辣椒辣素类似物对神经原性膀胱功能影响的临床研究

Clinical study of resiniferatoxin on neurogenic bladder

目的 探讨辣椒辣素类似物（RTX）对神经原性膀胱的影响.方法 选择最大膀胱容量〈250 ml的脊髓损伤患者24例,患者均为男性,均存在膀胱尿道功能障碍,不能自主排尿,行间歇导尿4～6次/d.依据损伤的部位和程度分类,包括颈髓不全损伤2例,胸髓完全损伤5例,胸髓不完全损伤4例,腰髓完全损伤8例,腰髓不完全损伤5例;年龄24～58岁;病程1-6年,平均2.3年.RTX每支含量0.0063 mg/4 ml,溶于50 ml生理盐水中,缓慢注入排空膀胱内,保留30 min,然后予以间歇导尿排空膀胱.记录接受RTX膀胱内灌注前后最大膀胱容量和膀胱顺应性的变化.以灌注后最大膀胱容量增加≥100 ml为有效,否则为无效.结果 灌药前及灌药1周后尿动力学检测提示最大膀胱容量分别为（210±23）ml和（360±30）ml;膀胱顺应性分别为（17±3）ml/cm H2O和（24 ±5）ml/cm H2O（1 cm H2O=0.098 kPa）,灌药前后两指标差异均有统计学意义（均P〈0.01）.共15例有效,9例无效,总有效率62.5%,有效期持续1-4个月不等.结论 RTX膀胱内灌注对于神经原性膀胱具有一定的扩大膀胱容量,增加膀胱顺应性,减少漏尿的作用.

Objective To understand the effect of resiniferatoxin on neurogenic bladder by intravesical filling. Methods Twenty-four male spinal cord injury patients with an obviously low cystometric capacity, 2 incomplete cervical cord injury, 5 complete thoracic cord injury, 4 incomplete thoracic cord injury, 5 incomplete lumbar cord injury and 8 complete lumbar cord injury were examined. The age range was 24-58 years old and the course of disease 1-6 years. There were 0. 0063 mg/4 ml RTX in each bottle.it was dissolved in 50 ml physiologic saline and was infused into bladder slowly, keeped 30 min, then was discharged by intermittent catheterization （IC）. During the process, the patients were requested to fill a micturition chart and conduct urodynamic examination before and after the infusion. We regulated that it was utility when the amount of increased maximal cystometric capacity（MCC） exceeded or was 100 ml, otherwise it was invalid. Results The urodynamic examination before intravesical filling and 1 week after intravesical filling showed that the average MCC were （210 ±23） ml and （360 ±30） ml respectively, the average bladder compliance were （17 ±3） ml/cm H2O and （24 ±5） ml/cm H2O, there were statistic difference between them（both P 〈 0. 01 ）. The overall effective rate was 62. 5% . It lasted 1-4 months. Conclusion Resiniferatoxin is effective to increase the cystometric capacity and booster the bladder compliance.