神经源性膀胱上尿路损害的危险因素分析

Analysis of risk factors for upper urinary tract injury in children with neurogenic bladder

目的 探讨神经源性膀胱(neurogenic bladder, NB)患儿发生上尿路损害的危险因素。方法 以2021年1月至2021年5月重庆医科大学附属儿童医院151例诊断为NB的住院患儿为研究对象,根据是否发生上尿路损害分为上尿路损害组(n=88)和上尿路正常组(n=63),比较两组一般特征(性别、年龄、住院时间、病程、排尿方式、既往脊柱手术史)、临床症状(是否伴有尿频尿急、排尿困难、尿失禁,是否伴有膀胱直肠综合征)、实验室检查结果(尿常规、腰骶部X线片)、尿动力学检查结果[膀胱顺应性、是否伴有膀胱过度活动(overactive bladder, OAB)]之间的差异,对差异有统计学意义的指标行多因素Logistic回归分析,筛选导致NB患儿出现上尿路损害的危险因素。结果 以P<0.2为单因素方差分析筛选标准,结果显示入院时伴有发热、泌尿系感染、腹压/其他排尿方式、膀胱顺应性差、伴有OAB,是导致NB患儿发生上尿路损害的危险因素。对以上指标进行多因素分析发现:腹压/其他排尿方式、膀胱顺应性差、伴有OAB是NB患儿发生上尿路损害的独立危险因素(P<0.05),其中膀胱顺应性较差的NB患儿发生上尿路损害的风险是膀胱顺应性正常患儿的2.712倍(OR=2.712,95%CI:1.182~6.224);存在腹压/其他排尿方式的NB患儿发生上尿路损害的风险是采用清洁间歇导尿患儿的2.160倍(OR=2.160, 0,95%CI:1.182~6.224);伴有OAB的患儿发生上尿路损害的风险是不伴有OAB患儿的2.265倍(OR=2.265,95%CI:1.077~4.763)。结论 膀胱顺应性差、腹压/其他排尿方式、伴有OAB是NB患儿发生上尿路损害的危险因素,在对NB患儿进行膀胱管理时应使其膀胱保持低压状态,以减轻对上尿路的损害。

Objective To explore the related risk factors of upper urinary tract damage in patients with neurogenic bladder(NB).Methods A total of 151 inpatients diagnosed with NB in Children’s Hospital Affiliated to Chongqing Medical University were selected as the research objects,and the patients were divided into upper urinary tract damage group and upper urinary tract normal group according to whether upper urinary tract damage occurred.The general characteristics(gender,age,length of hospital stay,course of disease,urination pattern,history of previous spinal surgery),clinical symptoms(whether frequency/urgency,dysuria,urinary incontinence,and bladder-rectal syndrome),laboratory results(urine routine,lumbosacral X-ray) and urodynamic results(bladder compliance,with or without OAB) were compared between the two groups.Multivariate Logistic regression analysis was performed on the indicators with statistically significant differences,and the risk factors for upper urinary tract damage in NB patients were screened.Results Using P<0.2 as the screening criteria for one-way ANOVA,it can be found that fever,urinary tract infection,abdominal pressure/other urination patterns,poor bladder compliance,and OAB are the risk factors for upper urinary tract damage in patients with NB.Multivariate analysis of the above indicators showed that abdominal pressure/other urination methods,poor bladder compliance,and OAB were independent risk factors for upper urinary tract damage in patients with upper urinary tract NB(P<0.05).The risk of upper urinary tract damage in patients with poor bladder compliance was 2.712 times that of patients with normal bladder compliance(OR=2.712,95%CI:1.182-6.224);patients with abdominal pressure/other urination patterns had upper urinary tract damage The risk of CIC was 2.160 times(OR=2.160,95%CI:1.182-6.224);the risk of upper urinary tract damage in patients with OAB was 2.265 times that of patients without OAB(OR=2.265,95%CI:1.077-4.763).Conclusion Poor bladder compliance,abdominal pressure/other urination patterns,and OAB are risk factors for upper urinary tract damage in patients with NB.During bladder management,the bladder should be kept in a low pressure state to reduce damage to the upper urinary tract.