不同梗阻程度下前列腺增生患者的尿动力学分析  

Urodynamic analysis in benign prostatic hyperplasia patients with different degrees of obstruction

作　　者：刘丹丹 陈敏[1] 韩晓敏 李莹 LIU Dandan;CHEN Min;HAN Xiaomin;LI Ying(Department of Urology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022

出　　处：《临床泌尿外科杂志》2018年第9期730-733,737,共5页Journal of Clinical Urology

摘　　要：目的:比较不同梗阻程度下良性前列腺增生(BPH)患者的尿动力学差异,分析尿动力学参数与膀胱出口梗阻(BOO)之间的关系,为临床医生的诊疗提供依据。方法:回顾性分析临床诊断为BPH患者的尿动力学资料,收集最大尿流率(Q_(max))、剩余尿(PVR)、最大尿流率逼尿肌压(PdetQ_(max))、最大瓦特因子(WF_(max))、Schaefer列线图梗阻程度、膀胱出口梗阻指数(BOOI)等参数。按照LinPURR中Schaefer列线图梗阻程度将患者分为0~Ⅵ级7组,采用Kruskal-Wallis非参数检验,分析不同梗阻程度下BPH患者的尿动力学差异。结果:本组455例患者,年龄36~87岁,平均(57.0±17.9)岁。Schaefer列线图无梗阻者(0~Ⅰ级)136例(29.9%),可疑梗阻者(Ⅱ级)87例(19.1%),梗阻者(Ⅲ~Ⅵ级)232例(51.0%)。从0~Ⅵ级梗阻Q_(max)逐渐降低,WF_(max)、PVR、P detQ_(max)、BOOI逐渐增加(P<0.05)。结论:随着BOO程度的增加,Q_(max)逐渐降低,PVR、PdetQ_(max)、WF_(max)和BOOI逐渐增加。当Q_(max)<8.96 ml/s,且PVR>86.77 ml,PdetQ_(max)>57.65cmH_2O,WF_(max)>11.52 W/m^2,BOOI>39.73时,则可以判定存在BOO,PVR、PdetQ_(max)、WF_(max)、BOOI值越高,梗阻程度越重;而当Q_(max)>13.08ml/s,且PVR<52.39ml,PdetQ_(max)<33.44cmH_2O,WF_(max)<9.08 W/m^2,BOOI<7.28,则可以判定无BOO。而在此范围之外者,则存在可疑梗阻。Objective：To compare the difference of urodynamic parameters among benign prostatic hyperplasia patients,and analyze the relationship between urodynamic parameters and bladder outlet obstruction.Then to provide the basis for clinical doctor＇s diagnosis and treatment.Method：This study included a retrospective collection of urodynamic data with benign prostatic hyperplasia patients.The parameters of Qmax,PVR,PdetQmax,WFmax,and bladder outlet obstruction index（BOOI）were collected.According to Schaefer nomogram,patients were divided into seven groups from grade 0 to gradeⅥ.All parameters in seven groups were analyzed by Kruskal-Wallis test statistical analysis.Result：A total of 455 men were included.The mean age was（57.0±17.9）years old,ranging from 36 to 87 years old.Among all patients,136（29.9%）patients were without obstruction（grade 0-Ⅰ）,obstruction was suspected in 87（19.1%）patients（gradeⅡ）,while 232（51.0%）patients were with obstruction（gradeⅢ-Ⅵ）.The Qmax decreased gradually,while PVR,PdetQ（max）,WF（max）,BOOI increased gradually from grade 0 to Ⅵ（P〈0.05）.Conclusion：Qmax continuously decreases with rising BOO grade.Parameters of PVR,PdetQmax,WFmax and BOOI increase with rising BOO grade.If Qmax〈8.96 ml/s,PVR〉86.77 ml,PdetQmax〉57.65 cmH2O,WFmax〉11.52 W/m^2,BOOI39.73 were found,there must be obstruction.The higher the number of PVR,PdetQmax,WF（max）,BOOI,the more severe the obstruction is.If Qmax 〉13.08 ml/s,PVR〈52.39 ml,PdetQmax〈33.44 cmH2O,WFmax〈9.08 W/m^2,BOOI〈7.28 were found,these mean no obstruction.Otherwise,obstruction may be suspected.

关 键 词：膀胱出口梗阻 良性前列腺增生 尿动力学 

分 类 号：R697[医药卫生—泌尿科学]