托特罗定在小儿神经原性膀胱的应用评价  

The evaluation of tolterodine on children with neurogenic bladder

作　　者：孙小兵[1] 李殿国[1] 张丽[1] 王若义[1] 刘倩[1] 李艳华[1] 陈维秀[1] 李金良[1] 陈雨历[1] 

机构地区：[1]山东大学第二医院小儿外科,济南250033

出　　处：《中华小儿外科杂志》2011年第3期199-201,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的 评价托特罗定治疗小儿神经原性膀胱的有效性和安全性。方法 随访126例2002年1月至2009年9月收治的神经原性膀胱患儿，男71例，女55例，年龄（6．2±3．1）岁，全部病例行清洁间歇导尿，81例同时服用托特罗定（0．1mg·kg-1·d-1，2次／d），45例未服用托特罗定。就诊时和治疗3个月后分别行尿动力学和临床评价。结果 导尿＋药物组中8例因副作用终止治疗，其中3例出现口干，2例头晕，3例便秘加重，73例坚持服用托特罗定。就诊时导尿组膀胱容量、膀胱顺应性、逼尿肌压分别为（119．3±19．6）ml、（4．0±1．1）ml／cmH2O、（56．7±10．4）cmH2O。3个月后膀胱容量、膀胱顺应性、逼尿肌压压分别为（122．0±20．1）ml、（4．1±1．1）ml／cmH2O、（55．8±10．9）cmH2O，无明显变化。11例（24．4％）逼尿肌过度活动减轻，13例（28．9％）漏尿分数下降。药物＋导尿组就诊时膀胱容量、膀胱顺应性、逼尿肌压分别为（119．8±17．6）ml、（4．4±1．3）ml／cmH2O、（55．1±11．7）cmH2O，3个月后膀胱容量、膀胱顺应性、逼尿肌压分别为（149．6±23．1）ml、（7．5±2．3）ml／cmH2O、（38．4±11．6）cmH2O，膀胱容量、膀胱顺应性明显增加，膀胱内压降低。58例（79．5％）逼尿肌过度活动减轻，53例（73％）漏尿分数下降及家长表示满意。结论 托特罗定可抑制逼尿肌过度活动，降低膀胱内压，增加膀胱顺应性和膀胱容量，较少有副作用，有利于保护上尿路功能，并可减轻尿失禁的程度，对于反射亢进型小儿神经原性膀胱的治疗是安全、有效的。Objective To evaluate the efficacy and safety of toheroding to treat neurogenic blad- der in children. Methods 126 patients （71 boys and 55 girls of 6. 2±3.1 years old） with hyperreflexia neurogenic bladder who were treated during January 2002 to September 2009 were followed up. All patients were performed clean intermittent catheterization. 81 patients took toherodine（0.lmg,kg-1·d-1 ,2 times/d） and 45 patients did not use toherodine. Urodynamic and leakage score were evaluated before the treatment and 3 months later. Results 8 patients stopped toherodine due to side effect, such as dry mouth in 3, dizziness in 2, sever constipation in 3. 73 patients took toherodine all the time. Before treatment, the bladder volume, compliance and detrusor pressure in catheterization group were 119. 3 ±19. 6 ml,4. 0 ± 1. lml/cmH2O,56. 7 ± 10. 4 cmH2O, respectively. Three months after the treatment, bladder volume, compliance and detrusor pressure were 122. 0 ± 20. 1 ml,4. 1 ± 1. 1ml/ cmH2O,55.8 ± 10. 9 cmH2O, respectively. There was no significant difference. Detrusor overactivity in 11 patients（24. 4%）and leakage score in 13 patients （28. 9%）decreased. Bladder volume, compliance and detrusor pressure in catheterization ＋ toherodine group in the beginning were 119. 8 ± 17. 6 ml,4. 4 ±1.3ml/cmH2O ,55.1 ± 11.7 cmH2O, respectively. 3 months later, bladder volume, compliance and detrusor pressure were 149. 6±23. 1 ml,7. 5±2. 3ml/cmH2O ,38.4±11.6 cmH2O, respectively. Bladder volume and compliance increased and detrusor pressure decreased significantly. Detrusor overactivity in 58 patients（79. 5 %） and leakage score in 53 patients （73 %） decreased. The parents satisfied with this result. Conclusions Toherodine could inhibit the detrusor overactivity, so it could decrease detrusor pressure and increase bladder volume and compliance and protect kidney. It was effective to the children with hyperreflexia nerurogenic bladder.

关 键 词：膀胱 神经原性 尿动力学 胆碱能拮抗剂 

分 类 号：R726[医药卫生—儿科]