合并神经原性膀胱活动低下非瘫痪脊髓功能障碍患者生命质量评估和尿动力学研究

Quality of life and urodyanmic characteristics in nonparalytic spinal cord dysfunction patients with neurogenic underactive bladder

目的 探讨合并神经原性膀胱活动低下（NUB）非瘫痪脊髓功能障碍（NPSCD）患者肠道膀胱扩大术（ECP术）后生命质量评估和尿动力学参数改善情况.方法 采用SF-36问卷表对72例合并NUB的NPSCD患者进行生命质量评分,并依据尿动力学膀胱功能障碍类型行ECP术联合自我清洁间歇导尿（CISC）或单一CISC治疗,最终对完成1年生命质量评分和尿动力学检查的58例（81%）患者[男30例（平均27±5岁）,女28例（平均26±4岁）]进行随访.选取40例无明显排尿异常症状正常志愿者[男20例（平均28±4岁）和女20例（平均29±4岁）]为对照组.结果 随访时,男女患者生理职能、生命力和社会功能得分分别为55±14和45±15、76±19和74±15、52±19和59±13,均显著高于治疗前35±10和32±11、27±18和33±17、40±12和34±15;最大膀胱压测定容量和膀胱顺应性分别为（320±44）和（338±50）ml、（55±15）和（60±17）cm H2O,显著高于治疗前的（131±30）和（140±35）ml、（5±3）和（6±4）cm H2O;逼尿肌漏尿点压分别为（6±2）和（6±3）cm H2O,显著低于治疗前的（28±9）和（25±6）cm H2O,治疗前后差异均有统计学意义（P＜0.05）;但男女生理职能、总体健康、生命力、社会功能、情感职能和精神健康评分均显著低于对照组（P＜0.05）;男女分别仅有17%和7%认为健康状况＂比1年前稍好＂.合并反流性上尿路损害患者随访时男女上尿路情况分别有89%和76%出现不同程度改善. 结论合并NUB的NPSCD患者应用ECP术和CISC治疗尿动力学参数显著改善,但生命质量仍较低,迫切需要更有效地治疗方法.

Objective To investigate the change of quality of life and urodynamics after the enterocystoplasty combined with clean intermittent self-catheterisation （CISC） in nonparalytic spinal cord dysfunction （NSCD） patients with neurogenic underactive bladder by the Medical Outcomes study 36-item short-form general health survey （SF-36）. Methods The quality of life of 72 NSCD patients with NUB were measured by SF-36 questionnaire, who had been taken enterocystoplasty combined with CISC or only CISC according to urodynamic results. In total, 58（81% ） patients were successfully followed for one year by SF-36 questionnaire and urodynamic examination, including 30 men （mean age 27±5 year） and 28 women （mean age 26±4 year）. The normal volunteers without lower urinary tract symptom were set as control group, including 20 men （mean age 28 ± 4 year） and 20 women （mean age 29±4 year）. Results At the follow-up, physical role, vitality and social function of men and women were 55±14 and 45±15, 76±19 and 74±15, 52±19 and 59±13 respectively, significantly higher than those before the treatment （35 ± 10 and 32 ±11, 27 ± 18 and 33 ± 17, 40 ±12 and 34 ±15）. The bladder compliance and maximum cystometric capacity were （320 ± 44 ） ml and （ 338 ±50）ml,（55±15）cm H2O and （60±17）cm H2O respectively, also significantly higher than those before the treatment （131±30ml and 140±35ml,5±3 cm H2O and 6±4 cm H2O）. However, detrusor leakage point pressures were （6±2）cm H2O and （6±3）cm H2O respectively, significantly lower than those before the treatment （28 ±9 cm H2 O and 25 ± 6 cm H2O）. Except for physical function and bodily pain, the all domains of quality of life in both men and women patients were significantly lower than those in control group. Only 17 % of men and 7 % of women believed ＂their health is better than that one year ago＂. There was no significant difference in the remission rate between men and women （89% vs 76%） in the patients with RUUTD before treatment. Conclusions It is suggested that urodynamic parameters are significantly improved. Many domains of quality of life were not improved and the reduced quality of life still occurred in NSCD patients with NUB using enterocystoplasty and CISC.