膀胱逼尿肌过度活动伴收缩功能受损的尿动力学分析

Urodynamic analysis of detrusor hyperactivity with impaired contractility

目的探讨膀胱逼尿肌过度活动伴收缩功能受损(DHIC)患者的尿动力学特点。方法回顾性分析因尿频、尿急伴排尿困难就诊的197例患者的尿动力学检查资料。通过压力-流率测定判断膀胱出口梗阻程度、逼尿肌稳定性和收缩强度。膀胱灌注过程中出现期相性非随意性逼尿肌收缩定义为逼尿肌过度活动。逼尿肌过度活动同时存在收缩力减弱,即为DHIC。结果 197例患者中,DHIC51例,单纯逼尿肌过度活动40例,单纯逼尿肌收缩力减弱98例,其余8例为单纯膀胱出口梗阻(BOO)患者。三组患者膀胱残余尿量(RUV)、最大尿流率(Qmax)、Qmax时的逼尿肌压(Pdet@Qmax)、膀胱顺应性和膀胱容量均有统计学差异(P<0.05);有BOO的DHIC与单纯逼尿肌收缩力降低患者比较,RUV、膀胱顺应性和膀胱容量有统计学差异(P<0.05);无论是否存在BOO,DHIC与单纯逼尿肌过度活动患者比较,仅RUV、Qmax、Pdet@Qmax有统计学差异(P<0.05、P<0.01)。结论系统的尿动力学分析有助于全面了解DHIC患者下尿路功能状态,指导制定合理的治疗方案。

Objective To investigate the urodynamic characteristics of detrusor hyperactivity with impaired contractility（DHIC）. Methods Data of urodynamic examination in 197 patients with urinary frequency, urgency associated with dysuria were retrospectively analyzed. Pressure-flow studies were performed to determine the degree of bladder outlet obstruction（BOO）, detrusor stability and contractile strength. Phasic and involuntary detrusor contraction during the process of bladder infusion was defined as detrusor overactivity, contractility was defined as DHIC. Results Of and detrusor overactivity coexisting with impaired 197 patients, 51 cases were diagnosed as DHIC, 40 cases were pure detrusor overactivity, and 98 cases were pure impaired detrusor contractility. Differences of residual urine volume（RUV） ,maximum urinary flow rate（Qrnax） and detrusor pressure at maximum flow rate（Pdet@Qmax） among three groups were statistically significant（P^0. 05）. The differences of RUV, bladder compliance and bladder capacity between DHIC with B（X） and impaired detrusor contractility with BOO were also statistically signifieant（P〈0. 05）. Conclusion Systematic urodynamic analysis is helpful in comprehensively understanding the lower urinary tract functional status of DHIC patients and guiding development of reasonable regimens for the treatments