脊髓损伤排尿功能障碍患者的尿动力学分析

Urodynamic analysis on spinal cord injury patients with urinary voiding dysfunction

目的了解不同节段脊髓损伤后膀胱尿道功能障碍的差异。方法回顾性分析30例脊髓损伤患者的尿动力学资料。男22例，女8例。年龄17～74岁，平均47岁。病程7．36个月，平均18个月。其中胸腰段脊髓损伤19例，骶髓损伤11例。2组尿动力检查结果行单因素方差分析或秩和检验比较。结果胸腰段脊髓损伤组与骶髓损伤组自由尿流率参数比较：最大自由尿流率（13．04-5．1）与（13．0±5．8）ml／s，2S时自由尿流率（6．5±5．1）与（6．9±6．4）ml／s，平均自由尿流率（5．44-2．4）与（3．4±0．5）ml／s，自主排尿量（279．1±131．1）与（450．0±26．6）ml，残余尿量（209．54-180．7）与（434．0±215．0）ml；2组排尿量和残余尿量比较差异有统计学意义（P〈0．05）。2组完全性膀胱测压参数比较：最大尿流率（16．0±23．3）与（7．1±3．3）mL／s，平均尿流率（4．6±2．3）与（3．9±2．3）ml／s，排尿后2s的尿流率（4．6±3．1）与（2．2±3．2）mL／s，排尿量（268．4±113．9）与（129．0±97．9）ml，最大尿流率时的逼尿肌压力（58．8±22．0）与（56．5±14．5）emH，0（1cmH2O=0．098kPa），逼尿肌最大压力时的尿流率（4．8±2．0）与（4．84-4．4）ml／s，逼尿肌最大压力（68．0±31．0）与（54．6±20．2）cmH2O，排尿期平均压力（47．4±20．0）与（42．6±13．9）cmH2O，2组排尿量比较差异有统计学意义（P〈0．05）。2组膀胱感觉及膀胱尿道协同性差异无统计学意义（P〉0．05），胸腰段损伤患者中低顺应性膀胱（4／11）发生率较高，骶髓损伤患者中高顺应性膀胱（11／19）发生率较高。结论骶髓损伤和胸腰段脊髓损伤患者区别主要为膀胱顺应性的差异和膀胱逼尿肌收缩能力的改变，骶髓损伤患者逼尿肌收缩能力降低、高顺应性膀胱发生率较高，胸腰段脊髓损伤患者逼尿肌收缩亢进、低顺应性膀胱发生率较高。

Objective To find the differences of bladder and urethra dysfunction between sacral spinal cord injury and Thoracolumbar spinal cord injury. Methods According to the criteria of inclusion and exclusion, we collected 30 patients in the study group. There were 22 males and 8 females, aged 17 - 74 （mean, 47） years, with duration between 7 -36 （mean, 18） months. There were nineteen cases of thoraeolumbar spinal cord injury and 11 cases of sacral spinal cord injury in the study group. We conducted a retrospective analysis of the urodynamic data of the 30 patients in the group. They were divided into a sacral spinal cord injury group and a thoracolumbar spinal cord injury group according to the location of the site of injury. The urodynamic findings of the two groups were comparable. SPSS 16. I） was used to compare the differences between the groups by ANOVA/rank sum test. Results We measured the free flow rate parameters between thoracolumbar and sacral spinal cord injury groups. The maximum free flow rate was （13.0 ±5.1） vs （13.0 ±5.8） ml/s, the free flow rate at2 s was （6.5 ±5.1 ） vs （6.9 ±6.4） ml/s, the mean free flow rate was （5.4±2.4） vs （3.4 ±0.5） ml/s, urine output volume was （279.1 ±131.1） vs （450.0 ±26.6） ml and the residual urine volume was （209.5 ±180.7） vs （434.0 ±215.0） ml. The residual urine volume and urine output volume of sacral the spinal cord injury group was higher than the thoracic spinal cord injury group （P 〈 0.05）. We also measured the the cystometric parameters. The maximum urinary flow rate was （16.0 ±23.3） vs （7, 1 ±3.3） ml/s, average flow rate was （4.6 ±2.3） vs （3.9 ± 2.3） ml/s, the flow rate after voiding 2 s was （4.6 ± 3.1 ） vs （2.2 ± 3.2） ml/s, urine output volume was （268.4 ± 113.9） vs （ 129.0 ± 97.9 ） ml, detrusor pressure of maximum flow rate was （ 58.8 ± 22.0 ） vs （56.5 ~14.5） cm HEO, flow rate of maximum detrusor pressure was （4.8 ±2.0） vs （4.8 ±4.4） ml/s, the maximum detrusor pressure was （68.0 ± 31.0） vs （54.6 ± 20.2） cm H2O and the average pressure of voiding period was （47.4 ±20.0） vs （42.6 ±13.9） cm H2O. The urine output volume of the thoracolumbar spinal cord injury group was lower than sacral spinal cord injury group （P 〈 0.05 ）. There were no significant differences in bladder sensation and coordination of bladder/urethra between the thoracolumbar spinal cord injury group and the sacral spinal cord injury group （P 〉 0. 05）. The incidence of low compliance bladder in the thoracolumbar spinal cord injury patients （4/11） was higher than the sacral spinal injury group, the incidence of high compliance bladder in the sacral spinal cord injury patients （11/19） was higherthan the thoracolumbar group. Conclusions The urodynamics＇ difference between the sacral spinal cord injury group and thoracolumbar spinal cord injury group was observed in bladder compliance and bladder detrusor contractility changes. Relatively, the incidence of decreased detrusor contractility and high compliance bladder in sacral spinal cord injury patients was higher, and the incidence of detrusor hyperreflexia and low compliance bladder in thoracolumbar spinal cord injury patients was higher.