经阴道使用雌激素对绝经后妇女下尿路血流的影响

Effects of vaginal estrogen use on the lower urinary tract in post-menopausal women

目的研究经阴道局部使用雌激素药物对绝经后妇女下尿路血流的影响。方法对58例绝经妇女采用雌激素（倍美力软膏）阴道局部使用3个月后，用彩色多普勒血流成像诊断仪观察动脉血流频谱，测量其尿道周、膀胱颈动脉的收缩期血流速度峰值和舒张末期血流速度及阻力指数，并观察萎缩性泌尿生殖系统症状的变化。结果经阴道雌激素软膏局部治疗3个月后，尿道周的收缩期血流速度峰值（PSBFV）从11．94cm／s升至13．23cm／s，舒张末期血流速度从1．91cm／s升至3．92cm／s，阻力指数从3．84降至2．79（P〈0．01）；膀胱颈动脉的收缩期血流速度峰值从12．77cm／s升至17．09cm／s，舒张末期血流速度从1．31cm／s升至2．83cm／s，血流速度增快，阻力指数从3．78降至2．78（P〈0．01）。下尿路局部的血管舒张，阻力降低，膀胱颈及尿道周的血流灌注增加。尿频、夜尿发生率降低，性生活满意度增加。结论绝经后妇女经阴道局部雌激素治疗可明显改善下尿路的血流灌注，从而减轻下尿路症状，提高生存质量。

Objective To study the effects of vaginal estrogen application on blood flow of the lower urinary tract in post-menopausal women. Methods Arterial blood flow frequency spectrum, peak systolic blood flow, end-diastolic blood flow velocity and resistance index of the peri-urethra and neck of the urinary bladder, as well as changes in their genitourinary system, were measured with color Doppler ultrasound imaging in post-menopausal women before and three months after their use of premarin ointment containing natural estrogen per vagina. Results Three months after treatment with estrogen-premarin ointment per vagina in post-menopausal women, their peak systolic blood flow velocity of the peri-urethra arteries increased to 13.23 cm/s from 11.94 cm/s before treatment, end-diastolic blood flow velocity increased to 3.92 cm/s from 1.91 cm/s and resistance index decreased to 2. 79 from 3.84 （P 〈0. 01 ）. And, their peak systolic blood flow velocity of the arteries of the neck of the urinary bladder increased to 17.09 cm/s from 12. 77 cm/s before treatment, end-diastolic blood flow velocity increased to 2. 83 cm/s from 1.31 cm/s and resistant index decreased to 2.78 from 3.78 （P 〈0. 01 ）. It indicated that local vasodilatation and decreased resistance of the lower urinary tract made blood flow of the arteries of the peri-urethra and neck of the urinary bladder increase, urinary frequency and nocturia occurrence decrease, and sexual satisfaction improve. Conclusions Blood flow, symptoms of the lower urinary tract and their quality of life can be improved in post-menopausal women after treatment with natural estrogen-premarin ointment per vagina.