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目的:研究双氯芬酸钠栓剂直肠给药及双氯芬酸钠对乙酰氨基酚肌注联合丁溴东莨菪碱治疗结石性肾绞痛的有效性和安全性。方法:84例输尿管或肾盂结石需止痛治疗的肾绞痛患者给予足量抗菌药后随机分为直肠组和肌注组,直肠组42例患者给予丁溴东莨菪碱静滴联合双氯芬酸钠栓剂直肠给药,肌注组42例患者给予丁溴东莨菪碱静滴联合双氯芬酸钠对乙酰氨基酚肌注,观察并比较两组疗效及不良反应。结果:两组患者年龄、病程等差异无统计学意义(P>0.05)。首次用药0.5 h后,直肠组疼痛缓解总有效率69.05%,高于肌注组总有效率59.52%(P<0.05),1 h后两组患者疼痛缓解总有效率比较,差异无统计学意义(P>0.05),3 h后,直肠组疼痛复发率4.76%,低于肌注组19.04%(P<0.05),二次给药后两组患者疼痛缓解总有效率比较,差异无统计学意义(P>0.05),直肠组不良反应发生率显著低于肌注组(P<0.05)。结论:肌注双氯芬酸钠对乙酰氨基酚比双氯芬酸钠栓直肠给药镇痛更快,但镇痛效果维持较短,不良反应较多,而双氯芬酸钠栓直肠用药效果稳定持久,安全性高。
Objective: To study the efficacy and safety of diclofenac sodium suppository and rectal administration of diclofenac sodium in combination with acetaminophen intramuscular injection and scopolamine bromide in the treatment of stone-induced renal colic. Methods: Eighty-four patients with renal colic who needed analgesia for ureter or renal pelvis were randomly divided into rectal group and intramuscular group after receiving adequate antibacterial agents. In rectal group, 42 patients were given intravenous infusion of scopolamine-buprenaline combined with diclofenac sodium suppository for rectal administration In the intramuscular injection group, 42 patients were treated with intravenous infusion of scopolamine butachlor combined with diclofenac sodium for acetaminophen intramuscular injection. The curative effect and adverse reactions of the two groups were observed and compared. Results: There was no significant difference in age and course between the two groups (P> 0.05). 0.5 h after the first administration, the total effective rate of pain relief in rectal group was 69.05%, which was 59.52% higher than that in intramuscular injection group (P <0.05). There was no significant difference in total effective rate of pain relief between two groups after 1 h (P> 0.05). After 3 hours, the recurrence rate of pain in rectal group was 4.76%, which was lower than that in intramuscular injection group (19.04%, P <0.05). There was no significant difference in the total effective rate of pain relief between two groups (P> 0.05). The incidence of adverse reactions in rectal group was significantly lower than that in intramuscular injection group (P <0.05). CONCLUSION: Intramuscular injection of diclofenac in paracetamol is more effective than diclofenac in rectal administration of analgesia, but the analgesic effect is maintained relatively short with more adverse reactions. However, the efficacy of diclofenac sodium suppository in rectal administration is stable and long-lasting with high safety.