遗尿儿童发生膀胱功能障碍的危险因素分析  

Analysis of risk factors for bladder dysfunction in children with nocturnal enuresis

作　　者：蔡淼 李琦 吴盛德[1] 刘星[1] 张德迎[1] 林涛[1] 魏光辉[1] Cai Miao;Li Qi;Wu Shengde;Liu Xing;Zhang Deying;Lin Tao;Wei Guanghui(Department of Urology,Children's Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Structural Birth Defect and Reconstruction,Chongqin 400010,China)

机构地区：[1]重庆医科大学附属儿童医院泌尿外科,国家儿童健康与疾病临床医学研究中心,儿童发育疾病研究教育部重点实验室,结构性出生缺陷与器官修复重建重庆市重点实验室,重庆400010

出　　处：《临床小儿外科杂志》2024年第3期234-237,共4页Journal of Clinical Pediatric Surgery

基　　金：国家儿童健康与疾病临床医学研究中心临床医学研究一般项目(NCRCCHD-2020-GP-04)

摘　　要：目的探讨遗尿患儿发生膀胱功能障碍的危险因素。方法本研究为回顾性研究,选取2020年9月至2022年9月在重庆医科大学附属儿童医院泌尿外科排尿障碍诊治中心进行尿动力压力-流率检查的343例遗尿患儿为研究对象,根据尿动力检查结果将患儿分为有膀胱功能障碍组(n=157)和无膀胱功能障碍组(n=186),比较两组一般情况(性别、父母文化、居住环境、睡前饮水、遗尿史、大便情况、日间症状、每周遗尿次数、膀胱容量、尿流率、残余尿、脊柱裂)、尿常规、泌尿系超声、X线骶尾椎平片、自由尿流率。结果343例遗尿患儿中,男性200例、女性143例,就诊年龄(7.85±2.36)岁。男性(OR=2.156,95%CI:1.085~4.285)、伴有日间症状(OR=4.471,95%CI:2.229~8.967)、功能性膀胱容量减小(OR=20.651,95%CI:9.094~46.895)、遗尿次数每周超过4次(OR=2.339,95%CI:1.131~4.838)、尿流率降低(OR=3.196,95%CI:1.360~7.510)、隐性脊柱裂(OR=2.359,95%CI:1.160~4.794)是儿童发生膀胱功能障碍的独立危险因素。结论男性、伴有日间症状、隐性脊柱裂、遗尿次数>4次、生理性膀胱容量减小以及尿流率降低可能与遗尿儿童发生膀胱功能障碍有关,这些遗尿患儿有必要常规行尿动力学检查了解膀胱功能,为规范诊疗提供依据。Objective To explore the risk factors of bladder dysfunction in children with nocturnal enuresis(NE).Methods From September 2020 to September 2022,343 NE children receiving urinary dynamic pressure-flow rate examination at Urinary Disorders Diagnosis and Treatment Center were selected as study subjects.According to the urodynamic results,they were assigned into two groups of bladder dysfunction(n=157)and non-dysfunction(n=186).Two groups were compared with regards to general profiles(gender,parental education,living environment,bedtime drinking water,history of enuresis,stool,daytime symptoms,weekly frequency of enuresis,bladder volume,urinary flow rate,residual urine&spina bifida),urinary routine,urological system ultrasonography,bococcygeal plain film and free urinary flow rate.Results There were 200 boys and 143 girls with a treatment age of(7.85±2.36)years.Male(OR=2.156,95%CI:1.085-4.285),daytime symptoms(OR=4.471,95%CI:2.229-8.967),lowered functional bladder volume(OR=20.651,95%CI:9.094-46.895),weekly frequency of enuresis>4 times(OR=2.339,95%CI:1.131-4.838),reduced urinary flow rate(OR=3.196,95%CI:1.360-7.510)and occult spina bifida(OR=2.359,95%CI:1.160-4.794)were independent risk factors for bladder dysfunction in children.Conclusions Male,daytime symptoms,occulted spina bifida,weekly frequency of enuresis>4 times,lowered physiologic bladder volume and decreased urinary flow rate are risk factors for bladder dysfunction in NE children.Routine urodynamic examination is necessary to understand bladder function and provide rationales for standardized management.

关 键 词：遗尿 膀胱功能障碍 尿动力 外科手术 儿童 

分 类 号：R726.9[医药卫生—儿科]