盆腔肿瘤患者放疗前膀胱充盈稳定性训练及可靠性研究

目的 探索患者尿感是否可靠、最佳膀胱充盈量和时间,以及训练患者膀胱充盈稳定性的方法。方法 搜集2014—2015年间有放疗指征的50例盆腔肿瘤患者,按是否有盆腔、泌尿系疾病及手术史分A、B两组。让患者排空膀胱后每次饮用相同量水,每隔30 min、45 min、1 h、>1 h自觉达极限时用膀胱容量测试仪(BladderScanBVI9400)测量,并同时完成尿感量表。探求最佳充盈量、时间,以及最佳训练次数。配对t检验比较预测值与测量值差异,Pearson法分析尿感与测量值的相关性。结果 A组和B组膀胱容量预测值与测量值均相近(P_A=0.777,P_B=0.061),均可用预测值反映测量值。A组比B组尿感与测量值相关性更高(r_A=0.812,r_B=0.762)。45 min、1 h的预测值与测量值的相关性最接近(r=0.858、0.916),其对应的膀胱充盈量为330~450 ml,尿感评分为4~6分。随着训练次数增加,预测值与测量值相关性增加(第2~6次r=0.914、0.917、0.930、0.951、0.962)。

A study of stability training and reliability of bladder filling before radiotherapy for pelvic tumors

Objective To explore the reliability of patients' sensation of the need to urinate,and to investigate the optimal volume and duration of bladder filling and training method for the stability of bladder filling. Methods From 2014 to 2015,Fifty patients with pelvic tumor were divided into group A and group B,according to whether they had the history of diseases or surgery in the pelvis or urinary system. Both groups received training of the sensation of the need to urinate. The training required patients to drink a fixed volume of water every time they emptied the bladder. The bladder capacity was measured by a bladder scanner ( BladderScan BVI 9400) ,and a rating scale of the sensation of the need to urinate was completed at 30 min,45 min,1 h,and over 1 h when the patient sensed the limit for bladder capacity. The optimal volume and duration of bladder filling or optimal frequency for the training were explored. The paired t-test method was performed for the difference between the predictive value and the measured value,Pearson method was performed for correlation between the sensation of the need to urinate and the measured value. Results In the A and B groups,there was no significant difference between the predicted value and measured value ( A:predicted value and measured value P=0. 777,B:predicted value and measured value P=0. 061) ,suggesting that the measured value could be used to reflect the predictive value. Compared with group B,group A had a higher correlation between the sensation of the need to urinate and the measured value ( rA=0. 812, rB=0. 762).The correlation between the predictive value and the measured value became the highest at 45 min and 1 h ( r=0. 858 and 0. 916) ,and the corresponding bladder filling volume and score of the sensation of the need to urinate were 330-450 ml and 4-6,respectively. The correlation between the predictive value and the measured value increased with the frequency of the training ( r2=0. 914, r3=0. 917, r4=0. 930, r5=0. 951,r6=0. 962) . Conclusions Before radiotherapy,patients with pelvic tumor should received at least 4-6 rounds of the training of bladder filling. Patients should drink 800-1 400 ml of water every time they empty the bladder,and the optimal bladder filling volume and the reliable and stable sensation of the need to urinate will be achieved after 45 min-1 h. For the patients with the history of urinary system diseases or pelvic surgery,the bladder filling volume needs to be measured using a bladder scanner ( BladderScan BVI 9400) during the training before radiotherapy.