脑桥上中枢损伤与腰骶段脊髓损伤患者的膀胱功能障碍及尿动力特点研究

A Study on the Bladder Dysfunction and Urodynamic Characteristics beween Suprapontine Neuropathy and Lumbosacral Spinal Cord Injury

目的:比较脑桥以上中枢损伤与腰骶段脊髓损伤患者的膀胱功能障碍及尿动力学特点。方法:回顾性分析2011年3月至2014年5月我院收治的78例中枢神经损伤患者的临床资料,包括临床表现、诊断、排尿方式、残余尿、尿动力学检查结果。其中,脑桥以上中枢损伤组43例,腰骶段脊髓损伤组35例,分析和比较两组患者的自由尿流率参数和完全膀胱测压参数。结果:两组间的最大尿流率、排尿量比较差异无统计学意义(P>0.05),脑桥上中枢损伤组的残余尿量明显低于腰骶段脊髓损伤组,差异有统计学意义(P<0.05)。与腰骶段脊髓损伤组比较,脑桥以上损伤组的膀胱容量明显减少,最大尿流率时的压力、逼尿肌的最大压力及平均压力明显增加,差异均有统计学意义(P<0.05)。两组膀胱的顺应性、逼尿肌稳定性比较差异有统计学意义(P<0.05),脑桥以上中枢损伤患者的多数表现为低顺应性膀胱(27/43),胸腰段脊髓损伤患者主要表现为高顺应性膀胱(21/35);脑桥以上损伤组多表现为逼尿肌的过度活动(29/43),而腰骶段脊髓损伤组更多表现为逼尿肌的无反射和弱反射(20/35)。结论:脑桥以上损伤患者主要表现为逼尿肌过度活动和膀胱容量的显著降低,以低顺应性膀胱为主;腰骶段脊髓损伤患者的逼尿肌多为无反射和弱反射,以高顺应性膀胱为主。

Objective： To compare the differences of bladder dysfunction and urodynamic characteristics between suprapontine neuropathy and lumbosacral spinal cord injury. Methods： The clinical data of 78 cases of patients with central nervous system damage admitted in our hospital from March 2011 to May 2014 were retrospective studied, including the clinical manifestations, diagnosis, urination way, residual urine, urodynamics. There were 43 cases of suprapontine neuropathy and 35 cases of lumbosacral spinal cord injury.The free flow rate parameters and cystometric parameters of two groups were compared. Results： There was no significant difference in the maximum free flow rate and urine output volume between two groups（P〉0.05）. The residual urine volume of suprapontine neuropathy group was lower than that of the lumbosacral spinal cord injury group（P〈0.05）. The bladder volume of suprapontine neuropathy was smaller than that of the lumbosacral spinal cord injury group（P〈0.05）. The maximum detrusor pressure, flow rate and detrusor pressure and the average pressure of voiding period of suprapontine neuropathy group were all higher than those of the lumbosacral spinal cord injury group（P〈0.05）. Significant differences were found in the bladder compliance and detrusor stability between two groups（P〈0.05）.Low compliance bladder was mainly found in the suprapontine neuropathy patients（27/43）, while high compliance bladder was mainly found in the lumbosacral spinal cord injury group（21/35）. The suprapontine neuropathy group mostly showed detrusor overactivity（29/43）, lumbosacral detrusor much performance had no reflection or weak reflection（20/35）. Conclusions： The patients with suprapontine neuropathy mainly showed detrusor hyperreflexia, small capacity bladder and low compliance bladder, while most patients with lumbosacral spinal cord injury showed decreased detrusor contractility and high compliance badder.