尿流动力学检查在胸腰段脊髓损伤神经源性膀胱输尿管返流评估中的意义  

The significance of urodynamic analysis in evaluating neurogenic vesicoureteral reflux in patients with tho- racolumbar spinal cord injury

作　　者：沈峰[1] 王惠芳[1] 

机构地区：[1]同济大学附属上海市养志康复医院(上海市阳光康复中心),上海201619

出　　处：《中华物理医学与康复杂志》2015年第7期528-530,共3页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：上海市残疾人康复科研项目（K201024）

摘　　要：目的探讨尿流动力学在胸腰段脊髓T10～L2损伤神经源性膀胱合并输尿管返流患者评估中的临床意义。 方法选取胸腰段脊髓损伤T10～L2排尿障碍合并膀胱输尿管返流患者26例，经膀胱尿道造影成像联合尿流动力学检测，将其分为逼尿肌反射亢进组（n=21）和逼尿肌无反射组（n=5），并对2组在输尿管返流点和漏尿点的膀胱容量、逼尿肌压以及膀胱顺应性进行测定，应用SPSS 14.0进行数据处理和分析。 结果经膀胱尿道造影成像联合尿流动力学检测发现，逼尿肌反射亢进组患者输尿管返流点的膀胱容量和顺应性分别为（122.46±87.89）ml和（5.94±4.96）ml/H2O，与逼尿肌无反射组比较，差异均有统计学意义（P〈0.01）；逼尿肌反射亢进组患者膀胱漏尿点的膀胱容量、逼尿肌压和顺应性分别为（210.81±69.72）ml、（42.29±9.57）cm H2O和（9.53±5.43）ml/H2O，与逼尿肌无反射组比较，差异均有统计学意义（P〈0.01）；且逼尿肌反射亢进组输尿管返流点的逼尿肌压与组内膀胱漏尿点的逼尿肌压比较，差异亦有统计学意义（P〈0.01）。 结论T10～L2脊髓损伤神经源性膀胱逼尿肌反射亢进患者在膀胱容量较小、顺应性较低，伤后早期即出现膀胱输尿管返流，发生返流时逼尿肌压〈40cm H2O；而逼尿肌无反射患者在逼尿肌压较低时亦会出现输尿管返流和膀胱漏尿。Objective To investigate the utility of urodynamie testing in the evaluation of neurogenie vesieoureteral reflux in patients with thoracolumbar spinal cord injury at the T10 to L2 level. Methods Twenty-six patients with thoracolumbar spinal cord injury at the T10 to L2 level and who displayed vesicoureteral reflux were enrolled and divided into a detrusor hyper-reflexia group （ n = 21 ） and a detrusor a-reflexia group （ n = 5 ） according to their cystourethrograms and urodynamic test results. Their bladder volume, detrusor pressure （Pdet） and compliance were observed and analyzed at the vesicoureteral reflux point and the leak point. Results The bladder volume and compliance of the detrusor hyper-reflexia group at the vesieoureteral reflux point were （ 122.46 ± 87.89 ） ml and （ 5.94 ± 4.96 ） ml/H2O respectively, significantly different from the detrusor a-reflexia group （ P 〈 0.01 ）. At the leak point, the average bladder volume of the detrusor hyper-reflexia group was （210.81 ± 69.72） ml, while the average bladder compliance was （9.53 ± 5.43 ） ml/H2O and the average detrusor pressure was （42.29 ± 9.57）cm HE2O. All were significantly different from the detrusor a-reflexia group＇s averages. Moreover, there was a significant difference in the Pdet between the leak point and the vesicoureteral reflux points in the detrusor hyper-reflexia group. Conclusions Patients with thoraeolumbar spinal cord injuries at the T10 to L2 level with neurogenie bladder and detrusor hyper-reflexia have low bladder volumes and compliance, and vesicoureteral reflux tends to occur at an early stage after injury with a destrusor pressure lower than 4-0 cm HE2O. For patients with detrusor a-reflexia, vesicoureteral reflux and bladder leakage may occur when detrusor pressure is low.

关 键 词：脊髓损伤 神经源性膀胱 膀胱输尿管返流 尿流动力学 

分 类 号：R694[医药卫生—泌尿科学] R651.2[医药卫生—外科学]