严重女性尿道综合征的药物综合治疗研究_医学论著【摘要】目的探讨以托特罗定为基础，药物综合治疗严重女性尿道综合征的疗效。方法采用前瞻性研究观察严重的尿道综合征女性患者23例。以托特罗定为基础用药，根据患者实际情况及症状联合应用α-受体阻断剂、雌激素、低成瘾性止痛剂、抗组胺药物、抗精神抑郁药物及镇静药物治疗。服药1周后复诊，如症状改善明显则继续服用；如用药有效但改善不明显，则再据病情加用更多的联合用药。对于症状尤其严重者或多方治疗无效及已实施过初始治疗效果不明显者，则开始时即加以多种药物联合应用。总疗程2个月，观察用药前及用药2个月后患者临床症状（每日排尿次数、尿痛程度评分及盆腔痛发作次数），并记录不良反应发生情况。结果（1）用药2个月后每日排尿次数明显减少，治疗前后分别为（31.5±4.4）和（16.6±3.2）次，盆腔痛发作次数明显减少，治疗前后分别为（15.6±2.7）次/周及（2.4±1.6）次/周。上述指标用药前后相比均有统计学意义（P＜0.01）。（2）尿痛程度评分明显下降，治疗前后分别为（6.8±1.1）和（3.7±1.5）分，盆腔痛程度有明显缓解。生活质量评分明显降低，治疗前后分别为（5.8±0.6）和（2.2±0.8）分，用药前后比较，差异有统计学意义（P＜0.01）。（3）精神症状明显改善，自杀倾向消除。（4）23例患者均无明显的服药后不适，考虑可能是明显缓解症状后精神状态的改善掩盖了患者对副作用的感受，其副作用有待于进一步的扩大病例及临床观察研究。结论以托特罗定为基础用药，并根据患者实际病情联合应用其他对症药物综合治疗，能有效而迅速缓解严重女性下尿路综合征的临床症状，明显改善其生活质量及精神状态，且耐受性及安全性较好。【关键词】女性尿道综合征；托特罗定；药物综合治疗ClinicalstudyoncombineddrugtherapyofseverefemaleurethralsyndromeTongKai-jun,CuiZhe.TianjinMedicalUniversityGeneralHospital,Tianjin300052,China【Abstract】ObjectiveToevaluatetheefficacyofatolterodinetartratebasedcombineddrugtherapyinthetreatmentofseverefemaleurethralsyndrome(FUS).MethodsTwenty-threefemaleUSpatientsdiagnosedwithseverefemaleurethralsyndromewererecruitedinthisprospective2-monthclinicaltrial.Theaveragecourseofpatient’shistorywas(40.7±11.6)months,rangingfrom19to72months.All23patientswereobservedwithsevereurinationfrequency(＞30/day,＞10/night),urinationurgency,urinationpainandfrequentacutepelvicpain,alongwithpsychologicalsymptomssuchaslossoffaithintreatment,neuroticism,suicidalmentality,anxiety,etc.Among23patients,3patientshadlostself-careability,1patienthadlostexerciseability,2patientshadsuicidaltendency,1patienthadsuicidalbehavior.Accordingtoindividualpatientconditionsandsymptoms,combineddrugtherapies,includingα-receptorblocker,estrogen,lowaddictivepainkiller,anti-histaminedrug,antidepressantdrugandsedativedrugwereapplied.Basicdosageoftolterodinetartrateis2mgbid,anddosagesofotherdrugswereconventional.Thetreatmentnormallystartswithα-receptorblockerandlowaddictivepainkiller.Antidepressantdrugandestrogenwereappliedtopatientswithstrongpsychologicalsymptomsandabnormalestrogenlevelwhenthetherapystarted.All15patientswerere-examinedoneweekafterthetherapy.Forpatientsobservedwithobviousimprovements,thetherapyremainedthesame.Forpatientswithnon-obviousimprovements,morecombineddrugswouldbeappliedbasedonthepatient’sconditions.Forpatientswithseveresymptomsornotresponsivetotheinitialtherapy,multi-drugswerecombinedinthebeginningofthetherapy.Thetrailwentonfor2months.Pre-treatmentandpost-treatmentpatientclinicalsymptoms(dailyurinationfrequency,urinationpainscoreandpelvicpainoccurrences)wereobserved.Sideeffectswererecorded.Results(1)Dailyurinationfr...
