尿动力学检测在儿童尿频症中的应用

The application of urodynamics examination in the daytime urinary frequency syndrome of children

目的探讨儿童白天尿频症的尿流动力学病理改变和治疗方法。方法随机选择40例白天尿频症患儿,进行尿动力学检测,观察尿流曲线、功能性膀胱容量(FBC)、逼尿肌稳定性及不稳定性指数、膀胱顺应性(BC)、最大膀胱测量容量(CBCmax)及CBCmax百分数、逼尿肌与尿道外括约肌协同性。在充盈性膀胱内压测定过程中当膀胱容量达正常CBCmax之前出现逼尿肌不稳定性收缩(DI)时嘱患儿收紧盆底肌、延长储尿时间,进行膀胱储尿功能训练,其中20例合并有DI的患儿在相同条件下间隔30min再行充盈性膀胱内压测定,比较两次测定的CBCmax百分数和不稳定指数。同期选15名排尿正常儿童做对照研究。结果膀胱充盈期出现DI17例,DI合并低顺应性膀胱15例,单纯低顺应性膀胱4例,充盈性膀胱内压测定正常4例。3例排尿期盆底肌电活动间断增强。CBCmax下降28例。第1次CBCmax与FBC比较有明显增加(P<0.05)。20例进行2次充盈性膀胱内压测定,第2次逼尿肌不稳定指数明显下降(P<0.05)、CBCmax百分数明显增加(P<0.05)。而正常对照组2次CBCmax无明显差异。结论儿童白天尿频症的主要尿动力学病理变化是DI,低顺应性膀胱和CBCmax降低是DI引起逼尿肌收缩的继发改变,均为功能性紊乱,而非膀胱壁组织结构器质性病变。行为疗法是治疗儿童尿频症的有效方法,其中以排尿训练为主,抗胆碱能药可辅助治疗儿童尿频症。

Objective To explore the urodynamic pathology and treatment of daytime urinary frequency syndrome in children. Methods 40 children with daytime urinary frequency syndrome were examined in order to assess the function of lower urinary tract for storing and voiding. The following parametes were observed：（1）functional bladder content （FBC） and uroflow curve.（2）the detrusor stability and instability index.（3） the bladder compliance （BC）.（4） CBCmax value and CBCmax percentage.（5） the function of detrusor-sphincter coordination. The children were asked to contract their pelvic floor muscles to prolong the bladder storing urine time and traing their storing urine function when the detrusor instability （DI） contretion occurred before reaching normal CBC max during the filling Cystometry determetion 20 cases of them who complicated with DI , at same condition, after interval 30min ,filling intravesil pressure were determined again,CBC max percentage and instability index was compared. In the corresponding period,chose 20 normosthemuria children as control research. Results 17 cases with DI occurred during filling period.15 cases with ID complicated low BC,15 cases existed in single low BC,4 cases with single low BC,other 4 patients had normal inteavesil pressure. The first time electric excitability was discontinuous enhanced of pelvic floor muscles in 3 cases. The first time CBCmax was greater than FBC for the all patients, which was statistically significance （P 〈0.05）.20 patients were tested repeatedly,the instability index decreased significantly （P〈0.05） and the CBCmax percentage increased markedly （P 〈 0.05）at second time.The second examination result did not differed statistically from the first for 20 children with normal function of lower urinary tract. Conclusions DI is the major urodynamic pathology of daytime urinary frequency syndrome, lower BC and CBCmax decrease are secondary change of detrusor contraction caused by DI ,all these are functional changes.The behabiour therapy is effective to daytime urinary frequency syndrome,the emiction training is the major method.The anticholinergic medicine can assistantly treat this kind of the disease.