脑卒中恢复期下尿路功能障碍相关、预测因素及尿流动力学

The risk factors of lower urinary tract dysfunction and urodynamics study in stroke patients in the convalescent stage

目的观察脑卒中恢复期下尿路功能障碍的发生情况、相关因素和预测因素以及尿流动力学特点。方法脑卒中恢复期患者131例，均收集一般资料、神经系统相关专科情况并详细了解排尿情况及既往病史，判断患者有无下尿路功能障碍及其类型，进行相关分析及尿流动力学检查。结果脑卒中后下尿路功能障碍发生率为44．3％，症状由多到少依次为：尿失禁、尿频、尿急、夜尿增多、排尿等待及排尿费力、尿潴留。MMSE量表评价认知功能有障碍组较无障碍组下尿路功能障碍发生率高1．8倍（χ^2=18．683，P=0．000）；改良巴氏指数≤20分者较≥25分者下尿路功能障碍发生率高1．2倍（χ^2=16．832，P=0．000）。经Logistic回归分析发现年龄（OR=1．622，95％CI1．183～2．224）、急性期留置导尿时间（OR=3．236，95％CI1．335～7．840）及病灶单或多发（OR=1．296，95％CI1．083～1．550）对脑卒中恢复期下尿路功能障碍发生有预测价值。尿流动力学检查发现78．9％患者逼尿肌过度活动，10．5％逼尿肌活动正常，10．5％逼尿肌无反射，无明确逼尿肌-括约肌协同失调患者。结论脑卒中恢复期下尿路功能障碍较为常见，以储尿期排尿障碍为主。下尿路功能障碍的患者高级脑功能及日常生活能力低下。高龄、持续留置导尿及多发病灶对恢复期下尿路功能障碍有一定的预测价值。尿流动力学改变多为逼尿肌过度活动，但症状与尿流动力学表现不完全一致，必要时应做此检查以利于进一步治疗。

Objective To analyze the prevalence of lower urinary tract dysfunction in stroke patients in the convalescent stage, its risk factors and the characteristics of urodynamics. Methods One hundred and thirty-one stroke patients in the convalescent stage were included in this study. Their general information, neurological system reviewing and past history were obtained, especially detailed micturitional histories. In patients with urinary symptoms, diagnosis and classification were made and relevant analysis and urodynamic study were performed. Results The prevalence of lower urinary tract dysfunction is 44. 3%. The most common symptom was urinary incontinence （frequency, urgency and nocturia） followed by hesitancy, straining and urinary retention. The incidence of micturitional disturbance is higher 1.8 times in cognitive disfunction group than normal cognitive function group （ χ^2 = 18. 683, P = 0. 000） ; it was higher 1.2 times in patients with modified Bathel index scale ≤ 20 than those with≥ 25 （ χ^2= 16. 832, P = 0.000）. Logistic multivariate analyses suggested that age （OR = 1. 622, 95% CI 1. 183-2. 224）, the during of urethral catheterization （OR = 3. 236, 95% CI 1. 335-7. 840 ） and single or multiple lesions （OR=1.296, 95% CI 1.083--1.550） to be the risk factors of lower urinary tract dysfunction at the convalescent stage in stroke patients. The urodynamics study found detrusor over activity in 78. 5% patients, normal in 10. 5% and detrusor areflexia in 10. 5% patients. There was no detrusor-sphincter dyssynergia. Conclusions Lower urinary tract dysfunction is common after stroke with the storage symptoms to be the most common. Patients with lower urinary tract dysfunction show impaired cognitive function and poor ability in daily life. Age, during of urethral catheterization and single or multiple lesions are among risk factors of lower urinary tract dysfunction. Detrusor overactivity is the most common finding in urodynamie study. Because the clinic symptoms are not often in accordance with the findings in urodynamics study, further urodynamies study are needed to benefit the treatment.