半坐卧位对良性前列腺增生患者压力-流率测定的影响

Effect of semi-reclining position on pressure-flow studies in patients with benign prostatic hyperplasia

目的探讨45°半坐卧位对良性前列腺增生(benign prostatic hyperplasia,BPH)患者压力-流率测定(pressureflow studies,PFS)的准确性和可行性。方法2007年11月至2008年5月在我科住院拟行前列腺切除术的BPH患者,随机分为A、B两组,每例先后连续行两次PFS测定,A组先取45°半坐卧位后改站立位检查,B组则先取站立位后改45°半坐卧位检查。结果共入选60例,A、B组各30例。其中48例(80%)在2种体位PFS排尿期均有尿流数据,48对数据采用两阶段交叉设计方差分析:半坐卧位和站立位的最大尿流率分别为(6.079±3.485)ml/s和(6.390±3.903)ml/s,均数95%可信区间分别为(5.712,6.436)ml/s和(6.033,6.757)ml/s,P=0.214;最大尿流率时逼尿肌压力分别为(72.844±37.800)cmH2O和(82.917±38.681)cmH2O,均数95%可信区间分别为(70.736,74.808)cmH2O和(80.953,85.024)cmH2O,P=0.000;AG数分别为(60.788±40.000)和(70.256±41.893),均数95%可信区间分别为(58.471,62.956)和(68.081,72.567),P=0.000;URA值分别为(46.576±23.595)和(51.512±25.503),均数95%可信区间分别为(44.535,48.598)和(49.490,53.552),P=0.001。余12例(20%)在站立位PFS排尿期能排尿,但在45°半坐卧位时不能排尿,未能得到完整PFS数据。结论采用45°半坐卧位PFS检查会低估膀胱出口梗阻的严重程度,检查成功率亦低于站立位。

Objective To investigate the accuracy and feasibility of the pressure-flow studies （PFS） carried out in 45° semi-reclining position in patients with benign prostatic hyperplasia （BPH）. Methods The cases of BPH admitted to our department to receive prostatectomy between November, 2007 and May, 2008 were divided into 2 groups randomly. Before the operation, each patient continuously underwent PFS twice in 45° semi-reclining and standing position, respectively. A total of 60 cases were included, either group A or group B consisted of 30 cases. The PFS was carried out in 45 ° semi-reclining position first, and then in standing position in group A, but conversely in group B. The data were analyzed by UNIANOVA with SPSS 13.0. Results Of the 60 cases, 48 （80%） had good flow curves in both 45° semi-reclining and standing position. No significant difference was noted in the Qmax between 45° semi-reclining [6. 079 ± 3. 485 ml/s, with 95% CI of the mean （5. 712, 6. 436） ] and standing position [6. 390 ±3. 903 ml/s, with 95% CI of the mean （6. 033, 6. 757） ]. But a highly significant difference was noted in the Pdet. Qmax between in 45° semi-reclining [ 72. 844 ± 37. 800 cmH2O, with 95% CI of the mean （70. 736, 74. 808 ） ] versus standing position [ 82. 917 ± 38. 681 cmH2O, with 95% CI of the mean（80. 953, 85. 024） 1 （P =0. 000）. The AG number in 45° semi-reclining [60.788 ±40.000, with 95% CI of the mean （58. 471,62.956） ] and standing position [70. 256 ±41. 893, with 95% CI of the mean （68. 081, 72.567）] revealed a highly significant difference （P = 0. 000）. The URA in 45° semi-reclining [ 46. 576 ± 23. 595, with 95 % CI of the mean （44.535,48. 598 ） ] and standing position [ 51.512 ± 25. 503, with 95% CI of the mean （49. 490, 53. 552 ） ] also showed statistical significance （ P = 0. 001 ）.The other 12 cases （20%） had flow curves only in standing position but did not （unable to void） in 45° semi- reclining position. Conclusion The accuracy and feasibility of the PFS carried out in 45° semi-reclining position are not as good as in standing position for patients with BPH.