小儿尿动力学评价参数的选择

Evaluation of the urodynamics parameters in children

目的通过评价小儿下尿路尿动力学检测中常用评价参数的临床符合率,探讨各参数的可靠性。方法参照ICCS小儿下尿路尿动力学检测和评价标准,评价尿流率、膀胱内压测定、压力/流率/EMG检测等各项参数,计算尿动力学结果与临床症状之间符合率。结果325例中,检测结果可用于分析者为317例(97.5%),均完成尿流率、膀胱内压和尿道压力分布检测,164例(50.5%)完成压力/流率/EMG检测。尿流曲线、膀胱容量、顺应性、稳定性的临床符合率高,分别为93.7%、99.1%、92.1%和96.8%,其余参数的符合率均较低。结论选择尿流曲线参数筛查小儿是否存在下尿路梗阻的可靠性相对较好。用于评价充盈期膀胱储尿功能的各参数中,除膀胱感觉外,均有较好的可靠性。尿道压力参数的可靠性较差。在小儿中检测排尿期压力/流率/EMG较难完成,其结果的可靠性差。

Objective To correlate the clinical features and the urodynamic parameters in children. Methods 325 children (183 boys, 142 girls, age range: 2 to 14 years) were studied using the standard of ICCS. The parameters included flow rate, curve of flow, cystometry bladder capacity, compliance, stability, closure pressure and maximum pressure of urethra, function length of urethra, and cooperative of detrusor-sphincter. Correlation between urodynamic result and clinical signs and symptoms. Results Of 325 studies, 317 results were complete with flowmetry, cystometry, and UPP data. 164 underwent simultaneous Pressure-Flow-EMG. The correlation rates of curve of flow, cystometry bladder capacity, compliance, stability, and function length of urethra are ~93.7% , ~99.1% , ~92.1% and ~96.8% , respectively. These are higher than other parameters. Conclusions Curve of flow is the most reliable screening for lower urinary tract obstruction in children. With exception of bladder sensation, all parameters are reliable in assessing bladder-filling function. Urethral pressure is less reliable. It is difficulty to test Pressure-Flow-EMG. And its result is less reliable.