膀胱顺应性对神经源性膀胱活动低下儿童清洁间歇导尿的影响

目的 初步探讨膀胱顺应性对神经源性膀胱活动低下(NUB)儿童自我清洁间歇导尿(CISC)的并发症和膀胱功能发育影响.方法 选取经尿动力学证实为NUB的学龄儿童109例进行CIFCS治疗,最终成功对93例(85%)进行2年随访.依据开始CISC膀胱顺应性(BC)分为正常顺应性组[49例,男30例,女19例,平均年龄(6.3±0.9岁)]和低顺应性组[44例,男29例,女15例,平均年龄(7.0±1.0岁)].比较二组随访2年后尿动力学参数和随访过程中并发症发生情况.结果CISC 2年随访时正常顺应性组最大膀胱压测定容量(MCC)和相对安全容量(RSCC)显著高于CISC治疗前,而低顺应性组RSCC显著低于治疗前.逼尿肌漏尿点压(DLPP)显著高于治疗前(P<0.05).同时,随访时低顺应性组BC、MCC和RSCC显著低于正常顺应性组,DLPP显著高于正常顺应性组(P<0.05).随访时菌尿和膀胱输尿管反流以及随访过程中出现发热性泌尿系感染和肉眼血尿发生率分别为33.3%(31例)、12.9%(12例)、24.7%(23例)和15.1%(14例).其中,低顺应性组发热性泌尿系感染和膀胱输尿管反流发生率均显著高于正常顺应性组(P<0.05).结论 膀胱顺应性可以影响NUB患儿CISC的并发症和膀胱发育,低顺应性患儿膀胱发育多进行性恶化,应进行严密随访监测.

The influence of bladder compliance on children with neurogenic underactive bladder treated with clean intermittent self-catheterization

Objective To investigate the influence of bladder compliance on complications and bladder development on children with neurogenic underactive bladder (NUB) treated with clean intermittent self-catheterisation (CISC). Methods In this study, 109 school children with NUB were enrolled. Of all the patients,93(85%) were successfully followed up for two years after CISC. According to bladder compliance,93 patients were further subdivided into two groups, normal bladder compliance group (49 patients including 30 boys and 19 girls with the mean age of 6. 3± 0.9 years,as the NBC group) and poor bladder compliance group (44 patients including 29 boys and 15 girls with the mean age of 7. 0± 1.0 years,as the PBC group). Urodynamic parameters and complications were compared between two groups. Results After CISC for two years, the maximal cystometric capacity (MCC) and relative safe cystometric capacity (RSCC) in the NBC group were respectively significantly higher than those before CISC. However, the RSCC in the PBC group was significantly lower than that before CISC,and detrusor leakage point pressure (DLPP) was significantly higher than that before CISC (P <0. 05). Moreover, the bladder compliance, MCC and RSCC in the PBC group were respectively significantly lower than those in the NBC group after CISC,and DLPP was significantly higher than that in the NBC group (P<0. 05). The incidence of baeteriuria,vesico ureteral reflux (VUR), febrile urinary tract infections (FUTI) and macroscopic hematuria were respectively 33. 3%, 12. 9%,24. 7% and 15. 1%. VUR and FUTI in the PBC group were significantly higher than those in the NBC group (P< 0. 05). Conclusions It is suggested that bladder compliance may influence the bladder development and complications in children with NUB treated with CISC. Close monitoring and follow-up are necessary for the patients with poor bladder compliance and progressive deteriorated bladder development.