良性前列腺增生伴脑梗死患者的尿流动力学检查

Urodynamic examination in the patients with benign prostatic hyperplasia combined with cerebral infarction

目的了解良性前列腺增生伴脑梗死患者的排尿情况,指导临床治疗。方法对90例良性前列腺增生伴脑梗死患者行尿流动力学检查,记录最大尿流率(Qmax)、残余尿量(PVR)、初尿意膀胱容量(FBS)、最大测压膀胱容量(MCBC)、最大逼尿肌压(MDP)、膀胱顺应性(BC)。将患者资料按脑梗死病程(病程<1月为急性期、1月≤病程≤1年为恢复期组、病程>1年为后遗症期组)分为急性期组、恢复期组、后遗症期组共3组。对检查结果进行多因素分析。结果 Qmax(ml/s)表现为急性期(7.11±1.76)小于恢复期(10.77±1.24)和后遗症期(10.33±1.61)(P<0.01);PVR(ml)表现为急性期(361.33±43.10)大于后遗症期(129.62±30.82)和恢复期(83.31±14.95)(P<0.01);FBS(ml)表现为急性期(347.33±69.95)大于恢复期(132.27±13.16)和后遗症期(211.25±26.81)(P<0.01);MCBC(ml)表现为急性期(696.00±42.39)大于后遗症期(537.92±62.74)和恢复期(233.38±38.30)(P<0.01);MDP(cmH2O)表现为急性期(16.11±4.11)小于恢复期(55.18±14.40)及后遗症期(50.85±15.27)(P<0.01);BC(ml/cmH2O)表现为恢复期(11.85±1.21)小于急性期(52.22±2.64)及后遗症期(39.75±1.14)(P<0.01)。结论脑梗死急性期对膀胱尿道功能影响最大,引起逼尿肌收缩无力;恢复期对膀胱尿道功能亦有较大影响,引起逼尿肌反射亢进,呈不稳定膀胱;后遗症期对膀胱尿道功能影响较小。

Objective To investigate the urination condition and guide the treatment of the patients with benign prostatic hyperplasia combined with cerebral infarction. Methods 90 patients with benign prostatic hyperplasia combined with cerebral infarction were underwent urodynamie evaluation. The maximum flow rate （ Qmax ） , postvoid residual urine （ PVR ） , first bladder sensation （ FBS ） , maximum cystometric bladder capacity （MCBC） , maximum detrusor pressure（ MDP） and bladder compliance（ BC） were recorded for analysis. According to course of brain lesion, all cases were divided into 3 groups including acute stage group, convalescence stage group, sequelae stage group. The results of the examination were statistics with multivariate analysis. Results Qmax（ ml/s ） in the acute stage grouP（7. 11 ± 1.76） was remarkably lower than those in the convalescence stage group（ 10. 77 ± 1.24） and sequelae stage group（ 10. 33 ± 1.61） （P 〈 0. 01） ;PVR（ml） in the acute stage group （361.33 ±- 43. 10）was remarkably higher than those in the se- quelae stage group （ 129. 62 ± 30. 82 ） （ P 〈 0.01 ） , PVR （ ml ） in the sequelae stage group （ 129.62 ± 30. 82 ） was remarkably higher than those in the convalescence stage group（ 83.31 ± 14. 95 ） （ P 〈 0. 01 } ; FBS{ ml） in the acute stage group 347.33 ± 69. 95 ） was re- markably higher than those in convalescence stage group（ 132. 27 ± 13.16） and sequelae stage group（211.25 ±-26. 81 ） { P 〈0.01 } ; MCBC （ ml ） it was remarkably higher in acute stage group （ 696. 00 ± 42.39 ） than those in the sequelae stage group （ 537.92 ± 62. 74 } （ P 〈 0. O1 ） , it was remarkably higher in sequelae stage group{ 537.92 ± 62. 74 } than those in convalescence stage group （ 233.38 ± 38.30 ） （ P 〈 0.01 ） ; MDP （ emil20 ） in the acute stage group （ 16. 11 ± 4. 11 ） was remarkably lower than those in the convalescence stage group （ 55. 18 ± 14. 40 ） and sequelae stage group （ 50. 85 ± 15.27 } （ P 〈 0. 01 ） ; BC （ ml/cmHO ） it was remarkably lower in the convalescence stage group （ 11.85 ± 1.21 ） than those in the acute stage group { 52. 22 ± 2. 64 ） and sequelae stage group （ 39.75 ± 1.14 ） （ P 〈 0. 01 ）. Conclusion Acute cerebral infarction has the greatest impact on the function of bladder and urethra and could causes detrusor weakness. In convalescence stage, it also has greater impact on the function of bladder and urethra. It cause detrusor hyperreflexia and lead to an unstable bladder. In sequelae stage, it has less effects on bladder and urethra.