西南地区尿动力学质量回顾:多中心随机抽样调查结果分析

Urodynamics quality in southwest China:a multicenter random study

目的探讨中国西南地区医疗机构尿动力学检查(UDS)质量及改进方法。方法以两阶段抽样的方法进行抽样:第1阶段,采用整群抽样方法抽取2020年3—6月西南地区10家开展尿动力学检查的医疗机构;第2阶段,根据西南地区UDS开展情况,使用样本量估算公式,同时考虑报告抽取中的失访率,最终确定初筛样本量为350份。由于纳入研究的10家医疗机构UDS工作量相当,故从每家医疗机构抽取35份尿动力学检查图谱进入初筛。本研究最终分析的纳入标准:①患者病史记录清晰,临床资料完整;②UDS图像清晰;③UDS系统为水测压检测系统;④患者年龄>18岁。由2名具有10年以上泌尿外科尿控专业工作经验的人员,参考国际尿控协会(ICS)制订的指南及已发表的相关文献,独立对所有入组的尿动力学图谱进行质量评价。主要评价图谱赝像发生情况,图谱赝像分为非技术性赝像和技术性赝像。非技术性赝像包括:腹压变异、自由尿流率检查排尿量<150 ml。技术性赝像包括:非标准化调零、未能记录所有尿动力学参数、基线漂移、导管移位、排尿期逼尿肌生理性收缩与逼尿肌终末型无抑制性收缩误判、储尿期逼尿肌无抑制性收缩与膀胱低顺应性误判。结果共150份尿动力学图谱纳入最终分析。非技术性赝像发生情况:腹压变异32例(21.3%)和自由尿流率检查排尿量<150 ml 21例(14.0%)。技术性赝像发生情况:非标准化调零28例(18.7%)、未能记录所有尿动力学参数8例、基线漂移16例、导管移位9例、排尿期逼尿肌生理性收缩与逼尿肌终末型无抑制性收缩误判12例和储尿期逼尿肌无抑制性收缩与膀胱低顺应性误判24例(16.0%)。结论目前中国西南地区UDS的主要问题是操作者对于尿动力学基础知识理解欠缺,以及不能严格按照标准指南进行操作。可以通过规范UDS操作和及时地识别、纠正赝像,同时推进标准化尿动力学培训课程的开展等进行改进。

Objective To retrospectively analyze the urodynamics quality in Southwest China,and find out the main issues of urodynamics quality in Southwest China and try to find out the improvement ways.Methods In this study,a two-stage sampling method was used.In the first stage,10 medical institutions in Southwest China were selected by cluster sampling from March to June,2020.In the second stage,according to the development of UDS in Southwest China,the sample size estimation formula was adopted,and the loss of follow-up rate in reports extraction was considered,the initial sample size was 350.As the workload of UDS in the 10 medical institutions involved in the study was equivalent,35 urodynamics traces from each medical institution were selected.The initial samples should also meet the inclusion criteria:①patients with clear medical history and complete clinical data;②UDS traces were clear;③UDS system was water filled system;@age>18,and 150 urodynamic traces were included in the final study.We evaluated the quality of enrolled urodynamics traces,and the quality evaluation standard according to the guidelines established by the International Continence Society(ICS).The evaluation conducted by two independent urologist with more than 10 years working experience.Artifacts were divided into non-technical artifacts:abnormal abdominal pressure changes,urine volume<150 ml when did the uroflow test,and technical artifacts:nonstandard zero setting,fail to record all urodynamics parameters,baseline drift,catheter displacement,misjudgment of detrusor physiological contraction and detrusor overactive in voiding phase,misjudgment between detrusor overactive and bladder low compliance in filling phase.Results non-technical artifacts:32 cases were found abnormal abdominal pressure changes(21.3%),21 cases(14.0%)were found when did the uroflow test the urine volume<150 ml,and technical artifacts:Non-standard zero setting in 28 cases(18.7%),fail to record all urodynamics parameters in 8 cases,baseline drift in 16 cases,catheter displacement in 9 cases and misjudgment of detrusor physiological contraction and detrusor overactive in voiding phase in 12 cases,misjudgment between detrusor overactive and bladder low compliance in filling phase in 24 cases(16.0%).Conclusions Al presenl,the urodynamics quality in Southwest China need to be improved.The main issues were that the operator didn't obey the basic operation and quality control process,and the operator did not have enough basic knowledge of urodynamics.It can be improved by strictly carry out the operation standard of UDS,identifying and correcting artifacts in time,and promoting the standardized urodynamic training courses.