体位对女性尿失禁B超影像尿动力检查的影响  

Effects of lying and sitting positions on ultrasound urodynamic parameters in women with incontinence

作　　者：文建国[1] 张国贤[1] 张鹏[1] 刘奎[1] 王庆伟[1] 李源[1] 车英玉[1] 张瑞莉[1] 乔保平[2] 

机构地区：[1]郑州大学第一附属医院尿动力学中心,河南省高校临床医学重点学科开放实验室,郑州450052 [2]郑州大学第一附属医院泌尿外科,郑州450052

出　　处：《医学信息（手术学分册）》2007年第12期1099-1102,共4页Medical Information Operations Sciences Fascicule

基　　金：河南省高等学校创新人才培养工程(2002~2007);河南省杰出人才创新基金(0221002000);国家自然科学基金(30571931)资助项目

摘　　要：目的探讨平卧位和坐位对女性各型尿失禁患者B超影像尿动力检查的结果影响。方法选取女性尿失禁患者78例(年龄24～76岁,平均51岁),按照国际尿控协会推荐标准方法分别于平卧位和坐位行B超、膀胱压力流率和静态尿道压测定,比较两次检查结果。结果坐位和平卧位相比,初始尿意容量(91±29vs103±35)ml,正常排尿感容量(251±97vs289±109)ml,强烈排尿感容量(402±117vs451±124)ml,最大膀胱测压容量(434±129vs.486±134)ml,排尿时间(56±29vs68±32)s,VLPP(105±48vs91±39)cmH2O均显示坐位显著小于平卧位测得的值(P<0.05);坐位测得的最大尿流率(23.3±8.5)ml/s大于平卧测得的最大尿流率(19.5±7.8)ml/s。在压力性尿失禁和混合性尿失禁中,平卧位B超观察发现静止期膀胱颈口呈现漏斗状开放分别为2例和1例,而在坐位为10例和8例,两者之间有统计学差异(P<0.05);在压力性尿失禁、急迫性尿失禁、混合性尿失禁的检出率,坐位分别检出31例、14例、10例,而平卧位分别检出16例、5例、2例,两者之间有统计学差异(P<0.05)。结论坐位较平卧位符合排尿习惯,更能使盆底肌肉放松;对各型女性尿失禁的评估更加准确、敏感。在B超影像尿动力检查测定中我们推荐受试者首先采用平卧位插入测压导管,然后患者改为坐位进行B超和膀胱压力/流率测定。Objective To investigate the effects of lying and sitting positions on ultrasound urodynamic parameters in women with incontinence. Methods Seventy - eight women [ Mean age was 51 （ 24 - 76 ） years ] with incontinence were selected and ultrasound, filling cystometry and the static urethral pressure profile were performed both in the lying and sitting positions according to the recommendations of the International Continence Society （ICS）. For filling cystometry,we infused normal saline at a rate of 50 ml/min. Results In sitting position ,first desire to void （FDV） ,normal desire to void （NDV）, strong desire to void （SDV）, maximum cystometric capacity （MCC）, voiding time, and valsalva leakage point pressure （VLPP） were all significantly lower,while Qmax was higher and voiding time was shorter, than those in supine position （ P 〈 0.05 ）. In patients with stress and mixed incontinence, the flask - shaped bladder neck was detected by ultrasound in 2 and 1 cases in lying position and 10 and 8 cases in sitting positions, the difference was significant （P 〈 0.05 ）. Thirty -one, 14 and 10 cases showed stress ,urgency and mixed incontinence, respectively, in sitting position, compared 16,5, and 2 cases in lying position was significant different （ P 〈 0.05 ）. Conclusions This study explains the higher detection rate of incontinence and morphology changes of bladder neck by ultrasound urodynamic study. Therefore, we recommend that sitting posture is preferred over lying position for performing urodynamic study.

关 键 词：超声影像尿动力学 体位 女性 尿失禁 

分 类 号：R694.54[医药卫生—泌尿科学]