储尿期症状明显的重度良性前列腺增生患者TURP术后M-受体阻滞剂用药方案探讨被引量：13

A dosage regimen of M-receptor blocker after TURP for severe BPH with predominant urine storage symptoms

导出

摘要目的:探讨储尿期症状明显的重度良性前列腺增生(BPH)患者经尿道前列腺电切术(TURP)后口服M-受体阻滞剂的用药方案及其临床效果。方法:储尿期症状明显的重度BPH患者,TURP 6 h后开始口服酒石酸托特罗定片(2 mg每12 h 1次或4 mg 1次/d),4周后停药,如储尿期症状加重,继续服药2周再停药观察,如此反复直至术后12周。回顾性分析其术前,术后1、4、8、12周IPSS评分(总分、储尿期、排尿期症状评分)、QoL评分、Qmax和排尿后膀胱残余尿(PVR)。结果:临床资料完备病例共106例。其中4周停药后储尿期症状未加重(成功停药)者33例,6~8周成功停药者51例,10~12周成功停药者13例,12周后仍需继续服药者9例。术前,术后1、4、8、12周IPSS总分分别为(25.33±3.45)、(19.33±3.62)、(11.56±2.45)、(8.38±2.08)、(7.74±1.87)分;储尿期IPSS分别为(11.97±1.53)、(10.76±1.82)、(6.16±1.22)、(4.08±1.19)、(3.91±1.15)分;排尿期IPSS分别为(9.80±1.60)、(5.59±1.45)、(3.40±0.92)、(2.85±0.71)、(2.61±0.67)分;QoL评分为(4.70±0.78)、(3.92±0.75)、(2.55±0.74)、(1.83±0.72)、(1.66±0.75)分;除术后12周与术后8周比较外,术前、术后各观察点之间,IPSS各项指标均有显著性差异(P均<0.01)。QoL、Qmax、PVR术后1、4周呈现进行性改善(P均<0.01),4周后变化不再显著(P均>0.05)。结论:储尿期症状明显的重度BPH患者TURP术后持续口服M-受体阻滞剂4~8周可能是治疗其术后储尿期症状的有效方案。 Objective： To study the dosage regimen of oral M-receptor blocker following transurethral resection of the prostate （TURP） tor severe benign prostate hyperplasia （BPH） with predominant urine storage period symptoms （USPSs） and its clinieal eft^ct. Methods： Severe BPH patients with predominant USPSs received oral toherodine （2 mg q l2d or 4 mg qd） 6 hours after TURP tor 4 weeks. The medication continued tbr another 2 weeks in ease of reeun＇ence of USPSs or until the 12th week in case of repeated re- currence. Before and at 1 , 4, 8 and 12 weeks after T URP, we analyzed the International Prostate Symptoms Score （IPSS） , quality of lith （QoL） score, maximum urinary flow rate （Qmax）, and postvoid residual wflume （PVR） of the patients. Results： Complete clinical data were collected fi＇om 106 cases, of which 33 achieved successful drug withdrawal with no aggravation of USPSs at 4 weeks after TURP, 51 at 6 -8 weeks, 13 at 10 - 12 weeks, and 9 needed medieation after 12 weeks. Before and at 1 , 4, 8 and 12 weeks a｜- terTUHP, the total IPSSs were 25. 33 ± 3.45, 19.33 ± 3.62, 11.56± 2.45, 8.38 ± 2.0and7.74 ± 1.87, those in the urine storage period were 11.97 ± 1.53, 10.76 ± 1.82, 6.16 ± 1.22, 4.08 ± 1. 19 and 3.91 ± 1. 15, those at urine voiding were 9.80 ± 1.60, 5.59 ± 1.45, 3.40 ± 0.92, 2.85 ± 0.71, and2.61 ± 0.67, and the QoL scores ere4.70 ± 0.78, 3.92 ± 0.75, 2.55 ± 0.74, 1.83 ± 0.72 and l. 66 ± 0.75, respectively, with statistieally significant differenees between the haseline and the scores at 1 and 4 weeks （P 〈0.01 ） but not at 8 or 12 weeks （P 〉0.05）. Qmax and PVllwere improved progressively and sig- nificantly at 1 and 4 weeks （ P 〈 0.01 ） hut not at 8 or 12 weeks （ P 〉 0.05 ）. Conclusion ： Four to eight weeks of oral administra- tion of M-receptor blocker may be an effective dosage regimen for severe BPH with predominant USPSs after TULIP. Natl J Androl, 2017. 23 （9）： 793-797