脊髓损伤患者下尿路功能障碍的尿动力学检查  

Urodynamics of neurogenic lower urinary tract disfunction caused by spinal cord injury

作　　者：韩春生[1] 戴凤君[1] 周国昌[1] 

机构地区：[1]中国康复研究中心附属博爱医院外科,北京100077

出　　处：《中华外科杂志》2002年第6期441-444,共4页Chinese Journal of Surgery

摘　　要：目的　提高对神经源性下尿路功能障碍患者的诊断水平 ,并为针对性选择康复手段提供可靠依据。　方法　对 2 2 0例不同损伤平面和程度的脊髓损伤患者进行尿动力学检查 ,其中 10 0例患者常规测定膀胱压力容积和尿道压力图 ,另 12 0例患者采用膀胱 外括约肌压同步连续测定法分别记录膀胱容量为 10 0ml时的逼尿肌压、反射排尿时的最大逼尿肌压、最大尿道压 ,并对所得结果进行统计学分析。　结果　除圆锥马尾损伤组的最大尿道压 (83± 38)cmH2 O(1cmH2 O =0 0 98kPa)和动态逼尿肌压 (12± 10 )cmH2 O低于其他各组 ,其差异有显著意义 (t=2 0 96～ 2 6 5 6 ,P <0 0 5 )外 ,不同损伤组患者膀胱顺应性降低的发生率相似 (分别为 5 1 2 % ,5 2 4 %和 5 0 % ) ;同组不同损伤程度患者间各项参数比较差异无显著意义 (t=1 0 2 3,P >0 0 5 )。 12 0例患者根据膀胱 外括约肌压同步连续测定法记录尿道压曲线发现 ,其曲线形状大致可分为 4型。　结论　除圆锥马尾损伤组的最大尿道压和动态逼尿肌压低于其他各组外 ,其他参数与损伤平面和损伤程度无关。圆锥马尾损伤组多为不完全性损伤 ,故而逼尿肌括约肌协同失调的发生率较低。Objectives To improve the diagnosis of patients with neurogenic lower urinary tract dysfunction and to provide a basis for proper selection of rehabilitation methods. Methods The urodynamics was tested with Assend Urodynamic Instrument in 220 patients with spinal cord injury. Of these patients, 100 received regular cystometrograrhy (CMG) and urethal pressure profile (UPP) test, and the remaining patients were measured by bladder/external sphincter pressure profile. The detrusor pressure, maximum detrusor voiding pressure, and maximum urethral pressure were recorded. The date from the tests were processed with SPSS 8 0 (independent samples T test). Results The maximum urethal pressure (83±39) cm H 2O (1 cm H 2O=0.098 kPa) and maximum voiding detrusor pressure (12±10) cm H 2O were lower in coda equina group than in other groups ( t =2 096, P <0 05). The group with different spinal cord injury had almost an equal ratio of low bladder compliance (51 2%, 52 4% and 50% separately) Statistical differences were found between complete injury and incomplete injury in each group( t =1 023, P >0 05). In bladder/external sphincter cystometry, urethral pressure profile could be classified into four types. Conclusions The maximum urethral pressure and maximum pressure of detrusor contractile were lower in the cauda equina injury group than in other groups. The cauda equina injury group showed a lower incidence of detrusor sphincter because most of these patients were incompletely injured. The features of urethral pressure profile in bladder/external sphincter cystometry resulted from the abnormal contraction of external sphincter and periurethral striated muscles.

关 键 词：脊髓损伤 下尿路功能障碍 尿动力学检查 尿失禁 

分 类 号：R744.904[医药卫生—神经病学与精神病学]