脊髓损伤并发上尿路扩张的危险因素分析
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摘要
目的探讨脊髓损伤患者并发上尿路扩张的尿动力学危险因素。方法随机抽取唐山地震脊髓损伤患者96例,经 B 超检查并发上尿路扩张16例为 A 组,无上尿路扩张80例为对照组B组,分别进行尿动力学测定。而后对两组患者间性别、年龄和尿动力学等参数进行单因素和多因素分析。结果男性上尿路扩张发生率明显高于女性,A 组残余尿量、最大膀胱容量、逼尿肌漏点压和膀胱低顺应性发生率明显高于 B 组,而两组年龄、逼尿肌反射亢进发生率、相对安全容量、逼尿肌括约肌协同失调发生率、最大尿流率和最大尿道关闭压差异无统计学意义。Logistic 回归分析结果显示,膀胱低顺应性是筛选出的惟一危险因素。结论对脊髓损伤患者及时进行尿动力学检查,阻止或减缓膀胱顺应性的改变,可防止上尿路扩张的发生。
Objective To evaluate the urodynamic risk factors of upper urinary tract dilatation (UUTD) secondary to spinal cord injury (SCI).Methods Ninety-six SCI patients of Tangshan earthquake were divided into 2 groups by ultrasonography:16 SCI patients (group A) with UUTD and 80 SCI patients (group B) without UUTD received nrodynamic test.Responses were evaluated using single and multiple analysis after examination.Results The incidence of male was significantly higher than that of female. Residual urine volume,maximum cystometric capacity,detrusor leak point pressure and the incidence of bladder low compliance in group A were significantly higher than those in group B.There were no significant differences in age,the incidence of detrusor hyperreflexia,relative safe bladder capacity,the incidence of detrusor-sphincter dyssynergia,maximum flow rate and maximum urethral closure pressure between 2 groups.Bladder low compliance was cardinal risk factors according to Logistic regression analysis. Conclusion An early urodynamic examination and treatment for SCI patients are important to prevent from bladder low compliance and upper urinary tract damage.
Objective To evaluate the urodynamic risk factors of upper urinary tract dilatation (UUTD) secondary to spinal cord injury (SCI).Methods Ninety-six SCI patients of Tangshan earthquake were divided into 2 groups by ultrasonography:16 SCI patients (group A) with UUTD and 80 SCI patients (group B) without UUTD received nrodynamic test.Responses were evaluated using single and multiple analysis after examination.Results The incidence of male was significantly higher than that of female. Residual urine volume,maximum cystometric capacity,detrusor leak point pressure and the incidence of bladder low compliance in group A were significantly higher than those in group B.There were no significant differences in age,the incidence of detrusor hyperreflexia,relative safe bladder capacity,the incidence of detrusor-sphincter dyssynergia,maximum flow rate and maximum urethral closure pressure between 2 groups.Bladder low compliance was cardinal risk factors according to Logistic regression analysis. Conclusion An early urodynamic examination and treatment for SCI patients are important to prevent from bladder low compliance and upper urinary tract damage.
引文
[1] 金锡御,宋波.临床尿动力学.北京:人民卫生出版社,2002: 314-316．
[2] Giannantoni A,Scivoletto G,Di Stasi SM,et al.Clean intermittent catheterization and prevention of renal disease in spinal cord injury patients.Spinal-Cord,1998,36:29-32．
[3] Grignon A,Filion R,Filiatrault D,et al.Urinary tract dilation in utero:Classification and clinical applications.Radiology,1986, 160:645-647．
[4] McGuire E J,Woodside JR,Borden TA,et al.Prognostic value of urodynamic testing in myelodysplasic patients.J Urol,1981,126: 205-209．
[5] Ghoniem GM,Roach MB,Lewis VH,et al.The value of leak point pressure and bladder compliance in the urodynanfic evaluation of menigomyelocele patients.J Urol,1990,144:1440-1442．
[6] Kim YH,Kattan MW,Boone TB.Bladder leak point pressure:the measure for sphineterotomy success in spinal injured patient with external detrusor-sphincter dyssynergia.J Urol,1998,159:493-496．
[7] 陈维秀,陈雨历,朱兰洁.膀胱高压和上尿路功能损害.中华小儿外科杂志,2000,21:167-169．
[8] 李龙坤,宋波,金锡御,等.逼尿肌漏尿点压在神经原性排尿功能障碍上尿路损害评估中的意义.中华泌尿外科杂志,2004,25:271-272．
[9] 鹿尔训,沈稚舟,方天祥,等译.临床神经泌尿学.北京:人民卫生出版社,1984:220-229．
[10] 吴阶平.泌尿外科.山东:山东科学技出版社,1993:832-843．
[2] Giannantoni A,Scivoletto G,Di Stasi SM,et al.Clean intermittent catheterization and prevention of renal disease in spinal cord injury patients.Spinal-Cord,1998,36:29-32．
[3] Grignon A,Filion R,Filiatrault D,et al.Urinary tract dilation in utero:Classification and clinical applications.Radiology,1986, 160:645-647．
[4] McGuire E J,Woodside JR,Borden TA,et al.Prognostic value of urodynamic testing in myelodysplasic patients.J Urol,1981,126: 205-209．
[5] Ghoniem GM,Roach MB,Lewis VH,et al.The value of leak point pressure and bladder compliance in the urodynanfic evaluation of menigomyelocele patients.J Urol,1990,144:1440-1442．
[6] Kim YH,Kattan MW,Boone TB.Bladder leak point pressure:the measure for sphineterotomy success in spinal injured patient with external detrusor-sphincter dyssynergia.J Urol,1998,159:493-496．
[7] 陈维秀,陈雨历,朱兰洁.膀胱高压和上尿路功能损害.中华小儿外科杂志,2000,21:167-169．
[8] 李龙坤,宋波,金锡御,等.逼尿肌漏尿点压在神经原性排尿功能障碍上尿路损害评估中的意义.中华泌尿外科杂志,2004,25:271-272．
[9] 鹿尔训,沈稚舟,方天祥,等译.临床神经泌尿学.北京:人民卫生出版社,1984:220-229．
[10] 吴阶平.泌尿外科.山东:山东科学技出版社,1993:832-843．
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