglandin synthetase inhibitors in the treatment of renal colic.
血管加压素类似物1-去氨基-8-精氨酸血管加压素（去氨加压素）是一种强效抗利尿药，无血管加压素的升压作用。共有18例因结石病导致急性肾绞痛的患者接受了40微克去氨加压素鼻内喷雾治疗，结果令人鼓舞。绞痛疼痛强度从初始平均视觉模拟评分为67±17毫米显著降至30分钟内的39±36毫米（p<0.001）。8例患者（44.4%）在给予鼻内去氨加压素喷雾后30分钟内疼痛完全缓解。10例需要肌内注射双氯芬酸钠的患者中有9例在另外30分钟内疼痛完全缓解。换句话说，当在双氯芬酸钠之前给予鼻内去氨加压素喷雾时，94.4%的患者疼痛完全缓解并出院回家。去氨加压素在肾绞痛中的镇痛作用机制尚不确定。在周围水平，去氨加压素可能通过其强效抗利尿作用或通过松弛肾盂和输尿管平滑肌来缓解急性肾绞痛。有人提出去氨加压素通过刺激下丘脑β-内啡肽的释放产生中枢镇痛作用。我们得出结论，鼻内去氨加压素喷雾可成功用于治疗肾绞痛。它也可能在治疗肾绞痛方面取代前列腺素合成酶抑制剂，具有避免潜在副作用的优势。需要进一步研究来调查去氨加压素与镇痛药或解痉药联合使用与前列腺素合成酶抑制剂在治疗肾绞痛方面相比是否能取得更有竞争力的结果。
