尿动力学质量控制(Ⅱ):典型信号模式的识别及其在实时定性质量控制中的作用

Urodynamic quality control (PartⅡ):recognition of typical signal pattern and its role in real-timequalitative quality control

目的通过分析充盈和排尿期膀胱测压数据识别和建立典型信号模式(TSP),并验证其在实时定性质量控制中的作用。方法对181例下尿路症状成年男性进行582次膀胱压力测定,识别和描述充盈和排尿期的膀胱压(Pves)、腹压(Pabd)和逼尿肌压(Pdet)的曲线信号模式;分别在膀胱充盈开始、充盈中、排尿开始、排尿中及排尿后比较上述曲线的TSP:信号的细微结构(模式Ⅰ)、信号对呼吸和说话或轻微移动的应答(模式Ⅱ)、信号对规则咳嗽的应答(模式Ⅲ),辨别逼尿肌不稳定、腹肌收缩和直肠运动导致的信号巨观改变(模式Ⅳ)。比较对应信号的符合率,对膀胱测压的TSP进行系统描述,以控制信号质量。结果充盈开始时,91.8%(534/582)曲线在Pves及Pabd具有相同的Ⅰ、Ⅱ型信号、为“活”信号;74.8%(435/582)对咳嗽的应答相同,仅3.1%(18/582)出现腹肌或直肠收缩产生的巨观改变。在充盈期,98.3%(572/582)的Pves及Pabd的Ⅰ型和Ⅱ型信号相同,98.5%(573/582)对咳嗽的应答相同或相似,8.3%(48/582)出现腹肌收缩,33.7%(196/582)逼尿肌不稳定,17.4%(101/582)直肠收缩。在排尿开始前,94.0%(547/582)的Pves及Pabd对咳嗽应答相同。排尿期91.2%(531/582)为“活”信号,95.2%(554/582)为典型逼尿肌收缩模式,2.1%(12/582)直肠收缩,15.3%(89/582)盆底松弛。排尿后,91.2%(531/582)仍为“活”信号,87.5%(509/582)Pves及Pabd对咳嗽的应答相同。结论TSP是尿动力学测定中进行实时定性质量控制的有力工具,熟悉和辨认所描述的TSP并与典型值范围结合可使质量控制具体化,具备可操作性。

Objective To establish and recognize typical signal patterns （TSP） by analyzing cystometry data,and to verify their roles in real-time qualitative quality control. Methods Totally,582 data sets of free flow, filling and voiding cystometry from 181 males（ age range ,43 -86 years）in a strictly qualitycontrolled study were analyzed. TSPs for the traces of P P.bd and Pdet, during filling and voiding phases were recognized and described. The TSP of pressures was classified into 4 types, ie, type Ⅰ ： fine structure （noise） ; Ⅱ ：minimal dynamic changes caused by breathing, talking and moving （microscopic changes）;Ⅲ： major changes due to regular cough tests ; Ⅳ ： typical macroscopic changes related to straining, detrusor instability,rectal contractions and detrusor contractions. TSPs were compared among Pves, Pabd and Pdet tracings at beginning of filling, during filling, before, during and after voiding respectively. Results At beginning of filling,91.8% （534/582） of traces showed the identical fine structure and microscopic changes with ＂live＂ signals;74.8% （435/582） of traces had the equal pressure changes corresponding to the test-coughs;3.1% （18/582） had the macroscopic changes of straining and rectal contractions. During filling, 98. 3% （572/ 582） of traces showed the identical Ⅰ and Ⅱ types of TSP;98.5% （573/582） had the equal or similar changes corresponding to the test-coughs;8.3% （48/582） of traces showed straining;33.7% （ 196/582 ） showed detrusor instability;and 17.4% （101/582） ,rectal contractions. Before voiding,94.0% （547/582 of traces had the equal rises in Pro, and Pabd corresponding to cough tests. During voiding,91.2% （531/582 of traces showed the ＂live＂ signals ;95.2% （554/582） of traces had the typical pattern of detrusor contracuon ; 53.3% （ 310/582） showed straining, 2. 1% （ 12/582 ） showed rectal contractions ; and 15.3% （ 89/582 ） showed relaxation of pelvic floor. After voiding,91.2% （531/582） of traces showed the ＂live＂ signals; 87.5% （509/582） had the equal response to cough tests. Conclusions TSP is a powerful tool for the real-time qualitative quality control for urodynamic investigation. Combined with typical value ranges, they allow definitive quality control for urodynamic data. The familiarity and identification for the described TSP are helpful for performing the qualitative quality control in clinical urodynamic practice.