脊髓损伤并发上尿路扩张的危险因素分析

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。

Analysis of the risk factors of upper urinary tract dilatation due to spinal cord injury

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 urodynamic 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.