托特罗定治疗脊髓损伤后逼尿肌反射亢进疗效观察

Clinical effect of tolterodine on detrusor hyperreflexia of patients with spinal cord injury

目的评价托特罗定治疗脊髓损伤后逼尿肌反射亢进的疗效及安全性。方法 2 0例脊髓损伤后逼尿肌反射亢进患者口服托特罗定每日 2次 ,每次 2mg ,共治疗 12周。通过治疗前后尿动力学和排尿日记的数据分析 ,评价托特罗定的疗效与安全性。结果治疗 12周后 ,患者平均每次排尿量从 (113 .95± 2 6.5 9)ml增加到 (176.5 8± 3 7.86)ml (P <0 .0 1) ;平均功能性膀胱容量从(2 17.63± 3 3 .76)ml增加到 (2 3 1.3 2± 3 9.72 )ml (P <0 .0 5 ) ;排尿间隔时间从 (12 6.5 8± 2 1.41)min延长到 (15 1.0 5± 19.83 )min(P <0 .0 1) ;第一次收缩时膀胱容量从 (62 .62± 3 6.3 7)ml增加到 (12 6.75± 3 4.64 )ml (P <0 .0 1) ;最大逼尿肌收缩压力从 (74.81± 2 8.60 )cmH2 O降至 (61.90± 16.2 2 )cmH2 O (P <0 .0 5 ) ;最大收缩波幅从 (4 7.2 4± 3 0 .42 )cmH2 O降至 (3 9.3 6± 2 5 .2 8)cmH2 O (P <0 .0 5 )。结论托特罗定治疗脊髓损伤后逼尿肌反射亢进安全有效 ,且依从性良好 ,不良反应较少。

ObjectiveTo evaluate the effect and safety of tolterodine on detrusor hyperreflexia of patients with spinal cord injury.Methods20 cases of spinal cord injury patients with detrusor hyperreflexia were treated with tolterodine (2 mg, twice daily), and the data of urodynamics and voiding diary before and after treatment were evaluated.ResultsAfter 12 weeks of treatment, it showed a significant increase from baseline in mean voiding volume ( P<0.01), functional bladder volume ( P<0.05) and interval of voiding ( P<0.01). The bladder volume at first contraction significantly increased from (62.62±36.37)ml to (126.75±34.64)ml ( P<0.01), the maximal pressure of detrusor contraction significantly decreased from (74.81±28.60) cm H 2O to (61.90±16.22) cm H 2O ( P<0.05), the maximal amplitude of wave significantly decreased from (47.24±30.42) cm H 2O to (39.36±25.28) cm H 2O.ConclusionTolterodine is effective and safety to detrusor hyperreflexia of patients with spinal cord injury, and has a better therapeutic compliance and less adverse reactions.