黄莪胶囊对前列腺癌根治术后膀胱功能损伤患者的治疗作用

目的 探讨黄莪胶囊对前列腺癌根治术后膀胱功能损伤的临床疗效。方法 选取实施腹腔镜下前列腺癌根治术治疗的前列腺癌患者108例,采用随机数字表法将其分为对照组和观察组各54例。对照组术后进行常规抗生素预防感染和康复训练,观察组在对照组基础上给予黄莪胶囊治疗,疗程为42 d。观察两组住院期间的膀胱痉挛和疼痛情况。疗程结束后,采用尿动力学检查仪检测患者最大尿流量、膀胱顺应性、最大逼尿肌压力、最大尿道压,采用国际尿控协会调查问卷评估患者尿控情况、健康调查简表（SF-36）评估治疗前后生活质量、中文版癌症自我管理效能感量表（C-SUPPH）评估自我管理效能。结果 与对照组比较,观察组住院期间膀胱痉挛疼痛度降低,痉挛次数、疼痛持续时间减少（P均<0.05）。治疗42 d,观察组最大尿流量、膀胱顺应性、最大逼尿肌压力和最大尿道压力较对照组升高,尿控分级优于对照组,SF-36评分、C-SUPPH各维度评分及总分均高于对照组,差异有统计学意义（P均<0.05）。结论 黄莪胶囊对前列腺癌根治术后膀胱功能损伤具有一定治疗作用,可减轻患者术后膀胱痉挛症状,改善尿控和尿动力学指标,提高生活质量。     

女性压力性尿失禁严重程度与尿动力学参数的相关性分析

目的 探讨女性真性压力性尿失禁（GSⅠ）患者临床表现严重程度与尿动力学参数的相关性。方法 50例GSⅠ患者安排填写国际尿失禁咨询委员会尿失禁问卷简表（ⅠCⅠ-Q-SF）,依据其评分分为三组,Ⅰ组问卷表评分≤7分。Ⅰ组7分〈评分〈14分,Ⅰ组14分≤评分≤21分。分别记录三组排尿日记并测定其尿动力学参数。结果 功能性膀胱容量和valsalva漏尿点压在Ⅰ、Ⅰ、Ⅲ组之间逐渐降低,具显著性差异（P〈0．05）。Ⅰ组最大尿道压、最大尿道闭合压、最大尿流率时逼尿肌压力和最大逼尿肌压力均显著高于Ⅰ、Ⅲ组（P〈0．05）。三组总排尿量、总排尿次数、最大尿流率、膀胱顺应性、最大膀胱压测定容量和功能性尿道长度无显著性差异（P〉0．05）。结论 有选择地应用排尿日记指标和尿动力学参数可有效地评估女性尿失禁患者的严重程度。     

妊娠期下尿路解剖支持缺陷与产后压力性尿失禁相关因素的探讨

目的研究分析妊娠期下尿路解剖支持缺陷与产后压力性尿失禁相关因素。方法选取2011年1月~2013年1月期间我院收治的28例正常孕妇与28例非孕妇,其中将28例正常孕妇按照分娩方式的不同分为正常阴道分娩组与选择性剖宫产组,然后用型号为ALOKA SSD-680的超声诊断仪,用型号为Dantec UD四导程尿动力仪器检查各项指标。结果和对照组相比,分娩前UVJ-M、FUL以及MUCP显著增加,两组相比差异明显,有统计学意义(P<0.05)。结论妊娠期女性下尿路解剖支持缺陷,和未妊娠的女性相比,膀胱尿道连接部位移动度明显增加,一直持续到分娩后,很可能妊娠本身是导致产后压力性尿失禁的主要因素,在妊娠后期应加强盆底功能训练,以支持女性下尿路解剖,预防产后压力性尿失禁的发生。     

膀胱水扩术在大鼠氯胺酮性膀胱炎治疗中的应用效果观察

目的 观察膀胱水扩术联合药物膀胱灌注对氯胺酮性膀胱炎大鼠的治疗效果.方法 将20只氯胺酮性膀胱炎模型大鼠随机分为水扩组与灌注组各10只,水扩组行膀胱水扩术联合膀胱灌注药物（碱性利多卡因与地塞米松）治疗;灌注组行单纯膀胱内灌注药物治疗;另取10只正常大鼠作对照组.行尿流动力学检测,观察三组大鼠储尿期和排尿期膀胱功能改变.结果 与灌注组比较,水扩组最大膀胱容量（MBC）显著增大（F=77.575,P=0.000）,排尿间隔显著缩短（F=71.922,P=0.000）,储尿期逼尿肌不稳定收缩频率显著降低（F =24.934,P=0.000）.结论 膀胱水扩术能扩大大鼠膀胱容量,增加排尿间隔时间,改善氯胺酮性膀胱炎大鼠的膀胱功能.     

全膀胱切除联合回肠新膀胱原位再造术治疗膀胱癌(附8例报告)

应用全膀胱切除联合回肠新膀胱原位再造术治疗膀胱癌患者8例.原位回肠再造的新膀胱控尿、排尿情况良好,术后静脉尿路造影、B超检查均未见上尿路扩张,膀胱造影术未发现输尿管反流,患者血生化正常.术后随访8～22个月,未发现新膀胱或尿道肿瘤复发.认为全膀胱切除联合回肠新膀胱原位再造术是治疗浸润性膀胱癌的理想方法.     

基于膀胱容量-压力测定指导间歇性导尿在老年神经源性膀胱康复中的应用研究

目的 观察基于膀胱容量—压力测定指导间歇性导尿在老年神经源性膀胱康复中的效果，为治疗该病提供有效康复方案。方法 选取空军军医大学第一附属医院西京医院2022年1月—2023年4月收治的老年神经源性膀胱患者82例，根据随机抽样法分为观察组和对照组，每组41例。患者入院即接受口服药物治疗，此外对照组患者予以临床常规护理，观察组在对照组处理基础上加用基于膀胱容量—压力测定指导间歇性导尿处理。记录并比较2组患者平均排尿次数、平均漏尿次数及最大排尿量；观察并比较2组患者干预前后残余尿量、膀胱容量、国际下尿路功能症状(LUTS)评分变化；评估并比较2组患者预后情况及护理满意度。结果 观察组平均排尿次数及平均漏尿次数均低于对照组(P<0.05),而最大排尿量高于对照组(P<0.05)。干预前，2组残余尿量、膀胱容量及LUTS评分差异均无统计学意义(P>0.05);干预后，2组患者残余尿量及LUTS评分均低于同组干预前，2组患者膀胱容量均高于同组干预前，且观察组残余尿量及LUTS评分均低于对照组，而膀胱容量高于对照组，差异均有统计学意义(P<0.05)。随访3个月，2组复发率、...     

胰激肽原酶对糖尿病神经原性膀胱的疗效观察

目的探讨胰激肽原酶（PK）对糖尿病神经原性膀胱的疗效。方法40例糖尿病神经原性膀胱女性患者随机分为PK治疗组（PK组）、对照组（Con组）各20例。PK组日1次肌注PK40U；Con组日1次肌注维生素B12 500μg。治疗前及治疗后的1个月、2个月检测尿流率、残余尿、最大尿流率、平均尿流率及排尿期逼尿肌压。结果治疗后PK组残余尿量显著降低，最大尿流率、平均尿流率及排尿期逼尿肌压均显著增加（P〈0.05）。Con组治疗后1个月各项结果较治疗前无统计学差异（P〉0.05）。治疗后2个月残余尿量轻度降低，最大尿流率及排尿期逼尿肌压升高，较治疗前差异有统计学意义（P〈0．05）。PK组与Con组比较，残余尿量更低，最大尿流率、平均尿流率及排尿期逼尿肌压更高，差异有统计学意义（P〈0.05）。结论胰激肽原酶可以作为治疗糖尿病神经原性膀胱的用药之一。     

老年前列腺增生症患者逼尿肌功能变化的尿动力学检测意义

目的探讨前列腺增生症（ＢＰＨ）患者逼尿肌功能变化的尿动力学特点及其临床意义。方法应用尿动力学技术，检查３５例ＢＰＨ患者的尿流率、膀胱充盈期和排尿期压力、膀胱感觉，观察膀胱容量－压力相关关系，测定剩余尿量，评估膀胱的稳定性、顺应性及逼尿肌受损程度。结果逼尿肌不稳定２２例（６２．９％），逼尿肌收缩功能受损８例（２２．９％），膀胱顺应性改变５例（１４．２％），表明ＢＰＨ可引起逼尿肌功能变化。结论尿动力学对判断逼尿肌功能状态、确定排尿功能障碍原因、选择药物治疗或手术适应证有重要意义。     

女性压力性尿失禁的尿流动力学检查及意义

压力性尿失禁（SUI）是妇女（尤其是中老年妇女）的常见疾病,可严重影响患者的生活质量。90％的SUI是解剖型SUI,系指患者腹压突然增高时尿液不自主地自尿道口流出。根据其发病机制,SUI可分为两类、三型：第一类为尿道移动度增加,因盆底松弛,膀胱颈及近段尿道下移,当腹压增高时,压力不能传递到近段尿道,而使原来的尿道膀胱压力梯度不复存在．发生漏尿。此类中根据尿道移动程度又可分为两型：尿道和膀胱颈下降〈2cm为Ⅰ型,否则为Ⅱ型。第二类为尿道内括约肌缺陷（即Ⅲ型）,由于盆腔广泛手术、尿道手术或损伤,或神经性病变等。使近段尿道和膀胱颈对合不良而长期处于开放状态,当腹压增高时即致漏尿。尿流动力学检查是通过尿动力学仪检测储尿期和排尿期整个膀胱和尿道的压力、     

尿动力学检查在临床老年女性糖尿病排尿异常患者诊治中的作用

目的该文针对超过60岁的临床尿动力学变化特点开展分析研究,初步探讨其对于临床治疗的重要作用。方法收集2009年12月—2013年12月期间的28例老年女性糖尿病排尿异常患者的尿动力学相关参数数值,将这些患者作为观察组,并收集14例正常老年女性患者与14例非糖尿病排尿异常患者组成对照组。对所有患者测定自由尿流率、静态尿道压力、压力一流率等参数,对比两组患者有关参数的差异。结果观察组中,具有逼尿肌活动低下表现的患者有11例,占39.29%;逼尿肌活动过度的患者有5例,占17.85%;膀胱出口梗阻的患者有6例,占21.43%;尿动力学参数呈正常表现的患者有6例,占21.43%。相对于对照组患者,在患者尿流率最大时,尿动力学参数之间存在的差异有统计意义(P0.05)。观察组患者膀胱的最大容量增大比较明显,尿动力学其它参数没有发现显著区别。结论在尿动力学参数上,超过60岁的女性老年糖尿病患者与非糖尿病排尿异常患者存在差异的情况比较多见,但前者膀胱的最大容量增加比较明显,表明降低了患者膀胱的敏感性。     

中医体质分型与妊娠期肝内胆汁淤积症的关系

[目的]结合中医体质学说,探讨妊娠期肝内胆汁淤积（ICP）的孕妇体质类型的分布,以及体质与ICP病情严重程度的关系.[方法]以2011年5月～2013年5月在我院住院的34例ICP的孕产妇为观察组,30例正常孕妇为对照组,进行中医体质和ICP病情评估,整理数据并进行统计分析.[结果]观察组偏颇体质孕妇占73.53％（25/34）,显著高于对照组的43.33％（13/30）,差异有统计学意义（x2=6.025,P＜0.05）.观察组25例偏颇体质患者中以湿热质、痰湿质和血瘀质为最多见类型,分别占26.47％,26.47％和20.59％.其中血瘀质患者ICP病情严重程度明显重于湿热质患者,差异有统计学意义（x2 =6.349,P＜0.05）,也重于痰湿质患者,但差异无统计学意义（x2=3.654,P＞0.05）.[结论]偏颇体质孕妇较平和体质孕妇易发生ICP,尤其是湿热质、痰湿质和血瘀质体质孕妇,而且以血瘀质型孕妇ICP病情更重.     

Sodium-blood pressure interrelationship in pregnancy

In non-pregnant individuals, a strong positive association of sodium intake with blood pressure has been established, but the relationship between sodium intake and blood pressure in human pregnancy remains obscure up to date. The aim of this prospective observational cohort study was to assess the relationship between urinary sodium excretion (as a measure for intake) and blood pressure from the early second trimester onwards throughout pregnancy. The study group consisted of 667 low-risk women with singleton pregnancies, of whom 350 were nulliparous and 317 parous. Blood pressure was measured in a standardised fashion at predetermined intervals from the first antenatal visit prior to 16 weeks gestation until delivery. Urinary sodium excretion was measured in 24-h urine collections on at least four occasions between 16 and 38 weeks gestation. Main outcome measures were the coefficients of correlation between changes in urinary sodium output and changes in blood pressure during six different gestational epochs. No significant correlations were found between changes in urinary sodium output and changes in blood pressure. Correlation coefficients were alike for nulliparous and parous women and for different gestational intervals. Prior to 32 weeks gestation, no differences were observed in sodium excretion between women who remained normotensive and those who developed gestational hypertension. These results suggest that changes in sodium intake are not associated with blood pressure changes in low-risk pregnant women. Blood pressure increases as observed in the second half of normotensive and hypertensive pregnancies are unlikely to be caused by changes in renal sodium handling.     

盆底肌电刺激疗法治疗老年女性真性压力性尿失禁

目的 探讨盆底肌电刺激疗法（以下简称电刺激疗法）治疗老年妇女真性压力性尿失禁（GSI）的疗效。方法 对40例老年女性GSI患者行电刺激疗法治疗;将神经肌肉电刺激治疗仪（ETS）皮肤表面电极置于会阴部（阴道与肛门连线的两侧）。电刺激模式为专为盆底肌锻炼设计的一组程序化刺激。每周3次,每次60min,12周为1个疗程。观察治疗前后主观及客观指标变化,评估治疗效果。结果 尿失禁症状消失11例,改善21例,无改善8例。症状消失和改善者功能性膀胱容量、valsalva漏尿点压、最大尿道压和最大尿道闭合压显著高于治疗前（P〈0．05）,总排尿次数、总漏尿事件次数和ICI-Q-SF评分显著低于治疗前（P〈0．05）,总排尿量、最大尿流率、膀胱顺应性、最大膀胱压测定容量、最大尿流率时逼尿肌压力和功能性尿道长度治疗前后无明显差异（P〉0．05）。结论 神经肌肉电刺激疗法治疗老年女性GSI疗效显著．且具有无创性和经济方便等优点。     

Excretion of vitamin A in urine of women during normal pregnancy and pregnancy complications

BACKGROUND/AIMS: The renal function, including the excretion of low-molecular-weight proteins, changes during pregnancy and may cause a urinary excretion of retinol-binding protein (RBP). Whether it is accompanied by a substantial loss of vitamin A (retinol) has not been established yet. We therefore determined the excretion of retinol and RBP in urine of pregnant women. METHODS: The study involved analyses of urine samples from 40 healthy pregnant women and 29 women with pregnancy complications during the third trimester. Analyses of plasma and urine of 7 healthy women and 5 women with pregnancy complications were also carried out 6 weeks antepartum, at time of delivery and 1 week postpartum. RESULTS: Urinary retinol was higher in women who suffered from pregnancy disorders with an influence on maternal metabolism (p < 0.01). RBP was excreted at substantial concentrations in the urine of all 69 women, but there were no differences between the groups. Women with a concomitant excretion of retinol had higher levels of urinary RBP than those without a retinol excretion (p < 0.05). Differences in plasma retinol and RBP were not significant. CONCLUSION: The excretion of urinary retinol may increase significantly during pregnancy complications, which needs further clarification to which extent this condition may negatively affect the vitamin A status in such women.     

Abnormal clinical and urodynamic findings in women with severe genitourinary prolapse

In order to investigate the effects of urogenital prolapse on lower urinary tract function, we studied 61 women with stage III to IV pelvic organ prolapse (prolapse group) and 40 volunteers without prolapse (control group). Each woman underwent urinalysis, urinary questionnaire, pelvic examination, and urodynamic study. The incidence of urinary symptoms, including urinary frequency and urgency, stress/urge incontinence, incomplete emptying, difficult voiding and nocturia, were significantly higher in the prolapse group compared to the control group (p < 0.05). Urodynamic parameters, including residual urine, total bladder capacity, and bladder volume at strong desire to void, were not significantly different between the two groups (p > 0.05). Maximal flow rate, bladder compliance at urgency, functional urethral length, and maximal urethral closure pressure, however, were significantly higher in the control group compared to the prolapse group (p < 0.05). In addition, there was a higher incidence of poor pressure transmission ratio in the prolapse group (p < 0.01). The results indicated that severe urogenital prolapse could produce abnormal clinical and urodynamic results.     

Suspected pulmonary embolism in pregnancy: clinical presentation,results of lung scanning,and subsequent maternal and pediatric outcomes

BACKGROUND: Ventilation-perfusion (VQ) scanning is used when pulmonary embolism (PE) is suspected during pregnancy; however, the distribution of lung scan results and safety of VQ scanning have never been studied. OBJECTIVE: To study the distribution of lung scan results and safety of VQ scanning as well as the safety of withholding anticoagulation therapy following a normal or nondiagnostic scan in pregnant women. METHODS: The study group comprised 120 consecutive pregnant women who presented with suspected PE. Clinical data were collected, and the lung scans were reinterpreted by 2 independent experts. Subsequent pregnancy and pediatric outcomes were determined by direct patient follow-up. RESULTS: During the study period, 120 pregnant women (mean age, 32 years) underwent 121 VQ scans. Eight cases (6.6%) were already receiving treatment for venous thromboembolism prior to VQ scanning. In the remaining 113 scans, 83 (73.5%) were interpreted as normal, 28 (24.8%) as nondiagnostic, and 2 (1.8%) as high probability. In the 104 women who did not receive anticoagulation therapy following lung scanning (80 normal and 24 nondiagnostic), no venous thromboembolic events were reported (mean [range] length of follow-up, 20.6 [0.5-108] months). Examination of pediatric data from 110 live births (90.2%) (mean [range] age, 20.5 [0.5-100] months) revealed no increase in the rates of congenital and developmental anomalies. CONCLUSIONS: The prevalence of high-probability VQ scans in pregnant women with suspected PE and probable PE is very low. Withholding anticoagulation in pregnant women with normal or nondiagnostic VQ scans is probably safe. In addition, pediatric risks from VQ scans are low. Large prospective studies are needed to evaluate diagnostic strategies for pregnant women with suspected PE.     

A teratological study of aminoglycoside antibiotic treatment during pregnancy

The aim of this study was to investigate the teratogenicity of aminoglycoside antibiotics, such as parenteral gentamicin, streptomycin, tobramycin and oral neomycin, during pregnancy. Pair analysis of cases with congenital abnormalities and matched healthy controls was carried out. The setting was the population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-96. In total, 38,151 pregnant women who had newborn infants without any defects (control group) and 22,865 pregnant women who had foetuses or newborns with congenital abnormalities were included in the study. 38 (0.16%) and 42 (0.11%) pregnant women in the case and control groups, respectively, were treated with the aminoglycosides studied. A teratogenic potential of gentamicin and neomycin was not indicated by a comparison of the occurrence of aminoglycoside antibiotic treatments in the total control group as referent with the figures of different congenital abnormality groups. In addition, the case-control pair analysis during the second-third months of pregnancy did not show a teratogenic risk of gentamicin and neomycin. The conclusion of this study is that treatment with parenteral gentamicin and oral neomycin during pregnancy presents no detectable teratogenic risk to the foetus, when restricted to structural developmental disturbances.     

Tuberculin sensitivity in pregnancy.

Of 452 women who had been tuberculin tested twice with an interval of one year between tests, there were 105 who were pregnant at the first test and 121 others who were pregnant at the second test. An equal number of matched control subjects were selected who were not pregnant on either occasion. All 3 groups showed slight and similar increases in median diameter of induration during the one-year interval. There was no indication that pregnancy affected the level of tuberculin sensitivity.     

Cardiac sympathetic activity during rat pregnancy

The turnover of injected tracer [3H] norepinephrine (NE) was determined in heart and interscapular brown adipose tissue of virgin and 10-day and 20-day pregnant rats. In two experiments fractional [3H]NE turnover in heart was 87% and 92% higher in 20-day pregnant animals compared to virgin controls, but did not differ between 10-day pregnant and control animals. NE turnover in brown adipose tissue did not differ between control and pregnant animals at either gestational age. Twenty-four-hour urinary excretion of NE, epinephrine (E), and dopamine (D) was measured serially in six pregnant rats and compared to virgin controls. NE excretion during pregnancy was significantly higher than the controls and showed a progressive increase during the last third of pregnancy. At term the excretion rate was 2.6-fold greater than that of controls. Excretion of E and D did not differ between pregnant and nonpregnant animals. It is concluded that cardiac sympathetic nervous system activity increases during rat pregnancy. That this change in sympathetic activity is not global is indicated by the finding of unchanged NE turnover in interscapular brown adipose tissue. Urinary excretion data are consistent with increased sympathetic activity during late gestation, with no change in adrenal medullary function.     

Outcomes of balloon mitral valvuloplasty for rheumatic mitral stenosis during pregnancy

Background Rheumatic mitral stenosis is the most common acquired valvular heart disease encountered during pregnancy. Balloon mitral valvuloplasty(BMV)is one of the treatment options if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. Prospective studies on BMV and its effect on pregnancy outcomes and neonates are needed. Methods All pregnant women with severe symptomatic isolated mitral stenosis who underwent elective BMV in our institute from January 2000 to December 2018 were analyzed retrospectively. Clinical,haemodynamic and echocardiographic outcomes immediately after the procedure were analyzed. Results This study involved twenty-seven pregnant women in whom BMV was performed. The procedure was successful in 26 patients(96.29%). There were significant changes after BMV in the measured 2 D MVA,pulmonary arterial systolic pressure and the mean left atrial pressure(P0.01). Post-procedure follow-up showed an improvement in NYHA status by at least one class in 85.19%(25/27)patients. In the cases of mitral valve regurgitation,the area of mitral valve regurgitation increased significantly after the procedure(P0.01). Four(19.05%)patients had a full-term normal vaginal delivery and seventeen(80.95%)underwent cesarean section for obstetric indications. Five patients had abortions after the procedure. After the procedure,only one patient had severe mitral regurgitation after the procedure and nine patients had moderate mitral regurgitation,and the rest had either no mitral regurgitation or mild mitral regurgitation. Symptomatic improvement was noted in all of the patients with on maternal and fetal complications except one case of mortality. Conclusion Percutaneous BMV is safe and effective in providing excellent symptomatic relief and hemodynamic improvement for pregnant patients with mitral stenosis.[S Chin J Cardiol 2019;20(2):63-68]