脊髓损伤患者逼尿肌厚度与下尿道功能的关系  

Detrusor wall thickness and lower urinary tract function after spinal cord injury

作　　者：朱红军[1] 张大伟[1] 昝云强[1] 刘传道[1] 冯金法[1] 沈卫东[2] 杨卫新[1] 

机构地区：[1]苏州大学附属第一医院康复医学科,苏州215006 [2]苏州大学附属第一医院影像科,苏州215006

出　　处：《中华物理医学与康复杂志》2014年第3期185-189,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：CYRUSTANGFOUNDATION（USA）资助

摘　　要：目的通过超声测量观察脊髓损伤后神经源性下尿道功能障碍（NLUTD）患者逼尿肌厚度（DWT）的变化，探讨患者DWT与膀胱容量（BC）及下尿道功能障碍类型的关系，并评估DWT在脊髓损伤患者风险预判中的作用。方法选取成年脊髓损伤合并下泌尿道功能障碍的患者48例作为病例组；另选取正常成年受试者41例作为对照组。2组患者均进行尿流动力学和最大膀胱容量（MBC）检测，并采用8～13MHz线阵超声探头测定膀胱前壁的DWT。根据逼尿肌漏尿点压，将病例组分为高危患者（逼尿肌漏尿点压≥40cmH2O）和低危患者（逼尿肌漏尿点压〈40cmH：O），并鉴别高危患者与低危患者的DWT临界值。结果MBC时，病例组DWT为（0．97±0．31）mm，对照组DWT为（0．59±0．08）mm，差异有统计学意义（P〈0．05）。病例组中，逼尿肌-尿道外括约肌收缩失协调（A型）患者的DWT为（1．10±0．54）mm，较逼尿肌无收缩而尿道外括约肌有收缩（C型）患者的DWT增加显著（P〈0．05）。病例组DWT与逼尿肌漏尿点压存在相关性（r=0．77，P〈0．01），当DWT≥0．87mm（敏感度为89．5％、特异度为58．6％）可作为预判NLUTD患者存在。肾功能损伤风险的临界值。结论脊髓损伤患者DWT显著增加，且DWT与逼尿肌漏尿点压呈正相关，表明DWT可用于脊髓损伤后NLUTD患者肾脏损害的风险评估。Objective To determine any relationship among detrusor wall thickness （DWT） , bladder ca- pacity （BC） and neurogenic lower urinary tract dysfunction （NLUTD） , and to study the clinical implications of using DWT to predict the risk of renal injury after spinal cord injury （SCI）. Methods Forty-eight adults with NLUTD due to SCI were recruited for the SCI group, and another 41 healthy adults formed a control group. Both groups underwent urodynamie evaluation and maximum bladder capacity （MBC） detection. The DWT of all sub- jects was measured by ultrasound imaging of the anterior bladder wall. Thereafter, the SCI group was divided into low and high risk subgroups based on the results of the urodynamic tests. Patients with detrusor leak point pressure 〈 40 cmH20 were classified as low risk. Results At MBC, the average DWT in the SCI group was （0.97 ＋ O. 31 ）mm and （0.59 ：t：0.08）mm in the control group, demonstrating a significant difference in DWT between pa- tients with NLUTD and normal adults. The average DWT among the patients with type A detrusor sphincter dyssyn- ergia was （ 1.10 ＋ 0.34） mm, which was significantly higher than among the patients with external urethral sphinc- ter contraction without detrusor contraction （ type C）. DWT was significantly correlated with detrusor leak point pressure. A DWT of 0.87 mm （ sensitivity 89.5% , specificity 58.6% ） could be used as a critical point for pre- dicting risk of renal injury in patients with NLUTD. Conclusions DWT is significantly greater among SCI pa- tients with NLUTD and it correlates positively with detrusor leak point pressure. DWT could be used as a risk pre- dictor for renal injury in patients with NLUTD due to SCI.

关 键 词：逼尿肌厚度 超声 脊髓损伤 神经源性下尿道功能障碍 

分 类 号：R651.2[医药卫生—外科学]