尿动力检查对指导老年缺血性脑卒中患者康复期下尿路功能障碍治疗的价值  

Value of urodynamic study in guiding the treatment of lower urinary tract dysfunction in elderly patients with ischemic stroke during convalescence

作　　者：司峰 左佳 李庆彬 王颂扬 刘亚凯 范毛川[1] 张会清[1] 文建国[3] SI Feng;ZUO Jia;LI Qingbin;WANG Songyang;LIU Yakai;FAN Maochuan;ZHANG Huiqing;WEN Jianguo(Department of Urology,The First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100;Department of Pediatric Surgery,The First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100;Department of Urology,The First Affiliated Hospital of Zhengzhou University,Henan Joint International Pediatric Urodynamic Laboratory,Zhengzhou 450052,China)

机构地区：[1]新乡医学院第一附属医院泌尿外科,河南新乡453100 [2]新乡医学院第一附属医院小儿外科,河南新乡453100 [3]郑州大学第一附属医院泌尿外科,河南省小儿尿动力国际联合实验室,河南郑州450052

出　　处：《现代泌尿外科杂志》2024年第9期776-780,共5页Journal of Modern Urology

基　　金：国家自然科学基金项目(No.U1904208);新乡市科技攻关计划项目(No.GG2020030)。

摘　　要：目的探究尿动力学(UDS)检查对指导老年缺血性脑卒中(IS)患者康复期下尿路功能障碍(LUTD)治疗的价值,以期为临床该病的治疗提供参考。方法纳入2020年1月—2022年1月就诊于新乡医学院第一附属医院的老年IS后康复期LUTD患者50例为研究对象。根据患者UDS检查结果给予相应临床治疗,逼尿肌过度活动(DO)者口服托特罗定;逼尿肌无反射导致残余尿增多并有排尿症状者给予清洁间歇导尿(CIC);膀胱出口功能性梗阻者口服坦索罗辛。同时合并多种情况者,联合相对应的措施进行治疗。比较患者治疗前与治疗3个月后的下尿路症状(LUTS)缓解率、UDS检查参数及生活质量(QoL)评分。结果UDS检查结果显示单纯DO者25例(50.0%),DO伴逼尿肌收缩功能受损者9例(18.0%),DO伴膀胱出口功能性梗阻者5例(10.0%),逼尿肌无反射者4例(8.0%),单纯膀胱出口功能性梗阻者7例(14.0%)。相较于治疗前,治疗3个月后患者的尿频、尿急、尿失禁、排尿困难、尿潴留等LUTS均有显著的改善(P<0.05),最大尿流率和排尿量显著增加,膀胱残余尿量显著减少,QoL评分显著降低,差异均有统计学意义(P<0.001)。结论UDS检查对指导老年IS后康复期LUTD的治疗有重要价值。Objective To investigate the value of urodynamic study(UDS)in guiding the treatment of lower urinary tract dysfunction(LUTD)in elderly patients with ischemic stroke(IS)during convalescence,in order to provide reference for clinical treatment.Methods A total of 50 LUTD patients with IS who were admitted to the First Affiliated Hospital of Xinxiang Medical University during Jan.2020 and Jan.2022 were selected.Oral tolterodine was administered to patients with detrusor overactivity(DO),clean intermittent catheterization(CIC)to those with no detrusor reflex and symptomatic increased residual urine,and oral administration of tamsulosin to those with functional obstruction of bladder outlet.The lower urinary tract symptoms(LUTS)relief rate,UDS parameters and quality of life(QoL)scores were compared before treatment and 3 months after treatment.Results The UDS examination results showed that 25 cases(50.0%)had simple DO,9 cases(18.0%)had DO with impaired detrusor muscle contraction function,5 cases(10.0%)had DO with bladder outlet functional obstruction,4 cases(8.0%)had no detrusor reflex,and 7 cases(14.0%)had simple bladder outlet functional obstruction.After 3 months of treatment,the symptoms of LUTS,including frequent urination,urgent urination,incontinence,dysuria and urinary retention were significantly improved(P<0.05).The maximum urine flow rate and urine output were significantly increased,the residual urine volume was significantly reduced,QoL scores were significantly reduced,with significant differences(P<0.001).Conclusion UDS is significant in guiding the treatment of LUTD in elderly patients with IS during convalescence.

关 键 词：缺血性脑卒中 下尿路功能障碍 尿动力学 下尿路症状 老年人 

分 类 号：R726.1[医药卫生—儿科]