新生儿膀胱压力和肌电图联合检查

Video cystometry in newborn with no apparent voiding dysfunction

目的 了解无排尿异常新生儿的尿动力学过程。 方法 肾盂扩张的新生儿 14例。男 10例 ,女 4例。年龄 2d～ 2 .5个月 ,平均 (1.2± 0 .8)个月。用DanTech膀胱测压和肌电图记录仪在X线电视监视下进行膀胱测压检查。患儿均未发现排尿异常症状和膀胱输尿管返流。 结果 膀胱剩余尿 (1.2± 0 .8)ml,最大膀胱容量 (33± 2 4 )ml,排尿效率为 0 .87± 0 .17。不稳定性膀胱发生率 2 1% (3/ 14 )。可见两种排尿类型 ,协调性排尿和非协调性排尿或间断性排尿。在协调性排尿过程中最大逼尿肌排尿压为 (74± 2 4 )cmH2 O(1cmH2 O =0 .0 98kPa) ,尿道外括约肌活动减弱或不变。6 4 % (9/ 14 )新生儿表现为非协调性排尿或间断性排尿 ,逼尿肌压力可升至 10 0cmH2 O以上。 结论 无排尿异常症状的新生儿膀胱多可完全排空 ,少数可有较多的剩余尿 ,可能与新生儿间断性排尿有关。新生儿最大逼尿肌排尿压与成人相似 ,如 >10 0cmH2 O ,常提示括约肌活动增强或膀胱出口梗阻。

Objective To investigate the urodynamic pattern in infants with no apparent lower urinary tract symptoms. Methods Video cystometry with simultaneous perineal EMG recording was performed in 14 infants (10 male and 4 female,age 2 d to 2.5 months) with congenital renal pelvis dilatation who were screened for potential bladder dysfunction and VUR.No abnormal lower urinary tract was observed at examination. Results The post-voiding residual urine volume was (1.2±0.8)ml.The maximum bladder capacity was (33±24)ml,with voiding efficiency being 0.87±0.17.Detrusor instability occurred in 21%(3/14) of the subjects. The intermittent voiding pattern was observed in 64% (9/14) of the subjects and characterized by one or repeated increase in sphincter activity with simultaneous rise in voiding detrusor pressure curve. The maximum voiding detrusor pressure was (74±24)cmH 2O.The peak voiding detrusor pressure induced by dyssynergia could rise up to more than 100 cmH 2O. Conclusions In infants with no apparent lower urinary tract symptoms,bladder instability is uncommon,but the capacity is lower than the expected normal range.The high voiding pressure is induced by detrusor-sphincter dyssynergia.