神经源性膀胱伴输尿管反流的尿动力学研究

目的 探讨有输尿管反流的神经源性膀胱(NB)患儿有或没有逼尿肌过度活动(DO)时的尿动力学差异,为临床治疗此类患儿提供理论参考依据.方法 选取2013～2015年就诊并经影像尿动力学检查发现膀胱输尿管反流的NB患儿68例,男30例,女38例,年龄4～12岁,平均7.5岁.按照充盈期有DO,将其分为DO组(n=20)与无DO组(n=48).观察记录两组发生膀胱输尿管反流时的膀胱灌注量、逼尿肌压并计算发生反流时的膀胱顺应性;记录两组充盈结束时最大膀胱测压容量、最大逼尿肌压、并计算充盈期膀胱顺应性.结果 DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(98.7±16.1)ml和(5.2±1.9) ml/cmH2O,无DO组发生膀胱输尿管反流时的膀胱容量与顺应性分别为(127.3±36.3)ml,(7.1±2.1)ml/cmH2O,差异均有统计学意义(P＜0.05);两组的逼尿肌压分别为(21.6±9.2)cmH2O、(19.2±7.4)cmH2O,差异没有统计学意义;DO组充盈结束时的膀胱容量与顺应性分别为(182.7±31.2)ml、(5.4±1.7) ml/cmH2O,与无DO组充盈结束时的膀胱容量(230.6±34.6)ml与顺应性(6.5±1.1)ml/cmH2O相比,差异有统计学意义;两组尿动力学检查结束时逼尿肌压分别为(33.8±7.8)cmH2O、(36.4±8.1)cmH2O,差异没有统计学意义.结论 膀胱容量小,膀胱顺应性差是有输尿管反流的NB患儿伴发DO时的尿动力学特征.     

清洁间歇导尿在小儿神经源性膀胱治疗中的价值

目的 评价清洁间歇导尿在小儿神经源性膀胱治疗巾的临床意义.方法 脊髓栓系综合征患儿64例.男49例,女15例,年龄3～13岁.均已行脊髓栓系松解手术.临床表现为尿失禁,611例合并大便失禁.52例合并足畸形.就诊时和就诊后1年分别行尿动力学和排泄件膀胱尿道造影以及超声检查,治疗期间36例坚持间歇导尿.28例未能坚持间歇导尿.结果 导尿组开始有9例合并Ⅲ°以下输尿管反流.4例为单纯肾积水.膀胱容量、顺应性、逼尿肌压分别为(176±34.5)ml、(3.5±0.6)ml/cmH2O、(54.6±13.2)cmH2O.1年后3例输尿管反流消失,2例肾积水减轻,膀胱容量、顺应性、逼尿肌压分别为(188±30.3)ml、(3.7±0.9)ml/cmH2O、(50.6±11.8)cmH2O,4例发生尿路感染(11.1%).未导尿组开始有7例合并Ⅲ°以下输尿管反流,5例为单纯肾积水,膀胱容量、顺应性、逼尿肌压分别为(168±37.2)ml,(3.2±0.7)ml/cmH2O,(59.6±15.6)cmH2O.1年后13例合并输尿管反流.9例合并肾积水.膀胱容量、顺应性、逼尿肌压分别为(142±23.6)ml,(1.6±0.7)ml/cmH2O,(72.4±9.3)cmH2O.3例发生尿路感染(10.7%).结论清洁间歇导尿可保护膀胱功能.避免或减轻上尿路功能的损害,并不增加尿路感染的发生率.对于神经源性膀胱治疗有重要的应用价值.     

遗尿伴急迫性和排尿延缓性尿失禁患儿膀胱功能的尿动力学评估

目的 探讨夜间遗尿伴白天急迫性尿失禁(UI)和夜间遗尿伴白天排尿延缓性尿失禁(VPI)患儿的尿流动力学表现,为临床治疗提供依据.方法 本研究选取2008年6月至2009年10月间因夜间遗尿伴白天尿失禁诊断的患儿64例,进行详细的体格检查、腰椎X线、泌尿系超声并测定膀胱壁厚度、尿常规,尿动力学检查.将患儿分为UI和VPI两组.结果 UI组与VPI组比较:膀胱壁厚度较正常增厚比例(5%比20%,P＜0.05),两组中伴随尿痛、便秘等显著临床症状(13%比36%,P＜0.05).最大尿流率VPI组与UI组分别为(20.2±9.0)ml/s、(14.1±11.6)ml/s(P＜0.05),最大尿道压VPI组与UI组分别为(152.3±47.5)cmH2O、(107.7±40.3)cmH2O(P＜0.05).结论 VPI患儿更易出现躯体不适及明显临床症状,VPI的尿动力改变和临床症状明显较UI严重,这些儿童有必要常规行尿动力学检查了解膀胱功能,为规范治疗提供依据.

Abstract：

Objective To evaluate the urodynamic parameters of the children with enuresis nocturna accompanied by daytime urgency incontinence(UI) or daytime voiding postponement incontinence(VPI).Methods From June 2007 to October 2009,a total of 64 children who had enuresis nocturna accompanied by daytime UI or daytime VPI were recruited in this studv.The urodynamics parameters including uroflowmetry,bladder pressure-volume,and static urethral pressure were examined and recorded.The physical examination,X-ray radiography,ultrasonography and urinalysis were of UI patients had thicker bladder wall(P＜0.05).Pain with urinating and constipation occurred in 13% UI patients,and 36%VPI patients(P＜0.05).The maximum flow rate in VPI patients was higher than that in UI patients(20.20±9.02 vs.14.09±11.56 ml/s,P＜0.05).Maximum urethral pressure in VPI patients was higher than that in UI patients(1 52.3±47.5 vs 107.7±40.3 cmH2O,P=0.003).Conclusions The symptoms and urodynamic dysfunction of the children with enuresis nocturna accompanied by VPI are more severe than those of the UI patients.The therapeutic plan should be made according to the urodynamic evaluations of these patients.     

CIC联合膀胱内灌注RTX治疗儿童神经源性膀胱并逼尿肌过度活动疗效观察

目的 探讨清洁间歇导尿(clean intermittent self-catheterization,CIC)联合膀胱灌注辣椒辣素类似物(resiniferatoxin,RTX)治疗儿童神经源性膀胱(neurogenic bladder,NB)并逼尿肌过度活动(detrusoroveractivity,DO)的疗效.方法 将NB并DO患儿38例,按随机数字表法分为CIC联合RTX灌注组(实验组,20例)和CIC联合30％乙醇灌注组(对照组,18例).采用前瞻性双盲平行对照试验,所有患儿在CIC期间每4周行1次灌注治疗,每3个月行尿动力学检查随访,治疗1年后对比两组患儿尿动力学参数异同.结果 治疗后3个月及12个月实验组患儿逼尿肌过度活动的发生率(40.0％和10.0％)明显低于对照组(94.4％和88.9％),差异有统计学意义(P＜0.01).治疗12个月后实验组首次过度活动膀胱容量明显增大[(107.8±46.3)ml vs (68.2±31.5)ml,膀胱安全容量明显增多[(206.8±50.6)ml vs (166.3±54.2)ml],与对照组比较,差异有统计学意义(P＜0.01).但实验组和对照组比较,膀胱顺应性[(20.8±11.5)ml/cmH2O vs (24±15.4) ml/cmH2O],最大尿流率[(9.5±5.1)ml/s vs (8.2±3.2) ml/s]差异均无统计学意义(P＞0.05).结论 CIC联合RTX膀胱灌注能显著控制神经源性膀胱患儿的逼尿肌过度活动,改善神经源性逼尿肌过度活动患儿的生活质量.     

瓣膜膀胱综合征尿动力学研究

目的　探讨瓣膜膀胱综合征(VBS)患儿的尿动力学表现及其意义。方法　16 例男性后尿道瓣膜电切术后患儿,年龄平均(3.2±1.8)岁。分为2组,全部患儿均在2岁前行后尿道瓣膜电切术。第一组7例,平均年龄(1.6±0.3)岁,术后至尿动力学检查间隔时间小于1 年。第二组9 例,平均年龄(4.5±1.2)岁,间隔时间大于1年,平均(3.5±1.3)年。对比两组尿动力学结果。结果　第二组最大逼尿肌收缩压(Pdet.max)和膀胱顺应性(BC)分别为(56.2±14.1) cmH2 O和(12.5±7.4)ml/cmH2O,低于第一组Pdet.max(95.1±18.3 ) cmH2 O和BC(52.4±26.9) ml/cmH2 O;第二组残余尿量(PVR)和最大膀胱容量(MBC)分别为(96.6±52.4) ml 和(217.4±61.7) ml,大于第一组PVR(42.8±38.9) ml和MBC(138.1±20.1) ml,差异有统计学意义(P<0.05)。两组分别有4 例和2例有逼尿肌不稳定(DI),Fisher’s精确概率检验两者差异无统计学意义(P>0.05)。在第二组中2例逼尿肌无收缩,有4 例出现较特殊的排尿,表现为逼尿肌收缩波不光滑, 该4 例Pdet.max平均(62.3±9.1) cmH2O,PVR平均(87.5±41.9) ml。结论　VBS膀胱功能异常多发.年龄较大患儿逼尿肌功能较年龄较小患儿差。尿动力学检查能及时发现膀胱功能异常和指导下一步治疗。因此,所有PUV患儿均应行该检查以了解膀胱功能,     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.     

肺保护性通气策略在儿童急性呼吸窘迫综合征中的应用价值

Objective To assess the effect of lung protective ventilation on outcome of children with acute respiratory distress syndrome(ARDS).Methods Between January 1999 and December 2007,43 children with ARDS were enrolled from PICU of Shanghai Children's Medical Center and assigned to the protective-ventilation group(group A) or the conventional-ventilation group(group B).The patients in group A (from January 2004 to December 2007)received lower tidal volume(6～7 ml/kg) and high levels of positive end-expiratory pressure(PEEP),and optimal oxygenation was achieved by adjusting FiO2 and PEEP.The patients in group B(from January 1999 to December 2003) received relatively higher tidal volume(8～12 mL/kg) with lower PEEP(2～6 cm H2O),and optimal oxygenation was achieved by adjusting FiO2.Tidal volume,PEEP,arterial blood gas,mortality and the number of ventilator-free days were compared between the two groups.Results Since protective ventilation was adopted after 2004,tidal volume was significantly lower in group A[(7.09±1.66)ml/kg]as compared with that in group B[(9.82±2.31) ml/kg](P=0.001).PEEP was significantly higher in group A[(7.15±2.08) cm H2O]as compared with that of group B[(5.40 + 1.84) cm H2O](P=0.021).The mortality was 30.3% in group A and 60.0% in group B.The number of ventilator-free days were(10.88±8.84) d in group A and(8.40±10.86) d in group B.Although mortality was lower and number of ventilator-free days was greater in group A,no significant differences were found between the two groups(P＞0.05).Conclusion Lung protective ventilation may improve the outcome for pediatric patients with ARDS,however,larger trials are required before a definite conclusion can be reached.     

神经源性膀胱扩大术远期疗效观察

目的 评价保留膀胱黏膜的双层肠管浆肌层膀胱扩大术的远期疗效.方法 病例选择条件:术前有明确支配膀胱的神经性损害,膀胱容量明显小于同龄儿童的正常值,同时伴有Ⅳ度以上膀胱输尿管反流,经过一段时间的口服抗胆碱能药物、清洁间歇导尿等保守治疗后,膀胱内压仍然较高,输尿管反流无明显改善,我们对符合上述条件的75例神经源性膀胱患儿行切除部分逼尿肌保留膀胱黏膜的双层肠浆肌层膀胱扩大术,同时根据患儿的具体情况选择性联合应用膀胱输尿管移植抗反流、膀胱颈紧缩、膀胱颈悬吊等手术方式,术后对患儿进行长期随访,对手术前后临床症状、肾脏功能、尿流动力学(膀胱容量、残余尿、逼尿肌压和顺应性)等方面进行评价.结果 75例手术患儿中68例获得随访,随访时间平均4.3年,术后无一例发生肾脏功能衰竭,45例获得一定的临床治疗改善.23例术后在尿流动力学、临床症状方面无明显改善.结论 术后膀胱容量不能有效扩大是导致术后疗效不理想的重要原因,保留膀胱黏膜的双层肠浆肌层膀胱扩大术是治疗神经源性膀胱的一种方法,但该方法有待改进.     

Long-term efficacy and safety of tolterodine in children with neurogenic detrusor overactivity

ObjectiveWe evaluated long-term (≥12 months) efficacy and safety of tolterodine in children with neurogenic detrusor overactivity.Subjects and methodsSubjects successfully completed one of three 12-week, open-label studies and had stable neurologic disease and urodynamic evidence of neurogenic detrusor overactivity requiring intermittent catheterization. Drug formulation and dosing were based on age (4 months–4 years, tolterodine oral solution 0.2–2 mg twice daily; 5–10 years, tolterodine oral solution 0.5–4 mg twice daily; 11–16 years, tolterodine extended-release capsules 2, 4, or 6 mg once daily). Daily doses were individualized for each subject. Efficacy was evaluated urodynamically and using parent-completed 3-day bladder diaries.ResultsThirty subjects were enrolled. Functional bladder capacity (volume at first leakage, first sensation of bladder fullness or 40 cm H₂O pressure) increased by month 12 in the younger age groups but not in the oldest subjects. Volume to first detrusor contraction >10 cm H₂O pressure and detrusor leak point pressure did not change in any age group. The number of incontinence episodes per 24 h decreased in all subjects, as did the number of catheterizations per 24 h. Mean volume per catheterization increased in all subjects. Seven treatment-related adverse events were reported.ConclusionsBoth tolterodine formulations were effective and well tolerated in children with neurogenic detrusor overactivity.     

保留膀胱黏膜肠浆肌层膀胱扩大术的尿流动力学评价

目的评价神经性膀胱行保留膀胱黏膜双层小肠浆肌层膀胱扩大术后的尿流动力学变化。方法45例逼尿肌反射亢进型神经性膀胱行保留膀胱黏膜的小肠浆肌层膀胱扩大术，男26例，女19例，年龄4～14岁。36例随访2年，手术前后行尿流动力学检查。结果手术后膀胱容量、膀胱顺应性、尿流率较术前增加，逼尿肌压降低，残余尿量／膀胱容量较术前减小，无抑制收缩减轻。逼尿肌括约肌不协调和尿道闭合压无改变。30例临床症状改善。结论保留膀胱黏膜的双层肠浆肌层膀胱扩大术可增加膀胱容量及顺应性，降低逼尿肌压，减轻逼尿肌反射亢进的程度，逼尿肌括约肌不协调以及尿道闭合压无明显变化。     

膀胱自体扩大术在神经性膀胱患儿中的应用评价

目的评价逼尿肌部分切除、膀胱自体扩大术的临床疗效。方法选择脊髓脊膜膨出患儿6例,其中男性3例,女性3例,年龄18个月至9岁。患儿均口服索利那新和行清洁间歇导尿3个月后无好转而行逼尿肌部分切除、膀胱自体扩大术,术后予清洁间歇导尿,手术前及术后1年行泌尿系超声、排泄性膀胱尿道造影,并行尿动力评价,评价指标为膀胱容量、膀胱顺应性和充盈末逼尿肌压。结果术前尿动力学检查显示6例患儿膀胱容量减小、膀胱顺应性下降及逼尿肌压升高,其中5例膀胱容量低于预期容量的50%。排泄性膀胱造影4例合并膀胱输尿管反流,其中左、右侧Ⅳ°反流各1例,双侧Ⅳ°反流2例。6例患儿手术后恢复顺利,无穿孔、感染发生。术后1年尿动力学检查显示6例患儿膀胱容量略有增加,但膀胱容量与预期膀胱容量(年龄×30+30)、膀胱顺应性及逼尿肌压力无明显变化,VCUG显示4例输尿管反流无减轻。结论对于膀胱容量明显变小的神经性膀胱患儿,逼尿肌部分切除、膀胱扩大术不能有效增加膀胱容量和顺应性,降低逼尿肌压,临床不能取得满意的效果。     

Botulinum toxin type A for neurogenic detrusor overactivity due to spinal cord lesions in children: A retrospective study of seven cases

ObjectiveTo assess the effectiveness and safety of intradetrusor injections of botulinum toxin type A (BTA) used to treat neurogenic detrusor overactivity in children.Patients and methodsWe retrospectively reviewed the records of seven children treated at least once (7/7: one injection; 4/7: two and three injections; 2/7: four injections; 1/7: five injections) with intradetrusor BTA injections in 2005–2008, for neurogenic detrusor overactivity with incontinence despite timed bladder catheterizations and anticholinergic agents. Clinical, urodynamic, and imaging study data at baseline were collected. Clinical efficacy criteria were the urinary tract infection (UTI) rate, continence, and need for anticholinergic agents. The following urodynamic data were assessed: maximum catheterized volume without leakage, reflex volume, maximum detrusor pressure, and bladder compliance.ResultsSeven children received 18 injections. Social continence was achieved from the first injection. No further recurrent lower UTIs occurred. Maximum catheterized volume and reflex volume increased, and maximum detrusor pressure decreased. Detrusor compliance became interpretable and increased. Grade II right vesicoureteral reflux, present at baseline in one patient, resolved after BTA therapy. UTIs were the only adverse effects.ConclusionInjection with BTA proved effective and safe in the short term. This may be an alternative to surgery in children with neurogenic detrusor overactivity.     

1岁以下脊髓脊膜膨出患儿术前尿动力学结果分析

目的：以脊髓脊膜膨出的婴儿为研究对象,进行术前尿动力学检查,评估其膀胱功能。方法2010年2月至2014年3月,本院收治脊髓脊膜膨出患儿25例,年龄45d至1个月,平均4个月,术前应用加拿大莱博瑞（Laborie）尿动力检查系统,慢速灌注充盈膀胱进行膀胱测压。结果术前尿动力检查结果：尿动力表现完全正常13例（52％）;膀胱活动活跃6例（24％）;间断排尿4例（16％）;逼尿肌不稳定2例,其中1例膀胱顺应性3 mL/cmH2 O。所有患儿膀胱容量正常,（48．3±19.8）mL。残余尿均未见明显增加,平均（3．2±4．5）mL。因膀胱活动活跃、间断排尿多见于正常婴儿,本组23例被认为尿动力结果正常,占92％。所有患儿均经手术确定脊髓脊膜膨出及脊髓栓系诊断,其中脂肪脊髓脊膜膨出15例（占60％）。结论尿动力学检查提示术前脊髓脊膜膨出的婴儿,其膀胱功能多为正常,其神经源性膀胱的损害在1岁以内多未表现出来。     

超声测量膀胱壁厚度预测脊柱裂患儿上尿路损害

目的 通过超声测定膀胱壁厚度和尿动力学检查测定膀胱功能,评价隐形脊柱裂患儿膀胱厚度和功能及上尿路损害的相关性,探讨用膀胱壁厚度评估隐性脊柱裂患儿上尿路损害的可能性.方法 选取超声检查确诊上尿路扩张的隐性脊柱裂患儿22例,年龄(8.8±4.9)岁,并选择同期超声检查无上尿路扩张的隐性脊柱裂患儿29例作为对照组,年龄(9.3±5.3)岁.所有患儿均行尿动力学检查,记录最大膀胱容量,充盈期最大逼尿肌压力,逼尿肌漏尿点压和逼尿肌过度活动最高压力.在膀胱充盈至预测正常膀胱容量的60%时行超声检查测量逼尿肌厚度.同时根据超声检查是否扩张将患儿分为有和无上尿路损害组,比较两组膀胱壁厚度的差异,并分析膀胱厚度与尿动力学参数相关性,计算膀胱壁厚度预测上尿路损害统计学指标.结果 上尿路损害组平均膀胱壁厚度(3.4±0.25)mm,显著高于无上尿路损害组的(2.5±0.45)mm,差异有统计学意义(P＜0.05).膀胱壁厚度与逼尿肌过度活动最高压力、逼尿肌漏尿点压和充盈期最大逼尿肌压力均呈正相关(r=0.87、0.91和0.85,P＜0.0001,P＜0.0001和P=0.017).膀胱壁厚度≥3.0 mm预测上尿路损害的灵敏度为90.9%,特异性为79.4%,阳性预测值76.9%,阴性预测值为92.0%.受试者工作特征曲线(ROC)显示超声测量膀胱壁厚度能高度预测隐形脊柱裂患儿上尿路损害的发生,曲线下面积(AUC)为0.929.结论 超声测定隐形脊柱裂患儿膀胱壁厚度可以帮助预测上尿路损害,膀胱壁厚度大于3.0 mm提示隐性脊柱裂患儿上尿路损害可能性大.     

大鼠获得性漏斗胸形成过程中肺功能的观察

目的 观察获得性漏斗胸形成过程中肺功能的变化.方法 4周龄SD大鼠40只按数字随机法分为实验组和对照组各20只.实验组行经胸骨旁切断下位三对肋软骨观察漏斗胸形成,对照组不做任何干预,于术后3d和4周测定动物肺功能指标,包括:吸气阻力(Ri)、呼气阻力(Re)、肺的顺应性(Cl)、每分钟通气量(MVV)、用力肺活量(FVC)、第0.2s用力呼气容积(FEV0.2)、FEV0.2/FVC%、呼出50%FVC量时的流速(FEF50%)及用力最大呼气流速(PEF)等,检测结果在组间进行比较分析.结果 造模术后1周内动物呼吸频率增快,其后漏斗胸逐渐形成并稳定.肺功能检测:术后3d测得Ri在实验组和对照组分别为(1.16±0.21)cmH2O·ml-1·s-1和(0.73±0.26)cmH2O·ml-1·s-1 (P=0.00),Re分别为(0.86±0.30)cmH2O·ml-1·s-1和(0.58±0.16)cmH2O·ml-1·s-1 (P=0.01),Cl分别为(0.05±0.01)cmH2O/ml和(0.09±0.02)cmH2O/ml(P=0.00),FVC分别为(3.69±0.10)ml和(3.89±0.19)ml (P=0.00),FEV0.2分别为(3.28±0.40) ml和(3.58±0.15)ml(P=0.02);术后4周测得Ri在实验组和对照组分别为(0.88±0.17) cmH2O·ml-1·s-1和(0.66±0.10)cmH2O·ml-1·s-1 (P=0.00),FVC分别为(5.76±0.52)ml和(5.47±0.20) ml(P=0.05).Ri在术后3d和4周的检测结果在同龄动物组间比较差异均有显著性,造模术后动物的吸气阻力增加(P<0.05);Re、Cl、FEV0.2和FVC等指标在术后3d的测得值组间差异有显著性,实验组Re增加而另3个指标减小(P<0.05),FVC在术后4周时组间比较P=0.05,而MVV 、FEV0.2/FVC%、PEF25%~75%和PEF等指标不论在术后3d还是4周的检测结果组间比较差异均无统计学意义(P>0.05).结论 通过胸骨旁切断下位三对肋软骨造成模型漏斗胸的形成过程中,幼鼠吸气和呼气阻力增加,胸壁和肺的顺应性均降低,随着漏斗胸的形成和稳定,肺功能重新建立适应,但胸廓的顺应性仍较正常降低.