脊髓损伤致神经源性膀胱功能障碍经直肠超声膀胱血流动力学分析

Hemodynamic analysis by transrectal ultrasonography of neurogenic bladder after spinal cord injury

目的分析实施间歇导尿(intermittentcatheterization,IC)的脊髓损伤(spinalcordinjury,SCI)后神经源性膀胱功能障碍(neurogenicbladder,NB)患者不同时段直肠超声膀胱血流动力学变化。方法选取本院康复科及脊柱外科2016年1月至2019年4月收治的SCI后NB患者56例,其中男48例,女8例,年龄(29.7±8.2)岁。入选患者按IC频次划分成5个不同时段,分别经直肠超声检查采集膀胱充盈期及排空后10~15 min膀胱影像、多普勒图谱、膀胱血流动力学数据。结果随着自控排尿量增多、残余尿量的减少,膀胱充盈期血流速度收缩期峰值流速(Vs)、舒张期峰值流速(Vd)、平均速度(Vm)与IC前比较均增快(F=26.141,P<0.001;F=9.127,P<0.001;F=15.819,P<0.001);血管阻力指数(RI)、脉动指数(PI)与IC前比较均增大(F=29.499,P<0.001;F=29.431,P<0.001);排空期血流速度Vs、Vd、Vm与IC前比较均增快(F=17.065,P<0.001;F=4.429,P=0.002;F=9.811,P<0.001);RI、PI与IC前比较均增大(F=14.370,P<0.001;F=12.463,P<0.001)。结论直肠超声膀胱检测IC的不同时段膀胱充盈期及排空期血流速度(Vs、Vd、Vm)随着IC频次减少速度加快,RI、PI亦逐渐增大,提示膀胱血流动力学检测对SCI后NB恢复和重建评价具有临床指导意义。

Objective To analyze the hemodynamic changes of bladder by rectal ultrasonography during different time periods in patients with neurogenic bladder(NB)after spinal cord injury(SCI)undergoing intermittent catheterization(IC).Methods Fifty-six(29.7±8.2)years old patients with NB after SCI,who were treated at the departments of rehabilitation and spinal surgery at our hospital from January 2016 to April 2019,were selected,including 48 males and 8 females.The patients were divided into 5 periods according to the IC frequencies.The data of bladder imaging,Dopplergram,and bladder hemodynamics were collected by transrectal ultrasonography during bladder filling period and 10-15 min after bladder emptying.Results As the controlled urine output increased and the residual urine output decreased,the blood flow velocities[peak systolic velocity(Vs),peak diastolic velocity(Vd),and mean velocity(Vm)]increased during bladder filling period as compared with those before IC(F=26.141,P<0.001;F=9.127,P<0.001;and F=15.819,P<0.001);the blood vessel resistance index(RI)and pulsation index(PI)were significantly higher than those before IC(F=29.499,P<0.001 and F=29.431,P<0.001).The Vs,Vd,and Vm increased in the emptying period were faster than those before IC(F=17.065,P<0.001;F=4.429,P<0.001;and F=9.811,P<0.001);the RI and PI were larger than those before IC(F=14.370,P<0.001 and F=12.463,P<0.001).Conclusion The blood flow velocities(Vs,Vd,and Vm)during bladder filling and emptying periods detected by rectal ultrasonography,as well as the RI and PI,increase as the IC frequency decreases,indicating that the detection of bladder hemodynamics have clinical guiding significance for the evaluation of function recovery and reconstruction in patients with NB after SCI.