脑血管意外尿失禁的机制探讨

To discuss the mechanism of the urinary incontinence due to the cerebrovascular accident

目的探讨脑血管意外引起尿失禁的可能机制。方法对42例诊断为脑血管意外伴有尿失禁的患者进行尿动力学检查（包括静止期尿道压测定、充盈期及排尿期膀胱尿道功能测定）并按Burney分类进行分析，同时研究病变部位、脑血管意外性质和病变半球侧与尿动力学的关系。结果42例脑血管意外患者中，表现为逼尿肌反射亢进者31例（73．8％）：其中外括约肌无抑制性松弛19例（45．2％）。逼尿肌-外括约肌不协调3例（7．1％），逼尿肌-外括约肌协调9例（21．4％）；逼尿肌反射减低，外括约肌协调者11例（26．2％）；无逼尿肌功能正常者。发生膀胱顺应性减低5例（11．9％）。发生尿感缺失者11例（26．2％）。初感尿容量（140．00±46．97）ml；膀胱最大容量（293．20±60．71）ml；最大尿道闭合压（65．14±19．83）cmH2O。逼尿肌最大收缩力（Pdetmax）为（60．98±31．11）emH2O；最大尿流率时逼尿肌压力（Pdet—Qmax）为（35．98±17．46）emH2O；逼尿肌收缩时间（Teon）为（86．07±36．09）sec；最大流量（Qmax）为（9．02±5．62）ml／s。中风后尿失禁患者其发病部位多见于基底节、皮层多灶以及额顶叶，脑出血与脑梗塞患者的尿动力学表现无明显差异，左右半球病变对尿动力学也无明显差异。结论脑血管意外后尿失禁的尿动力学异常主要为逼尿肌反射亢进。部分出现逼尿肌反射减弱,但感觉正常。感觉缺失者较少见；外括约肌功能以无抑制性松弛为主。其次为逼尿肌一外括约肌协调，少数出现不协调；较少出现膀胱顺应性降低。

Objectives To discuss the mechanism of the urinary incontinence due to the cerebrovascular accident. Methods Urodynamic examinations （ including UPP, Filling and Voiding cystometric pressure） were carried out and classified by Burney in 42 patients who were diagnosed the urinary incontinence due to the cerebrovascular accident. At the same time the relationship between the position of pathology, the character of cerebrevascular accident, the laterality of the lesions and urodynamics are rescarehed. Results Thirty - one of 42 cases （ 73. 8% ） showed detruscr hyperreflexia. Of these, 19 patients （45.2%） were found to have unstable urethra sphimcter and 3 patients （ 7.1% ） to have detrusor - external sphincter dyssynergia and 9 patients （21.4% ） to have detrusor - external sphincter synergia. Eleven of 42cases （ 26.2% ） showed detruser hyporeflexia and detrusor - external sphincter synergia. No one showed normal detrusor function. Five cases （ 11.9% ） had low bladder compliance, and 11 casscs （ 26.2% ） had sensory deficiency of urine. The volume at the first desire to void was（ 140.00 ±46.97 ） ml. The maximum cystometric capacity was（293.20 ± 60.71 ）ml; The maximum urethral close pressure was （65.14 ± 19.83 ） cmH2O; The maximum pressure of detrusor （ Pdetmax ） was 60.98 ± 31.11 cmH2O; The detrusor pressure at maximum flow （ Pdet - Qmax） was （ 35.98 4-17.46 ） cmH2O ; The time of detrusor contraction （Tcon） was （86.07 ± 36.09 ） sec ; The maximum flow rate （Qmax） was （ 9.02 ±5.62 ） ml/s. The positions of pathology of 42 eases were often seen in basal ganglia, multicerebral lesions and the frontal lobe. There was no difference between cerebral hemorrhage and cerebral infarction in urodynamics. And there was no difference in the laterality of the lesions. Conclusions The studies of the urinary incontinence due to cerebrovascular accident mainly reveal detrasor hperreflexia, and partly reveal detrnsor hyporeflexia. But the sense of urine is always normal. The studies on external sphincter mainly revealed uninhibited relaxation, and then detruscr- external sphincter synergia, seldom reveal detrusor- sphincter dyssynergia. Low bladder compliance seldom takes place.