全麻对膀胱逼尿肌功能的影响及其尿动力学的变化特点

Influence of general anesthesia on the function of the bladder detrusor and the characteristics of urodynamic changes

目的研究全麻对膀胱逼尿肌功能的影响及其尿动力学的变化特点。方法2010年11月至2011年10月，全麻手术患者42例，男28例，女14例。年龄18～70岁，平均38岁。腹腔镜手术35例，开放手术7例，于麻醉前、麻醉期、麻醉结束清醒后进行尿动力学检查，统计学比较麻醉前后尿动力学参数的差异。42例患者均成功完成检查。麻醉期间膀胱逼尿肌排尿功能丧失，充盈膀胱至麻醉前测得患者的最大膀胱容量后停止灌注。根据麻醉结束清醒后检查的参数将患者分为正常顺应性组27例和低顺应性组15例，对麻醉前后数据行统计学分析。结果正常顺应性组麻醉前初尿意容量（FD）、强烈尿意容量（SD）、膀胱最大容量（MCC）分别为（118．2±16．8）、（204．6±27．4）、（395．8±50．1）ml，麻醉后分别为（160．9±21．6）、（244．8±44．0）、（394．7±56．9）ml，FD、SD麻醉前后差异有统计学意义（P〈0．01），MCC无统计学意义（P〉0．05）。低顺应性组麻醉前FD、SD、MCC分别为（118．9±15．1）、（208．8±22．9）、（403．9±48．1）ml，麻醉后分别为（123．0±16．9）、（189．1±35．9）、（275．4±33．7）ml，麻醉前后差异均有统计学意义（P〈0．01）。低顺应性组患者予留置测压管1h后复测，膀胱顺应性均恢复正常。结论全麻结束后膀胱稳定性正常，感觉功能较正常状态减弱，患者逼尿肌均能有效收缩并自主排尿，部分患者出现一过性顺应性降低；正常情况下全麻患者可予麻醉诱导后留置尿管，术毕后及时拔除。

Objective To study the influence of general anesthesia on the bladder detrusor and the characteristics of urodynamic changes. Methods From November 2010 to October 2011, 42 patients un- derwent abdominal surgery with general anesthesia （28 males and 14 females, mean age of 38 years, laparo- scopic operation in 35 cases, traditional operation in 7 cases） were taken urodynamic analysis before, during and after anesthesia. The urodynamic parameters were recorded, and statistically analyzed the differences before and after anesthesia. Results All 42 patients were successfully completed the test. During anesthesia we filled the bladder to the measured maximum bladder capacity just before anesthesia, and no es- traordinary findings were found during this period. According to the results when the patients awake, we divided the patients into two groups： normal compliance group in 27 cases and low compliance group in 15 cases. We statistically analyzed the data respectively. FD, SD, MCC in normal compliance group were （118.2±16.8） ml, （204.6 ±27.4） ml, （395.8 ±50.1） ml, and （160.9 ±21.6） ml, （244.8± 44.0） ml, （394.7 ± 56.9） ml respectively before and after the anesthesia. There were significant differences in FD, SD （P〈0.01）, and no significant difference in MCC （P〉0.05）. FD, SD, MCC in low compliance group were （118.9 ±15. 1） ml, （208.8 ±22.9） ml, （403.9 ±48.1） ml, and （189. 1 ± 35.9） ml, （123.0 ± 16.9） ml, （275.4± 33.7） ml respectively. There were significant differences in FD, SD, MCC （P 〈0.01 ）. We retested the low compliance group one hour after the anesthesia, and found its compliance returned normal. Conclusions After a general anesthesia the bladder detrusor was ~table, but the sensory function is diminished. Some patients showed a transient phenomenon of low compliance. All pa- tients were capable of urinate autonomously with detrusor contraction. In normal circumstances we may cath- eterize the patients after the induction of anesthesia, and timely removal it postoperatively.