未经授权:小儿尿路结石是一种常见的疾病,医学排斥疗法已经被许多父母接受。我们进行了一项荟萃分析,以确定α-肾上腺素能受体阻滞剂治疗小儿尿石症的疗效和安全性。
UNASSIGNED:我们确定了PubMed的相关文章,Embase,和Cochrane图书馆数据库。所有已发表的随机对照试验(RCT)描述了使用α-肾上腺素能受体阻滞剂和安慰剂治疗小儿远端尿石症。结果包括结石排出率,排石时间,疼痛发作,需要镇痛,不良事件,以及相关的亚组分析。
未经评估:共有9项RCT参与了我们的研究,包括586名患者。我们发现α-肾上腺素能阻滞剂可以显着增加结石排出率[优势比(OR),3.49;95%置信区间(CI),2.38-5.12;p<0.00001],减少结石排出时间[平均差(MD),-5.15;95%CI,-8.51至-1.80;p=0.003],并减少疼痛发作(MD,-1.02;95%CI,-1.33至-0.72;p<0.00001)和镇痛需求(MD,-0.92;95%CI,-1.32至-0.53;p<0.00001),但副作用发生率较高(MD,2.83;95%CI,1.55至5.15;p=0.0007)。在亚组分析期间,不同的药物(坦索罗辛,多沙唑嗪,和西洛多辛)也表现出比安慰剂更好的效率,除了多沙唑嗪,显示驱逐时间没有差异(MD,-1.23;95%CI,-2.98至0.51;p=0.17)。三种α-肾上腺素能受体阻滞剂的耐受性也较好,除了坦索罗辛的不良事件较多(MD,2.85;95%CI,1.34至6.03;p=0.006)。Silodosin导致比坦索罗辛更好的驱逐率(OR,0.42;95%CI,0.20至0.92;p=0.03)。此外,无论结石大小如何,α-肾上腺素能阻滞剂都会增加结石排出率,并减少<5mm的结石排出时间(MD,-1.71;95%CI,-2.91至-0.52;p=0.005),对于排出时间>5毫米的结石,情况并非如此(MD,-3.61;95%CI,-10.17至2.96;p=0.28)。
UNASSIGNED:我们的综述表明,α-肾上腺素能受体阻滞剂对于治疗小儿远端尿路结石具有良好的耐受性和有效性。我们还得出结论,西洛多辛是最好的药物选择,提供更好的驱逐率,但仍有待未来研究进一步评估。
UNASSIGNED: Pediatric urolithiasis is a common condition, and medical expulsive therapy has grown to be accepted by many parents. We carried out a meta-analysis to identify the efficacy and safety of α-adrenergic blockers for the treatment of pediatric urolithiasis.
UNASSIGNED: We identified related articles from the PubMed, Embase, and Cochrane Library databases. All published randomized controlled trials (RCTs) describing the use of α-adrenergic blockers and placebo treatment for pediatric distal urolithiasis were involved. The outcomes included stone expulsion rate, stone expulsion time, pain episodes, need for analgesia, adverse events, and related subgroup analyses.
UNASSIGNED: A total of nine RCTs were involved in our study, including 586 patients. We found that α-adrenergic blockers could significantly increase the rate of stone expulsion [odds ratio (OR), 3.49; 95% confidence interval (CI), 2.38-5.12; p < 0.00001], reduce the stone expulsion time [mean difference (MD), -5.15; 95% CI, -8.51 to -1.80; p = 0.003], and decrease pain episodes (MD, -1.02; 95% CI, -1.33 to -0.72; p < 0.00001) and analgesia demand (MD, -0.92; 95% CI, -1.32 to -0.53; p < 0.00001) but had a higher incidence of side effects (MD, 2.83; 95% CI, 1.55 to 5.15; p = 0.0007). During subgroup analyses, different medications (tamsulosin,
doxazosin, and silodosin) also exhibited better efficiencies than placebo, except for
doxazosin, which showed no difference in expulsion time (MD, -1.23; 95% CI, -2.98 to 0.51; p = 0.17). The three kinds of α-adrenergic blockers also appeared to be better tolerated, except for tamsulosin with its greater number of adverse events (MD, 2.85; 95% CI, 1.34 to 6.03; p = 0.006). Silodosin led to a better expulsion rate than tamsulosin (OR, 0.42; 95% CI, 0.20 to 0.92; p = 0.03). In addition, α-adrenergic blockers increased the stone expulsion rate regardless of stone size and decreased the expulsion time of stones measuring <5 mm (MD, -1.71; 95% CI, -2.91 to -0.52; p = 0.005), which was not the case for stones measuring >5 mm in expulsion time (MD, -3.61; 95% CI, -10.17 to 2.96; p = 0.28).
UNASSIGNED: Our review suggests that α-adrenergic blockers are well-tolerated and efficient for treating pediatric distal urolithiasis. We also conclude that silodosin is the best choice of drug, offering a better expulsion rate, but it remains to be evaluated further by future studies.