动态尿动力学和常规尿动力学检查评估难治性单症状性夜遗尿症的对比  

Evaluation of refractory monosymptomatic nocturnal enuresis with ambulatory urodynamics monitoring and conventional urodynamics

作　　者：贾智明 文建国[1] 朱文[1] 张瑞莉[1] 王焱[1] 张晨阳[1] 王钏宇 冶卓[1] 任川川[1] 王庆伟[1] Jia Zhiming;Wen Jianguo;Zhu Wen;Zhang Ruili;Wang Yan;Zhang Chenyang;Wang Chuanyu;Ye Zhuo;Ren Chuanchuan;Wang Qingwei(Department of Urology and Urodynamic Center,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科和尿动力中心,郑州450052

出　　处：《中华医学杂志》2021年第2期142-146,共5页National Medical Journal of China

基　　金：国家自然科学基金(U1904208);河南省科技攻关项目(182102310581)。

摘　　要：目的探索动态尿动力学检查(AUM)和常规尿动力学检查(CUD)评估难治性单症状性夜遗尿症(RMNE)患儿的尿动力学参数的对比。方法收集2017年5月—2019年9月期间于郑州大学第一附属医院泌尿外科就诊并经门诊医生详细了解患儿病史诊断为RMNE的40例患儿(男22例、女18例)的病历资料,患儿年龄9~16岁,夜间尿床频率≥2次/周。分别行CUD和1个睡眠周期AUM,分别记录尿动力学参数并进行统计比较。结果40例中有5例患儿或其父母依从性较差,中途退出研究。35例RMNE组患儿年龄(12.6±2.1)岁,男女性别比例为19∶16,遗尿症状严重程度(遗尿频率)为(4.2±1.7)次/周。与CUD组比较,AUM组膀胱顺应性(BC)[(28.4±7.7)ml/cmH2O比(23.6±6.1)ml/cmH2O(1 cmH2O=0.098 kPa)]、最大逼尿肌收缩压力(Pmax.det)[(44.6±9.1)cmH2O比(36.8±8.3)cmH2O]较高(均P<0.05)。两组间最大尿流率(Qmax)[(19.6±7.2)ml/s比(20.9±5.4)ml/s]、残余尿量(PVR)[(9.5±5.7)ml比(10.9±5.3)ml]差异无统计学意义(均P>0.05)。与CUD组比较,AUM组逼尿肌过度活动(DO)阳性率[77.1%(27/35)比45.7%(16/35)]较高(P<0.05)。其中15例(42.9%)CUD中发现DO的患儿,在AUM中同样检出DO;12例(34.3%)患儿在CUD中未发现DO,而只在AUM中检出DO。对于CUD和AUM均检出DO的15例患儿,与CUD组比较,AUM组DO发生频率[(3.1±1.0)次/h比(2.4±0.8)次/h]、DO最大值[(22.9±4.5)cmH2O比(19.2±4.0)cmH2O]较高(均P<0.05)。结论AUM可以诊断RMNE患儿是否伴有膀胱功能障碍,在评估BC、Pmax.det、DO等方面较CUD更为精确;对于CUD结果不理想的RMNE患儿,推荐进一步行AUM以明确病因。Objective To explore the clinical value of ambulatory urodynamics monitoring(AUM)in the diagnosis and treatment of children with refractory monosymptomatic nocturnal enuresis(RMNE)by comparing the urodynamic parameters of AUM with those of conventional urodynamics(CUD).Methods A total of 40 children(22 males and 18 females)diagnosed with RMNE in the First Affiliated Hospital of Zhengzhou University from May 2017 to September 2019 were collected.They were aged 9-16 years,and their frequency of nocturnal bed-wetting was≥2 times per week.CUD and one sleep cycle AUM were performed,respectively.Then,the urodynamic parameters were recorded and analyzed.Results Five of the 40 children dropped out of the study because of the poor compliance.The age of children with RMNE was(12.6±2.1)years old,the ratio of male to female was 19∶16,and the severity of enuresis(enuresis frequency)was(4.2±1.7)times per week.Compared to the CUD group,the bladder compliance(BC)[(28.4±7.7)ml/cmH2O vs(23.6±6.1)ml/cmH2O(1 cmH2O=0.098 kPa)]and maximum detrusor pressure(Pmax.det)[(44.6±9.1)cmH2O vs(36.8±8.3)cmH2O]in the AUM group were significantly higher(P<0.05).The maximum flow rate(Qmax)[(19.6±7.2)ml/s vs(20.9±5.4)ml/s]and post void residual(PVR)[(9.5±5.7)ml vs(10.9±5.3)ml]between the two groups showed no statistically significant differences(P>0.05).Detrusor overactivity(DO)was detected in 27 cases(77.1%)during AUM and in 16 cases(45.7%)during CUD;the difference was statistically significant(P<0.05).Among them,15 cases(42.9%)with DO were detected both in CUD and AUM,while 12(34.3%)with DO were not detected in CUD.For the 15 cases with DO detected by both CUD and AUM,the frequency[(3.1±1.0)times/h vs(2.4±0.8)times/h]and maximum value of DO[(22.9±4.5)cmH2O vs(19.2±4.0)cmH2O]in the AUM group were both higher than those in the CUD group(P<0.05).Conclusions Bladder dysfunction can be diagnosed in children with RMNE using AUM.Furthermore,AUM is more accurate than CUD in evaluating BC,Pmax.det,DO,and other parameters.For children wit

关 键 词：尿动力学 夜遗尿症 膀胱功能障碍 逼尿肌过度活动 

分 类 号：R726.9[医药卫生—儿科]