不同剂量A型肉毒素经尿道膀胱壁注射治疗脊髓损伤患者神经源性尿失禁的疗效对比  

Efficacy of Botulinum-A toxin injection into bladder to treat neurogenic incontinence in patients with spinal cord injury： comparison of two doses

作　　者：付光[1] 吴娟[1] 丛慧玲 查丽华[1] 李东[1] 鞠彦合[1] 陈国庆[1] 熊宗胜[1] 廖利民[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北京博爱医院泌尿外科,100068

出　　处：《中华医学杂志》2015年第48期3920-3923,共4页National Medical Journal of China

摘　　要：目的 评估A型肉毒素膀胱壁注射治疗脊髓损伤患者神经源性尿失禁的疗效,对比注射200 U和300 U不同剂量的临床效果.方法 统计2009年1月至2014年10月期间中国康复研究中心北京博爱医院收治的损伤平面在骶髓以上的脊髓损伤患者60例,男56例、女4例,平均年龄32岁.所有患者术前均记录排尿日记并行影像尿动力学检查.患者应用随机数字表分为200 U组和300 U组,每组30例.200 U组：将200 U的A型肉毒素溶解于10 ml生理盐水,使用膀胱镜注射针分20个点注射于膀胱壁,其中10个点注射在膀胱三角区以外的膀胱壁,10个点注射在膀胱三角区,0.5 ml/点;300 U组：将300 U的A型肉毒素溶解于15 ml生理盐水,使用可弯曲膀胱镜注射针分30个点注射于膀胱三角区以外的膀胱壁,0.5 ml/点.随访期间记录排尿日记、复查影像尿动力学检查以评估疗效并观察毒副作用.结果 治疗前200 U组和300 U组每日平均尿失禁次数分别为（15.2±3.2）次/d、（16.2±2.9）次/d,注射后第4周,200 U组和300 U组每日平均尿失禁次数分别降低到（2.9±1.2）次/d、（2.5±1.4）次/d,两个剂量组注射治疗后尿失禁次数均降低（P＜0.05）,而两个剂量组间控尿率差异无统计学意义[63％ （19/30）比70％ （21/30）,P＞0.05].注射后起效平均时间为1周,注射后第4周时影像尿动力学结果表明两组最大膀胱测压容积、充盈末最大逼尿肌压力、膀胱顺应性均较注射前显著改善（均P ＜0.05）,而两个剂量组间差异均无统计学意义（均P＞0.05）.平均随访时间（6.3±1.2）个月,随访期间两组均未观察到毒副作用.结论 200 U包含膀胱三角区的注射方案与常规的300 U避开膀胱三角区的注射方案短期疗效基本相当,是一种治疗脊髓损伤患者神经源性尿失禁有效、安全的治疗方法.Objective To evaluate the efficacy of Botulinum-A toxin injection into bladder to treat neurogenic incontinence in patients with spinal cord injury and compare effectiveness of two different doses （200 U and 300 U）.Methods Between January 2009 and October 2014,A total of 60 adult patients with spinal cord injury above the sacral （mean age,32 years;male 56,female 4） were selected in Beijing Bo＆#39;ai Hospital of China Rehabilitation Research Center.All the patients kept voiding diary and underwent urodynamic examination before operation.All the patients were allocated with a random number table into 200 U Botulinum-A toxin injection group or 300 U group （both n =30）.In the 200 U group,200 U of Botulinum-A toxin were dissolved in 10 ml of normal saline,which was injected into 20 different sites （0.5 ml for each site） of bladder wall,including 10 outside the bladder trigone and the remaining 10 inside trigone.In the 300 U group,300 U of Botulinum-A toxin were dissolved in 15 ml of normal saline,which was injected into 30 different sites （0.5 ml for each site） in bladder outside of the bladder trigone using a flexible cystoscopic needle.The evaluation of the effects and follow-up included voiding diary,urodynamic testing and observation of adverse and toxic effects.Results At baseline,mean urinary incontinence frequencies were （15.2 ± 3.2） episodes/day and （16.2 ± 2.9） episodes/day in 200 U and 300 U group,which reduced to （2.9 ± 1.2） episodes/day and （2.5 ± 1.4） episodes/day,respectively in week 4 （P 〈 0.05）.However,continence rate was not significantly different between the two dose groups [63% （19/ 30） vs 70% （21/30）,P 〉 0.05].The effect of botulinum-A toxin started to be observed from the 1st posttreatment week on average.Obvious improvements in maximum cystometric capacity,end-filling maximum detrusor pressure,and bladder compliance were observed at week 4 as shown by urodynamics （all P 〈 0.05）,but with no significant difference between the 200 U an

关 键 词：尿失禁 脊髓损伤 A型肉毒素 膀胱镜检查 

分 类 号：R651.2[医药卫生—外科学]