神经源性膀胱活动低下儿童生命质量评估和尿动力学研究

The efficacy of clean intermittent self-catheterization （CISC） or CISC combining enterocystoplasty for the school age patients with neurogenic underactive bladder

目的探讨神经源性膀胱活动低下（NUB）学龄儿童肠道膀胱扩大术（ECP术）联合自我清洁间歇导尿（CISC）或单一CISC治疗后生命质量和尿动力学参数改善情况。方法采用Qual—iveen量表对94例NUB学龄儿童进行生命质量评分，并依据尿动力学膀胱功能障碍类型进行ECP术联合CISC或单一CISC治疗，最终对62例（66％）完成1年随访。选取20例无明显排尿异常正常志愿儿童为对照组。结果与治疗前相比，患儿随访时生命质量缺陷和强制评分均显著降低，膀胱顺应性和最大膀胱压测定容量均显著增加，但是生命质量焦虑和情感评分无显著改善。随访时生命质量四方面评分均显著高于对照组。未合并反流性上尿路损害（RUUTD）患儿随访时无一例发生RUUTD。合并RUUTD患儿随访时无一例加重，血肌酐均正常，其中80％男性患儿出现不同程度改善，与女性患儿（69％）差异无统计学意义。结论ECP术和CISC可显著改善NUB学龄患儿尿动力学参数，但Qualiveen生命质量仍较低，需要更有效的治疗方法。

Objective To investigate the efficacy of clean intermittent self-catheterization （CISC） or CISC combining enterocystoplasty for the school age patients with neurogenic underactive bladder （NUB）. Methods Ninety four school age patients with NUB were recruited in this study. Twenty school age children with normal urodynamic profile were taken as normal controls. According to urodynamic test results, the NUB patients were treated with CISC or CISC combining enterocystoplasty. Of the 94 NUB patients, 62 （66%） patients urodynamic profile and quality of life were fol- lowed up for 1 year. The quality of life was evaluated using Qualiveen questionnaire. Results The life quality scores of the NUB patients were significantly higher than those of normal controls. After proper treatment, the NUB patients life quality scores in the domains of limitations and constraints decreased significantly. However, in the domains of fears and feelings, no significant difference was noted Bladder compliance and maximum cystometric capacity increased significantly after treatment. There was no significant difference of the life quality scores and urodynamic profiles between boys and girls. During follow-up, no patients reflux upper urinary tract deterioration （RUUTD） aggravated. The blood creatine of the NUB patients complicated with RUUTD stayed at the normal level during follow-up. Conclusions CISC or CISC combining enterocystoplasty produce good clinical and urodynamic outcomes in the school age patients with NUB.