中枢与周围神经源性膀胱老年患者尿动力变化的比较研究  

Comparison of urodynamic changes in elderly patients with central neurogenic bladder and with peripheral neurogenic bladder

作　　者：李庆彬 左佳 张会清[1] 范毛川 窦启锋[1] 文建国 Li Qingbin;Zuo Jia;Zhang Huiqing;Fan Maochuan;Dou Qifeng;Wen Jianguo(Department of Urology,the First Affiliated Medical College of Xinziang Medical College,Xinriang 453000,China;Department of Urology,the First Affiliated Hospital of Zhengzhou University and Henan International Joint Laboratory of Pediatric Urodynamics,Zhengzhou 450052,China)

机构地区：[1]新乡医学院第一附属医学院泌尿外科,新乡453000 [2]郑州大学第一附属医院泌尿外科和河南省小儿尿动力国际联合实验室,郑州450052

出　　处：《中华老年医学杂志》2023年第7期821-825,共5页Chinese Journal of Geriatrics

基　　金：国家自然科学基金(NSFC)(81670689,U1904208)。

摘　　要：目的分析中枢性与周围神经源性膀胱(NB)老年患者尿动力变化的差异。方法选取60岁以上57例NB老年患者,根据神经损伤不同分为中枢神经损伤组(CNB)和周围神经损伤组(PNB),对两组记录的尿流动力学参数,进行比较及分析。结果和PNB相比,CNB组逼尿肌过度活动(DO)发生率[66.7%(16/24)和36.4%(12/33),χ^(2)=5.105,P=0.024]明显增加,与PNB组最大膀胱容量(MCC)[CNB组(277.8±101.1)ml和PNB组(481.4±110.2)ml,t=-7.149,P=0.001]、安全膀胱容量(SBC)[CNB组(283.2±28.8)ml和PNB组(348.6±33.9)ml,t=-7.636,P=0.000]比较差异具有统计学意义。两组在最大尿流率、残余尿量、排尿量、逼尿肌漏尿点压、最大尿流率时逼尿肌压力差异均无统计学意义(均P>0.05)。CNB组患者膀胱感觉正常8例,消失4例,减退10例,敏感2例;PNB组膀胱感觉正常9例,消失8例,减退14例,敏感2例。将两组患者不同膀胱感觉的SBC组内比较,差异均无统计学意义(均P>0.05)。结论老年人中枢与周围NB患者尿流动力学特征上存在差异。CNB组更容易出现DO和MCC及SBC减小。Objective To examine differences in urodynamic changes between central neurogenic bladder(CNB)and peripheral neurogenic bladder(PNB)in elderly patients.MethodsA total of 57 elderly patients over 60 years old with neurogenic bladder(NB)were divided into a CNB group and a PNB group based on the types of nerve injuries.Data on urodynamic parameters recorded for the two groups were compared and analyzed.ResultsThe rate of detrusor overactivity(DO)in the CNB group was significantly higher than that in the PNB group[66.7%(16/24)vs.36.4%(12/33),χ^(2)=5.105,P=0.024].There were significant differences between the two groups in maximum bladder capacity(MCC)[(277.8±101.1)in the CNB group vs.(481.4±110.2)ml in the PNB group,t=-7.149,P=0.001]and in safe bladder capacity(SBC)[(283.2±28.8)ml in the CNB group vs.(348.6±33.9)ml in the PNB group,t=-7.636,P=0.000].There was no significant difference between the two groups in the maximum urine flow rate,residual urine volume,urination volume,leak point pressure,or detrusor pressure at the maximum urine flow rate(all P>0.05).In the CNB group,8 patients had normal bladder sensation,4 had disappeared bladder sensation,10 had decreased sensation,and 2 had increased sensation.In the PNB group,9 patients had normal bladder sensation,4 had disappeared bladder sensation,14 had decreased sensation,and 2 had increased sensation.There was no statistical significance in SBC between different sensation levels within each group(P>0.05).ConclusionsThere are differences in urodynamic characteristics between the elderly patients with CNB and those with PNB.Decreases in MCC,SBC and DO are more likely to occur in CNB.

关 键 词：膀胱 神经原性 尿动力学 中枢神经系统 膀胱 过度活动性 

分 类 号：R694.5[医药卫生—泌尿科学]