305例原发性遗尿症儿童尿流率检测结果分析

Study of Urine Flow Rates in 305 Children With Primary Nocturnal Enuresis

目的通过分析尿流率检测结果评价原发性遗尿症患儿的膀胱尿道功能。方法选择2001年10月￣2005年8月在我院尿动力学室进行尿流率检测的原发性遗尿症患儿。患儿先饮水,待有强烈尿意时,在不受干扰的环境中采取自然体位排尿于尿流率测量仪器上。记录最大尿流率、平均尿流率、排尿时间、尿流时间、尿量、达峰时间及尿流曲线等,同时于肛门口贴电极片同步测量盆底肌募集肌电图。结果原发性遗尿症患儿共305例,男183例,女122例。平均年龄8.4±0.3岁(5～18岁)。白天有尿频、尿急、湿裤症状的复杂性遗尿病例225例,占73.8%;单症状性夜间遗尿病例80例,占26.2%。88.2%的患儿有效膀胱容量减小,其中单症状性夜间遗尿患儿中,82.1%存在有效膀胱容量减小,而复杂性遗尿患儿中90.0%有此现象,二者相比,差异有统计学意义(P<0.05)。7～14岁女孩最大尿流率平均为19.7±1.2ml/s,明显小于正常(P<0.05),男孩为18.6±1.1ml/s。尿流率曲线中钟形曲线占54.8%;Staccato排尿曲线占12.5%;间断排尿曲线占7.2%;功能性膀胱出口梗阻形曲线占14.4%。128例(占42.0%)患儿排尿时出现收缩的肌电图信号。结论通过尿流率分析发现部分原发性遗尿症患儿存在膀胱尿道功能异常,表现为有效膀胱容量减小、最大尿流率降低和逼尿肌-括约肌收缩不协调等。与尿动力学检查相比,尿流率检测无创易行,值得在原发性遗尿症儿童中进行。

Objectives To evaluate the characteristics of urodynamics in children with primary nocturnal enuresis （PNE） by analyzing urine flow rates. Methods PNE patients who underwent uroflowmetry in our department during Oct 2001 to Aug 2005 were studied. After drinking, patients voided spontaneously over a flowmeter in a private condition when they felt at the maximum sensation of bladder fullness. Parameters of maximum urine flow rate, average urine flow rate, urination time, urine flow time, voided volumes, to achieve maximum flow time and flow curves were recorded on a computer. At the same time the patches were stuck around the anal, and the electromyography was collected. Results 305 PNE patients including 183 boys and 122 girls, whose age between 5 and 18 years old （mean 8.4±0.3 years）. 225 cases （73.8%） suffered from frequency, urge or incontinence in daytime （complex nocturnal enuresis, CNE） and 80 cases （26.2%） were primary monosymptomatic nocturnal enuresis （PMNE）. Decreasing voided volume was detected in 88.2% of all patients, in 82.1% of PMNE and in 90.0% of CNE respectively （P〈0.05）. Mean maximum flow rate in girls between 7 to 14 years old was 19.7±1.2 ml/s, which was significantly lower than that in normal （P〈0.05）. And the parameter in boys was 18.6±1.1 ml/s. Flow curves included ＂bell-shaped＂ （54.8%）, Staccato urination curves （12.5%）, intermittent curves （7.2%） and functional obstructive curves of the flow urinary tract （14.4%）. Sphincter electromyogram contraction signal during voiding was found in 128 cases （42.0%）. Conclusion Voiding abnormalities were detected in some of children with primary nocturnal enuresis by uroflowmetry, majority of which were reduction of voided volume, decrease of maximum flow rates and detrusor urinae-sphincter inconsistent. As compared with urodynamic test, the uroflowmetry result has the comparative efficacy, and easy to perform and not invasive. So it is worth applying to children with primary nocturnal enuresis.