小儿神经源性膀胱不同充盈期顺应性与上尿路扩张的关系研究  

The study on the relationship between bladder compliance and detrusor pressure at different bladder filling Stages and upper urinary tract dilatation

作　　者：文建国[1] 姚亚雄[1] 张国贤[1] 王庆伟[2] 娄安峰[1] 王焱[1] 邢璐[1] 王亚伦[3] 

机构地区：[1]郑州大学第一附属医院小儿尿动力学中心河南省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 [3]郑州大学第一附属医院神经内科

出　　处：《临床泌尿外科杂志》2012年第2期124-128,130,共6页Journal of Clinical Urology

基　　金：国家自然科学基金(No:30901485);河南省医学科技攻关计划资助项目(No:200801002);郑州市技术研究与开发经费支持项目(No:074SGHH32262)

摘　　要：目的:探讨小儿神经源性膀胱不同充盈期顺应性(BC)与上尿路扩张的关系,了解分别测定膀胱充盈早期、中期BC是否能比常规尿动力学检查测定的充盈期BC更好地预测神经源性膀胱患儿上尿路扩张(UUTD)。方法:随机选取138例神经源性膀胱患儿,根据泌尿系造影和B超检查结果,将有UUTD的32例患儿作为UUTD组,3～16岁,(8.9±3.1)岁,其余为无UUTD组,3～16岁,(8.0±5.4)岁;分别将膀胱充盈早期、中期和末期的BC进行比较。结果:BC以膀胱充盈中期小于8ml/cmH2O、充盈末期小于8ml/cmH2O为标准预测UUTD的特异度略高于以充盈末期以BC小于9ml/cmH2O为标准预测UUTD的特异度(73%、71%vs.62%);△Pdet以膀胱充盈早期大于8cmH2O、中期大于20cmH2O和末期大于25cmH2O为标准预测UUTD的灵敏度明显高于膀胱充盈末期△Pdet>40cmH2O为标准预测UUTD的灵敏度(81%、84%、84%vs.50%)。结论:充盈中、末期BC降低和充盈早、中、末期△Pdet升高是神经源性膀胱功能障碍患儿并发UUTD的相关因素,与现在常规预测方法相比以充盈中、末期△Pdet能更准确地预测NBD患儿并发UUTD。Objective：To explore relationship between bladder compliance（BC） and detrusor pressure（△Pdet） at different bladder filling Stages and upper urinary tract dilatation. Method：One hundred and thirty eight children（3~16 y） with neurogenic bladder dysfunction were divided into two groups by using urography and Bultrasound：UUTD group,32 cases and control group,106 cases.Urodynamic studies were performed and the filling phase was divided into 3 equal parts defined as the early,middle and end bladder filling stage.Different stages were analyzed by One-factor Analysis of Variance and Receiver Operating Characteristic（ROC） Curve. Result：The children in UUTD group were found to have a significant lower BC in the middle and end bladder filling stage and higher △Pdet in the early,middle and end bladder filling stage than that of control group（P0.05）.As a prediction of UUTD,according to the ROC curve the bladder compliance which is lower than 8 ml/cmH2O in middle bladder filling stage and lower than 8 ml/cmH2O in end stage is more specific than that of lower than 9 ml/cmH2O at the end stage of bladder filling（73%、71%vs.62%）,and the △Pdet higher than 8 cmH2O in early,20cmH2O in middle and 25 cmH2O in the end bladder filling stage is more sensitive than that of higher than 40 cmH2O at the end filling phase（81%、85%、84%vs.50%）.The △Pdet higher than 20 cmH2O in middle bladder filling stage had a good prediction according to the area under the ROC curve criterion. Conclusion：The lower bladder compliance in early and end bladder filling stage and the higher △Pdet in early,middle and end bladder filling stage are good factors to predict UUTD.Both middle and end bladder filling stage △Pdet show a good prediction of UUTD.

关 键 词：神经源性膀胱 上尿路扩张 

分 类 号：R694[医药卫生—泌尿科学]