毒蛇咬伤后尿潴留的原因分析

目的：讨论毒蛇咬伤后尿潴留的原因。方法：对2009年6月-2012年6月期间，毒蛇咬伤尿潴留的病人进行尿动力学检查，进行分类并分析尿潴留的原因。结果：通过对27例尿潴留患者进行尿动力学检查并分析，可分为出口梗阻伴逼尿肌收缩乏力型14例（51．9％），逼尿肌收缩乏力型6例（22．2％），逼尿肌外括约肌协同失调型9例（18．5％），单纯性膀胱出口梗阻2例（7．4％）。受测患者最大逼尿肌压（Pdetmax）、最大尿道压（Puramax）、最大尿流率（Qmax）与正常参考值之间存在统计学差异（P〈0．05）。结论：毒蛇咬伤后，蛇毒可能作用于外周神经系统，并对膀胱逼尿肌产生影响，引起膀胱顺应性下降，导致高危人群（膀胱出口梗阻、中枢或周围神经系统病变患者）尿潴留发病率提高。

Cause Analysis of Urinary Retention after Snakebite

Objective ： To explore the reasons of snakebite - patients＇ urinary retention. Methods ： Urodynamic checkings for snakebite patients with urinary retention during June 2009 to June 2012 in inpatients were performed, and then the reasons were classified and analyzed. Results ：27 snakebite patients with urinary retention received urodynamic checking. By analyzing the data, they can be divided into 4 types：outlet obstruction and detrusor atony （51.9%）, simple detrusor atony （22.2%）, detrusor sphincter dyssynergia （ 18.5 % ）, simple bladder outlet obstruction （7.4%）. The patients＇ maximum detrusor pressure （Pdetmax）, maximum urethral pressure （Puramax）, and maximum flow rate （Qmax） were tested, and there were significant differences compared with the normal reference values（P 〈 0.05 ）. Conclusions：After viper biting, the venom may lead to bladder compliance decline by acting on the peripheral nervous system and affecting detrusor, and thus the high - risk patients＇ （ bladder outlet obstruction, central or peripheral nervous system chronic patients） urinary retention incidence was increased.