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目的基于疾病负担,循证评价与遴选我国乡镇卫生院治疗泌尿系结石的基本药物。方法采用本系列研究之二制定的研究方法、标准和流程,循证评价和遴选治疗泌尿系结石药物。结果①共纳入3个循证制定的泌尿系结石指南。②根据WHO基本药物目录、中国基本药物目录、中国国家处方集及纳入指南所推荐药物的种类及其证据的质量和数量,推荐双氯芬酸钠、硝苯地平、别嘌呤醇和布洛芬作为泌尿系结石的对症治疗药。③国内研究(4个RCT,n=566;2个观察性研究,n=96,质量较低)表明:双氯芬酸钠、硝苯地平、别嘌呤醇治疗结石排出率分别为91.5%、93.3%和86.4%,与对照组相比差异有统计学意义,每日费用分别为7.00～8.57元、1.48～4.44元、0.24～0.82元;布洛芬治疗肾绞痛镇痛总有效率为94.5%,差异有统计学意义,每日费用为0.105元。上述4种推荐药物均安全有效,口服不需督导,国内均有相应剂型和规格上市,经济性适用性较高。结论泌尿系结石对症治疗推荐用药:①强推荐双氯芬酸钠(缓释胶囊/肠溶片),禁用于胃肠道出血,妊娠及计划怀孕妇女。②弱推荐硝苯地平(片剂/软胶囊),接受透析治疗的恶性高血压患者和不可逆肾衰竭患者慎用。③弱推荐别嘌呤醇片剂,对该药过敏、严重肝肾功能不全和明显血细胞低下者禁用。④强推荐布洛芬片剂,对阿司匹林或其他非甾体抗炎药过敏者禁用。
Objective Based on the burden of disease, evidence-based evaluation and selection of the basic drugs for treating urolithiasis in township hospitals in our country. Methods Using the research methods, standards and procedures developed in this series of studies, evidence-based evaluation and selection of drugs for the treatment of urolithiasis. Results ① A total of 3 guidelines for urinary stones were enrolled. ②Dicclofenac sodium, nifedipine, allopurinol, and ibuprofen were recommended as urinary calculi according to the quality and quantity of drugs recommended by the WHO Essential Drugs Inventory, China Essential Drugs List, China National Prescription Set and Inclusion Guide, and their evidence Symptomatic treatment of drugs. ③ Domestic studies (4 RCTs, n = 566; 2 observational studies, n = 96, lower quality) indicated that the rates of diclofenac, nifedipine and allopurinol treatment were 91.5% and 93.3%, respectively 86.4% compared with the control group, the difference was statistically significant, the daily costs were 7.00 ~ 8.57 yuan, 1.48 ~ 4.44 yuan, 0.24 ~ 0.82 yuan; ibuprofen analgesic treatment of renal colic total effective rate was 94.5% The difference was statistically significant, the daily cost of 0.105 yuan. The four recommended drugs are safe and effective, oral without supervision, the country has the appropriate dosage forms and specifications listed, higher economic applicability. Conclusion Urinary calculi symptomatic treatment recommended medication: strong recommendation diclofenac sodium (sustained-release capsules / enteric-coated tablets), banned in gastrointestinal bleeding, pregnancy and pregnant women planning. ② weak recommendation nifedipine (tablets / soft capsules), dialysis treatment of patients with malignant hypertension and irreversible renal failure patients with caution. Weak recommended allopurinol tablets, allergic to the drug, severe liver and kidney dysfunction and significant blood cells were disabled. ④ strongly recommended ibuprofen tablets, aspirin or other non-steroidal anti-inflammatory drugs are allergic disabled.