颈胸段完全性脊髓损伤患者尿动力学的特点与处理  

Video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients

作　　者：吴娟[1] 付光[1] 廖利民[1] 李丹[1] 鞠言合[1] 李东[1] 梁文立[1] 熊宗胜[1] 

机构地区：[1]首都医科大学康复医学院中国康复研究中心附属北京博爱医院泌尿外科,100068

出　　处：《中华医学杂志》2013年第42期3343-3346,共4页National Medical Journal of China

摘　　要：目的 分析颈胸段完全性脊髓损伤患者影像尿动力学检查特点及泌尿系统处理方法与疗效.方法 回顾性分析2008年1月至2010年5月中国康复研究中心附属北京博爱医院收治的颈胸段完全性脊髓损伤患者113例的影像尿动力学检查结果和泌尿系统管理方法,追踪3年后其泌尿系统情况及并发症的发生情况.结果 113例中82例（72.57%）表现为逼尿肌过度活动,31例（27.43%）表现为逼尿肌无反射;71例（62.83%）出现逼尿肌-外约肌协同失调,59例（52.21%）表现为膀胱顺应性下降,6例（5.31%）出现膀胱输尿管反流;12例（10.62%）超声检查发现肾积水.根据检查结果对逼尿肌过度活动的患者选择口服抗胆碱能制剂、A型肉毒毒素注射等方法,对逼尿肌无反射的患者进行规律间歇导尿进行膀胱训练.追踪随访3年,治疗效果满意,发生膀胱结石2例,泌尿系统感染7例,未出现其他特殊并发症.结论 颈胸段完全性脊髓损伤患者影像尿动力表现不尽相同,大部分患者表现为逼尿肌过度活动,同时合并逼尿肌括约肌协同失调,膀胱顺应性下降,选择适当的治疗方法能有效的保护上尿路功能,预防泌尿系统并发症.Objective To explore the video-urodynamic characteristics and management in complete cervical and thoracic spinal cord injury patients. Methods Video-urodynamic examination was performed in 113 patients with complete cervical and thoracic spinal cord injury from January 2008 to May 2010. And their characteristics, managements and 3-year follow-up outcomes were reviewed and analyzed retrospectively. Results Among them, there were detrusor overactivity （ n = 82, 72. 57% ）, detrusor areflexia （n = 31, 27. 43% ）, detrusor external sphincter dyssynergia （ n = 71, 62. 83% ）, low-compliance （n =59, 52. 21% ）, reflux （n =6, 5. 31% ） and ultrasonic uronephrosis （n = 12, 10. 62% ）. According to the result of the video-urodynamic examination, detrusor overactivity patients chose oral anticholinergic agents, botulinum toxin type A injection method, detrusor areflexia patients chose regular intermittent catheterization for bladder training. During a 3-year follow-up, there were cystic calculus （ n = 2） and urinary infection （ n = 7 ）. No special complication occurred. Conclusions The video-urodynamic characteristics vary in complete cervical and thoracic spinal cord injury patients. The major symptoms include detrusor overactivity, detrusor external sphincter dyssynergia and low-compliance bladder. Proper management is essential for protecting upper urinary tract and preventing urinary system complication.

关 键 词：脊髓损伤 尿动力学 治疗 

分 类 号：R651.2[医药卫生—外科学]