脊髓损伤患者下尿路功能障碍的尿动力学检查

目的提高对神经源性下尿路功能障碍患者的诊断水平,并为针对性选择康复手段提供可靠依据. 方法对220例不同损伤平面和程度的脊髓损伤患者进行尿动力学检查,其中100例患者常规测定膀胱压力容积和尿道压力图,另120例患者采用膀胱-外括约肌压同步连续测定法分别记录膀胱容量为100 ml时的逼尿肌压、反射排尿时的最大逼尿肌压、最大尿道压,并对所得结果进行统计学分析. 结果除圆锥马尾损伤组的最大尿道压(83±38)cm H2O(1 cm H2O=0.098 kPa)和动态逼尿肌压(12±10)cm H2O低于其他各组,其差异有显著意义(t＝2.096～2.656,P<0.05)外,不同损伤组患者膀胱顺应性降低的发生率相似(分别为51.2%,52.4%和50%);同组不同损伤程度患者间各项参数比较差异无显著意义(t＝1.023,P>0.05).120例患者根据膀胱-外括约肌压同步连续测定法记录尿道压曲线发现,其曲线形状大致可分为4型. 结论除圆锥马尾损伤组的最大尿道压和动态逼尿肌压低于其他各组外,其他参数与损伤平面和损伤程度无关.圆锥马尾损伤组多为不完全性损伤,故而逼尿肌括约肌协同失调的发生率较低.尿道压力曲线的表现与外括约肌和尿道周围横纹肌活动有关.

Urodynamics of neurogenic lower urinary tract disfunction caused by spinal cord injury

OBJECTIVES: To improve the diagnosis of patients with neurogenic lower urinary tract dysfunction and to provide a basis for proper selection of rehabilitation methods. METHODS: The urodynamics was tested with Assend Urodynamic Instrument in 220 patients with spinal cord injury. Of these patients, 100 received regular cystometrograrhy (CMG) and urethal pressure profile (UPP) test, and the remaining patients were measured by bladder/ external sphincter pressure profile. The detrusor pressure, maximum detrusor voiding pressure, and maximum urethral pressure were recorded. The date from the tests were processed with SPSS 8.0 (independent samples T test). RESULTS: The maximum urethal pressure (83 +/- 39) cm H(2)O (1 cm H(2)O = 0.098 kPa) and maximum voiding detrusor pressure (12 +/- 10) cm H(2)O were lower in coda-equina group than in other groups (t = 2.096,P < 0.05). The group with different spinal cord injury had almost an equal ratio of low bladder compliance (51.2%, 52.4% and 50% separately). Statistical differences were found between complete injury and incomplete injury in each group(t = 1.023, P > 0.05). In bladder/external sphincter cystometry, urethral pressure profile could be classified into four types.CONCLUSIONS: The maximum urethral pressure and maximum pressure of detrusor contractile were lower in the cauda-equina injury group than in other groups. The cauda-equina injury group showed a lower incidence of detrusor sphincter because most of these patients were incompletely injured. The features of urethral pressure profile in bladder/external sphincter cystometry resulted from the abnormal contraction of external sphincter and periurethral striated muscles.