老年男性脑卒中后排尿异常尿动力学检查分析

Urodynamic Evaluation of Bladder Functon in Old Man with Abnormal Voiding After Stroke

目的:探讨60岁以上老年男性脑卒中后排尿异常的尿动力学改变。方法:选择50例脑卒中后恢复期或后遗症期排尿异常老年男性患者,其中无BPH脑卒中22例,年龄(69.25±5.78)岁;有BPH脑卒中28例,年龄(71.49±7.65)岁;另选择20例无下尿路异常的正常老年男性[(70.63±6.52)岁]作为对照组,分别进行尿动力学检查,并对各种尿动力学参数进行统计分析。结果:无BPH和有BPH脑卒中组比较,最大尿流率时逼尿肌压为(4.54±0.80)vs.(5.34±0.97)kPa(1 cmH_2O=0.098 kPa),最大尿道闭合压为(5.45±0.55)vs.(6.99±1.05)kPa,剩余尿量为(9.0±3.4)vs.(12.9±5.3)ml,差异有统计学意义(P<0.05)。与正常老年组比较,无BPH和有BPH脑卒中组逼尿肌反射亢进发生率均显著增加[72.7%(16/22)vs.75%(21/28)vs.10.0%(2/20)],其最大膀胱容量明显减少[(298.8±112.6)vs.(276.5±132.21)vs.(478.6±92.6)ml]。结论:脑卒中后排尿异常应进行尿动力学检查。有BPH脑卒中患者逼尿肌排尿压、尿道闭合压和剩余尿量变化较无BPH脑卒中患者更为明显,提示应同时治疗BPH。

Objective：To explore the urodynamic changes of the old man above 60 years with abnormal voiding after stroke. Methods：Urodynamic evaluation was performed in 50 old men with abnormal voiding after stroke including 28 cases（71.49±7.65 y） with benign prostatic hyperplasia（BPH） and 22 （69.25±5.78 y） with no BPH. Twenty old men（70.63±6.52 y） with normal voiding as control. The urodynamic parameters were compared between different groups. Results：There are significant differences between the stroke group without t3PH and those with BPH of maximal voiding detrusor pressure （Pdet. max. void）（4.54±0. 80 kPa vs. 5.34±0.97 kPa）, maximal urethral closure pressure （Pmax. close, urethra） （5.45±0. 55 kPa vs. 6.99±1.05 kPa） and the residual （9.0 ±3.4 ml vs. 12.9±5.3 ml）（P〈0.05）. Compared with normal controls, the patients without BPH and those with BPH showed a significant increase in detrusor hyperreflexia frequency[72.7% （16/22） vs. 75%（21/28） vs. 10.0% （2/20）1] and their maximum bladder capacity decreased significantly（298.8± 112.6 ml vs. 276.5 ± 132.21 ml vs. 478.6±92.6 ml）, P〈0.05. Conclusions：Abnormal voiding after stroke should carry out urodynamic examinations. The significant changes in urodynamic evaluation in eases with BPH after storke indicating the importance of treating BPH spontaneously during the stroke recovery in cases with abnormal voiding.