神经源性膀胱功能障碍超声声像图特点与脊髓损伤的关系分析

Ultrasonographic characteristics of neurogenic bladder dysfunction and its relationship with spinal cord injury

目的分析神经源性膀胱功能障碍超声声像图特点与脊髓损伤的关系。方法选取2017年5月至2019年3月浙江省监狱中心医院脊髓损伤康复科收治的83例脊髓损伤患者作为研究对象。采用二维超声观察双肾、输尿管、尿内回声、膀胱壁以及前列腺声像图变化,并分析其与脊髓损伤的关系。结果超声声像图主要表现为:①膀胱壁增厚且伴有结节,膀胧壁毛糙,可见大量肌小梁、小房及多个憩室形成;②尿液内有异常回声,尿内形成沉积物、结石以及血凝块;③膀胱大量尿潴留,存在双肾积水及结石;④尿道内口扩张呈漏斗状,前列腺增大。不同级别超声声像图阳性率呈下降趋势,差异具有统计学意义(P<0.05);83例神经源性膀胱功能障碍患者中,不完全性损伤2例,完全性损伤81例,以A级、颈段以及完全性损伤多见;不同级别脊髓损伤患者残余尿量与尿培养阳性率比较,差异无统计学意义(P>0.05)。结论神经源性膀胱功能障碍超声声像图具有一定特点,且与脊髓损伤相关,可为患者膀胱功能康复训练提供一定指导价值。

Objective To explore the relationship between the ultrasonographic characteristics of neurogenic bladder dysfunction and spinal cord injury.Methods A total of 83 patients with spinal cord injury admitted to the Department of Recovery form Spinal Cord Injury of Zhejiang Prison Central Hospital from May 2017 to March 2019 were selected.Two-dimensional ultrasonography was used to observe the changes of bilateral kidneys,ureters,urinary echoes,bladder wall and prostate,and analyze their relationship with spinal cord injury.Results Ultrasonography showed:①Thickening of bladder wall with nodules,rough bladder wall,a large number of muscle trabeculae,small chambers and diverticula;②abnormal echoes in urine:formation of deposits,stones and blood clots;③massive urinary retention of bladder with hydronephrosis and calculi;④funnel-shaped urethral dilatation and prostatic enlargement.The positive rate of ultrasonography at different levels showed a downward trend,and the difference was statistically significant(P<0.05).Among the 83 patients with neurogenic bladder dysfunction,there were 2 incomplete injuries and 81 complete injuries,most of which were grade A,cervical segment and complete injuries.There was no statistically significant difference between the residual urine volume and the positive rate of urine culture among patients with different levels of spinal cord injury(P>0.05).Conclusions Ultrasonography of neurogenic bladder dysfunction has certain characteristics and is related to spinal cord injury.which can provide guidance for rehabilitation training of bladder function.