重复膀胱灌注测压中不同类型逼尿肌过度活动的变异性研究

A study of variability in detrusor overactivity of different types on repeated filling cystometry

目的探讨重复膀胱灌注测压中不同类型的逼尿肌过度活动（detrusor overactivity，DO）的变异性。方法选取2006年2月至2012年6月78例男性DO患者，其中脊髓损伤（spinalcord injury，SCI）41例，BPH37例。DO诊断标准为在膀胱充盈灌注期间发生逼尿肌非自主性收缩（involuntary detrusor contraction，IDC）。患者均进行两次膀胱灌注测压，间隔时间为10min。分别记录两次检查的膀胱初始感觉容量、膀胱最大容量、Qmax、最大尿流时逼尿肌压、初次IDC容量、最大IDC压力，IDC频次等参数。在SCI与BPH两组中分别对两次检查的数据进行对比。结果SCI组中，两次检查的各项数据差异均无统计学意义（P〉0．05）。BPH组第2次与第1次检查比较，膀胱初始感觉容量分别为（120．0±40．2）ml、（112．3±42．1）ml，膀胱最大容量分别为（307．5±73．3）ml、（295．4±82．5）ml，初次IDC容量分别为（146．2±43．9）ml、（134．3±48．2）ml，IDC频次分别为（2．2±1．5）次、（2．8±1．3）次，差异均有统计学意义（P〈0．05）；5例在第2次检查中未发生DO。结论在重复膀胱灌注测压中，不同类型DO的变异性存在差异。神经源性DO的变异性不强，而特发性DO有减轻的趋势。

Objective To evaluate the variability in detrusor overactivity of different types on repeated filling eystometry. Methods The repeated filling eystometry were performed in 78 male patients who had presented with detrusor overactivity （DO） in the urodynamie studies during the period of February 2006 to June 2012, including 41 spinal cord injury （SCI） patients and 37 benign prostatic hyperplasia （ BPH ） patients. DO was defined as occurrence of involuntary detrusor contractions （IDC） during filling eystometry. All of the patients had undergone a second filling cystometry 10 minutes after the first filling cystometry completed. The urodynamical parameters were recorded as the first sense volume of bladder, the maximum bladder capacity, Q the detrusor pressure at Q the volume at the first involuntary detrusor contraction （IDC） , the maximum IDC amplitude, IDC number in the first and the second filling cystometry separately. The urodynamical parameters were compared between the first and the second filling cystometry in SCI and BPH patients separately. Results In SCI patients, differences of urodynamical parameters between the first and the second filling cystometry were not significant （P〉0.05）. In BPH patients, the first sense volume （ 120.0±40.2 ml and 112.3±42.1 ml） was larger （P = 0.00） , the maximum capacity （ 307.5± 73.3 ml and 295.4±82.5 ml） was larger （P=0.01）, the volume at the first IDC （146.2±43.9 ml and 134.3±48.2 ml） was larger （P=0.00） , and IDC number （2.2±1.5 and 2.8±1.3） was reduced （P=0.00） in the second filling cystometry compared with the first filling cystometry. 5 out of 37 （ 13.5% ） BPH patients did not demonstrate DO in the second filling cystometry. Conclusions The variability of detrusor overactivity varies in different type of detrusor overactivity. Neurogenic detrusor overactivity is stable, and idiopathic detrusor overactivity has a tendency of alleviation on repeated filling cystometry.