星状神经节阻滞联合舍曲林治疗原发性早泄
【摘 要】 目的:观察舍曲林联合星状神经节阻滞(SGB)治疗原发性早泄(PE)的近期疗效和安全性。方法:原发性PE患者50例，随机分为两组，每组25例。药物组每日口服舍曲林50mg；联合组(舍曲林+SGB组)每日口服舍曲林50mg，同时每周两次SGB，两组疗程共4w。评价治疗前后阴道内射精潜伏期(IELT)的变化；同时以问卷形式评价治疗前后射精控制感、性满意度、焦虑程度、人际关系紧张程度的变化；并进行组间对比。结果:与治疗前相比，治疗后两组IELT均有明显延长,药物组和联合组分别从治疗前的(0.75±0.36)分和(0.77±0.29)分，增加到治疗后的(2.63±1.66)分和(2.71±1.57)分；治疗前后IELT的差异有显著性，而组间IELT差异无显著性。两组治疗后射精控制感、性满意度、焦虑程度、人际关系紧张程度都有明显改善。联合组的射精控制感和性满意度优于药物组，差异具有显著性。结论:SGB与舍曲林联合治疗，可以有效地延长IELT，其效果与单纯舍曲林治疗无差异。但是，联合治疗可以更好地提高患者对射精的控制能力和性满意度。因此，SGB能否作为一种有效治疗原发性PE的手段，还有待于进一步临床验证。
【关键词】 原发性早泄; 星状神经节阻滞；阴道内射精潜伏期
Sertraline combined with stellate ganglion block in treatment of premature ejaculation
ZHANG Guoxi1， WANG Xiaofeng1, BAI Wenjun1， YANG Junjun2
1 Department of Urology，People’sHospital, Peking University, Peking 100044, China
2 Department of Anesthesiology，People'sHospital, Peking University, Peking 100044, China
【Abstract】 Objectives: To investigate on the efficacy and safety of sertraline combined with stellate ganglion block(SGB)in treatment of premature ejaculation(PE).Methods： A total of 50 patients with PE were randomly enrolled into 2 groups，each including 25 members. Over a 4-week treatment period, the sertraline group took sertraline 50mg once a day；and the combined group(Sertraline with SGB)were given both sertraline 50mg once a day as well as SGB therapy twice a week. All patients finished PE questionnaires which include 4 items (perceived control over ejaculation, personal distress related to ejaculation, satisfaction with sexual intercourse, interpersonal difficulty related to ejaculation), and estimated intravaginal ejaculation latency time(IELT) was recorded. Results：After treatment, IELT increased for both group, from baseline(4.34±2.12)to(3.65±2.23)min in sertraline group, and from(6.23±2.66), to(5.22±3.22)in combined group, respectively. Moreover, the improvements of IELT and PRO achieved were more satisfied in combined group than in sertraline group. The differences were significant. Conclusions： The combination of sertraline with SGB was more effective in treatment of PE than sertraline monotherapy, which indicated that the combined theropy may provide a new way for treatment of PE.
【Key words】 Lifelong premature ejaculation； Stellate ganglion block(SGB)； Intravaginal ejaculation latency time(IELT)
PE是射精功能障碍中最常见的疾病,发病率占成年男性的35%～50%[1]。其治疗方法包括服用抗抑郁药、磷酸二酯酶V型的拮抗剂、α受体阻滞剂以及海绵体注射血管活性药等[2]。5-HT再摄取抑制剂(SSRI)是临床上常用的治疗早泄的药物,需要长期服药并有一定的副作用[3、4]。联合其他疗法以期减少SSRI的用药剂量，以便降低其副作用是我们要考虑的问题之一。交感神经系统在射精反射的外周调控中起主要作用，其兴奋性过高是引起早泄的机制之一。精囊、前列腺及后尿道有丰富的交感神经末梢支配，在射精反射中，神经冲动信号通过其末梢，诱导受支配器官的收缩反应而射精。在临床上，α1受体阻滞剂是常用的阻滞交感神经效应的药物，有作者将其用于治疗早泄,并取得了一定的疗效[5，6]。星状神经节阻滞(SGB)治疗，是用局麻药阻滞星状神经节，降低交感神经系统的兴奋性，调节交感与副交感神经之间的平衡，使受其支配的器官功能发生改变，从而达到治疗的目的。目前临床上SGB常用作因植物神经紊乱引起的躯体疼痛的止痛治疗，因为SGB对交感神经系统的抑制作用，在理论上为其治疗早泄提供了可能性。作者初步观察了SGB与舍曲林联合治疗25例原发性PE，并将其疗效与单纯药物治疗对比，现报告如下。
1 资料和方法
1.1 病例选择
PE由本院男科医生诊断，参照美国精神病协会《精神疾病诊断和统计手册第四版(DSW-IV-TR)》早泄的定义[7]，并且IELT在1min以内[8]对同时符合以下条件者入组：(1)年龄大于18岁，首次性生活即有PE，有固定的异性性伴侣(或已婚)并超过6个月；(2)勃起功能正常(IIEF-5≥21分)；(3)无泌尿生殖系统感染性疾病；(4)无下尿路症状；(5)凝血功能正常。入组患者共50例，年龄19～65岁，平均37.3岁；病史0.5～15年，平均7.5年。病人随机分为两组，每组25例。, http://www.100md.com(张国喜 王晓峰 白文俊 杨进军)
【关键词】 原发性早泄; 星状神经节阻滞；阴道内射精潜伏期
Sertraline combined with stellate ganglion block in treatment of premature ejaculation
ZHANG Guoxi1， WANG Xiaofeng1, BAI Wenjun1， YANG Junjun2
1 Department of Urology，People’sHospital, Peking University, Peking 100044, China
2 Department of Anesthesiology，People'sHospital, Peking University, Peking 100044, China
【Abstract】 Objectives: To investigate on the efficacy and safety of sertraline combined with stellate ganglion block(SGB)in treatment of premature ejaculation(PE).Methods： A total of 50 patients with PE were randomly enrolled into 2 groups，each including 25 members. Over a 4-week treatment period, the sertraline group took sertraline 50mg once a day；and the combined group(Sertraline with SGB)were given both sertraline 50mg once a day as well as SGB therapy twice a week. All patients finished PE questionnaires which include 4 items (perceived control over ejaculation, personal distress related to ejaculation, satisfaction with sexual intercourse, interpersonal difficulty related to ejaculation), and estimated intravaginal ejaculation latency time(IELT) was recorded. Results：After treatment, IELT increased for both group, from baseline(4.34±2.12)to(3.65±2.23)min in sertraline group, and from(6.23±2.66), to(5.22±3.22)in combined group, respectively. Moreover, the improvements of IELT and PRO achieved were more satisfied in combined group than in sertraline group. The differences were significant. Conclusions： The combination of sertraline with SGB was more effective in treatment of PE than sertraline monotherapy, which indicated that the combined theropy may provide a new way for treatment of PE.
【Key words】 Lifelong premature ejaculation； Stellate ganglion block(SGB)； Intravaginal ejaculation latency time(IELT)
PE是射精功能障碍中最常见的疾病,发病率占成年男性的35%～50%[1]。其治疗方法包括服用抗抑郁药、磷酸二酯酶V型的拮抗剂、α受体阻滞剂以及海绵体注射血管活性药等[2]。5-HT再摄取抑制剂(SSRI)是临床上常用的治疗早泄的药物,需要长期服药并有一定的副作用[3、4]。联合其他疗法以期减少SSRI的用药剂量，以便降低其副作用是我们要考虑的问题之一。交感神经系统在射精反射的外周调控中起主要作用，其兴奋性过高是引起早泄的机制之一。精囊、前列腺及后尿道有丰富的交感神经末梢支配，在射精反射中，神经冲动信号通过其末梢，诱导受支配器官的收缩反应而射精。在临床上，α1受体阻滞剂是常用的阻滞交感神经效应的药物，有作者将其用于治疗早泄,并取得了一定的疗效[5，6]。星状神经节阻滞(SGB)治疗，是用局麻药阻滞星状神经节，降低交感神经系统的兴奋性，调节交感与副交感神经之间的平衡，使受其支配的器官功能发生改变，从而达到治疗的目的。目前临床上SGB常用作因植物神经紊乱引起的躯体疼痛的止痛治疗，因为SGB对交感神经系统的抑制作用，在理论上为其治疗早泄提供了可能性。作者初步观察了SGB与舍曲林联合治疗25例原发性PE，并将其疗效与单纯药物治疗对比，现报告如下。
1 资料和方法
1.1 病例选择
PE由本院男科医生诊断，参照美国精神病协会《精神疾病诊断和统计手册第四版(DSW-IV-TR)》早泄的定义[7]，并且IELT在1min以内[8]对同时符合以下条件者入组：(1)年龄大于18岁，首次性生活即有PE，有固定的异性性伴侣(或已婚)并超过6个月；(2)勃起功能正常(IIEF-5≥21分)；(3)无泌尿生殖系统感染性疾病；(4)无下尿路症状；(5)凝血功能正常。入组患者共50例，年龄19～65岁，平均37.3岁；病史0.5～15年，平均7.5年。病人随机分为两组，每组25例。, http://www.100md.com(张国喜 王晓峰 白文俊 杨进军)