本文選題：原發(fā)性早泄　切入點(diǎn)：鹽酸帕羅西汀　出處：《第三軍醫(yī)大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：背景和目的 對(duì)于原發(fā)性早泄的治療，雖有不少方法，但各種治療方法的有效性和安全性尚有待進(jìn)一步證實(shí)。在原發(fā)性早泄的治療選擇中，心理療法及行為訓(xùn)練療法的有效性和依從性欠佳；手術(shù)治療的療效不確切且可能造成不可逆性損害而并沒(méi)有得到國(guó)內(nèi)外各類診治指南的推薦；因而，藥物治療早泄仍是臨床上廣泛應(yīng)用的主要方法和國(guó)際多種診治指南所推薦的首選措施。目前全世界范圍內(nèi)僅達(dá)泊西汀(dapoxetine)作為早泄治療的適應(yīng)癥性用藥。5－羥色胺再攝取抑制劑(SSRIs)，局部麻醉劑和選擇性α-腎上腺素能受體阻斷劑等是早泄的治療常用藥物。但由于患者個(gè)體差異以及早泄病因的不同，不同患者對(duì)同種藥物治療反應(yīng)效果不一。本研究選擇鹽酸帕羅西汀和鹽酸坦索羅辛兩種藥物，以探討其在原發(fā)性早泄治療中，聯(lián)合用藥及單獨(dú)用藥的有效性及安全性；并評(píng)價(jià)5-HT濃度在原發(fā)性早泄的診斷及治療效果判斷中的意義，并對(duì)SSRIs的具體作用機(jī)制進(jìn)行探討。 方法 根據(jù)國(guó)際性學(xué)會(huì)(International Society for Sexual Medicine， ISSM)2008年制定的原發(fā)性早泄的診斷標(biāo)準(zhǔn)：“射精往往或總是在插入陰道1min左右發(fā)生;大多數(shù)或每次插入陰道后，沒(méi)有延長(zhǎng)射精的能力;有消極的后果，例如苦惱、痛苦、沮喪或/和逃避親密接觸等”，篩選本院男科門(mén)診18-65歲原發(fā)性早泄患者225例，按照就診的先后隨機(jī)分成A、B和C組，每組75例。每組符合篩選要求的原發(fā)性早泄患者予以治療前血樣采集并提取血漿凍存。同樣方法采集同期就診于我科，無(wú)早泄癥狀的50例其他疾病患者血樣，作為健康男性血樣，同法處理及保存。A組單用鹽酸帕羅西汀，20mg/d；B組單用鹽酸坦索羅辛，0.4mg/d；C組同時(shí)服用鹽酸帕羅西汀和鹽酸坦索羅辛，劑量同A、B組，均連用8周。治療8周后再次予以血樣采集并離心提取血漿凍存。采用美國(guó)clound-clone corporation生產(chǎn)的5-HT ELISA試劑盒測(cè)定血漿中5-HT濃度并予以比較分析。采用問(wèn)卷調(diào)查形式比較三組治療8周后與治療前的平均陰道內(nèi)射精潛伏時(shí)間(IELT)、早泄量表(premature ejaculation profile, PEP)中患者性交滿意度，控制射精的能力，早泄相關(guān)苦惱以及早泄相關(guān)夫妻溝通困難等指標(biāo)的改變情況，并對(duì)治療期間的所有不良反應(yīng)進(jìn)行收集和統(tǒng)計(jì)總結(jié)。 結(jié)果 共計(jì)198例患者獲得可靠隨訪數(shù)據(jù)， A組IELT的均值由用藥前的1.23min增加到8.52min，增加了7.29min；B組IELT的均值由用藥前的1.16min增加到2.30min，增加了1.14min，C組IELT的均值由用藥前的1.16min增加到9.31min，增加了8.15min；三組平均IELT在治療后顯著高于治療前均增加(B組：P 0.01，A，C組：P0.001)。聯(lián)合用藥C組治療后IELT增加了8.02倍。顯著高于B組(1.98倍)和A組(6.92倍)(P0.001)。早泄量表中射精控制能力，性交滿意度，早泄相關(guān)苦惱及早泄相關(guān)兩性溝通困難四項(xiàng)指標(biāo)評(píng)分顯示，在治療后各組較治療前均有顯著提高(P0.001)；而聯(lián)合用藥組四項(xiàng)指標(biāo)的均值提高更為顯著。A、組有10例(13.3%)患者出現(xiàn)了不良反應(yīng),B組有2例(2.6%),C組有9例(12.0%)。 A，B，C組患者在治療前血漿5-HT濃度均值分別為：61.64ng/mL，62.31ng/mL，，62.77ng/mL，均顯著低于對(duì)照組的132.21ng/mL(P0.001)，經(jīng)過(guò)治療后A,C組血漿5-HT濃度較治療前顯著增加,A組增加至113.59ng/mL，C組增加至117.82ng/mL(同治療前相比，P0.001)，治療后A,C組血漿5-HT濃度之間無(wú)明顯差異(P0.05)，B組治療前后血漿5-HT濃度無(wú)明顯改變(P0.05)。 結(jié)論 1.聯(lián)合應(yīng)用鹽酸帕羅西汀和鹽酸坦索羅辛治療原發(fā)性早泄的有效性和安全性均較好，可作為一種原發(fā)性早泄藥物治療的優(yōu)選方案. 2.血漿5-HT濃度可作為原發(fā)性早泄的較客觀的診斷指標(biāo)，并對(duì)早泄治療效果的判斷有一定的意義。
[Abstract]:Background and purpose
For the treatment of primary premature ejaculation, although there are many methods, but the safety and efficacy of various treatment methods still need to be further confirmed. In the treatment of primary premature ejaculation, effectiveness and compliance of psychological therapy and behavior training is poor; the effect of surgical treatment for imprecise and may cause irreversible the damage has not been recommended guidelines for the diagnosis and treatment of all kinds of domestic; therefore, the preferred drug for the treatment of premature ejaculation is still widely used measures of the main clinical guidelines for the diagnosis and treatment of a variety of methods and international recommended. At present all over the world only Daboxi ting (dapoxetine) as premature ejaculation treatment indications medication.5 serotonin reuptake inhibitors (SSRIs), a local anesthetic and selective alpha adrenergic receptor blockers are commonly used in the treatment of premature ejaculation drugs. But because of individual differences and the different causes of premature ejaculation, different The patients of the same drug reaction results. This research chooses Pa Rossi Dean hydrochloride and tamsulosin hydrochloride two drugs, in order to explore its treatment of primary premature ejaculation, the efficacy and safety of combined therapy and medication alone; and to evaluate the significance of the concentration of 5-HT in diagnosing the primary premature ejaculation diagnosis and treatment effect the discussion and the specific mechanism of SSRIs.
Method
According to the international society (International Society for Sexual Medicine, ISSM) in 2008 to develop primary premature ejaculation diagnostic criteria: "often or always in the vagina ejaculation occurred around 1min; most time is inserted into the vagina, not prolong ejaculation ability; have negative consequences, such as distress, pain, depression and / or avoid close contact", the Academy of andrology clinic screening at the age of 18-65 patients with primary premature ejaculation in 225 cases, according to the treatment were randomly divided into A, B and C group, 75 cases in each group. Each group meets the requirements of the screening of primary premature ejaculation patients treated before blood samples were collected and extracted from the plasma of cryopreservation. The same method selected collection in our department, no premature ejaculation symptoms of 50 patients with other diseases were as healthy male blood samples, with the method of processing and preservation of.A group with Pa Rossi Dean hydrochloride, 20mg/d; group B treated with hydrochloric acid Tanzania Sorosin, 0.4mg/d; group C at the same time Take Pa Rossi Dean and tamsulosin hydrochloride, the same dose of A, B group, both for 8 weeks. After 8 weeks of treatment, blood samples were collected and centrifuged again to extract plasma cryopreservation. Determination of plasma concentration of 5-HT and to compare the analysis by 5-HT ELISA kit clound-clone Corporation production. By questionnaire treatment between the three groups after 8 weeks and the average vagina before treatment in premature ejaculation, premature ejaculation (IELT) scale (premature ejaculation profile, PEP) in patients with sexual satisfaction, ability to control ejaculation, premature ejaculation, premature ejaculation changes related distress related indicators such as communication difficulties, and all adverse reactions during treatment were collected and statistical summary.
Result
A total of 198 patients received reliable follow-up data, the average A group IELT increased from 1.23min to 8.52min before treatment, increased by 7.29min; the average B group IELT increased from 1.16min to 2.30min before treatment, 1.14min increased, the average C group IELT increased from 1.16min to 9.31min before treatment, increased by 8.15min; three the average IELT was significantly higher than that after treatment before treatment were increased (B group: P 0.01, A, C group: P0.001). The combination of C group after treatment, IELT increased 8.02 times. Significantly higher than that of group B (1.98 times) and A group (6.92 times) (P0.001). The ability to control scale, ejaculation in the four indicators of sexual satisfaction of premature ejaculation, premature ejaculation and ejaculation related distress related to gender communication difficulties score showed that after treatment were significantly improved (P0.001); the mean and the combination group of four indexes was more significant.A group had 10 cases (13.3%) patients had adverse reactions, B group There were 2 cases (2.6%), 9 cases in C group (12%). A, B, C groups before treatment, mean plasma concentrations of 5-HT were: 61.64ng/mL, 62.31ng/mL, 62.77ng/mL, 132.21ng/mL were significantly lower than the control group (P0.001), A after treatment, the plasma 5-HT concentration in C group than before treatment significantly with the increase of A group increased to 113.59ng/mL, C group increased to 117.82ng/mL (compared with before treatment, P0.001, A) after treatment, no significant difference between the concentration of plasma 5-HT C (P0.05) group, B group before and after treatment of plasma 5-HT concentration did not change significantly (P0.05).
conclusion
The safety and efficacy of the 1. combined application of Pa Rossi Dean and tamsulosin for the treatment of primary premature ejaculation is good, can be used as the preferred scheme of a primary premature ejaculation treatment.
2. the concentration of plasma 5-HT can be used as an objective diagnostic index for primary premature ejaculation, and it is of certain significance to the judgment of the effect of premature ejaculation.

【學(xué)位授予單位】：第三軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R698

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