| 摘要: |
| 目的 探讨脑卒中后下尿路功能障碍患者的尿动力学改变及临床干预疗效。方法 回顾性分析我院于2007年3月至2011年7月间40例行尿动力学检查的脑卒中后下尿路功能障碍患者的资料,总结其膀胱尿道功能障碍的尿动力学特点,并根据其尿动力学表现给予相应临床干预,观察疗效。结果 40例患者中,逼尿肌过度活动23例(57.5%),逼尿肌无反射5例(12.5%),安全膀胱36例(90%),上尿路积水2例(5%),未出现逼尿肌-尿道外括约肌协同失调。根据尿动力学结果给予临床干预后,2例肾积水患者中1例积水消失,1例积水减轻；临床干预2周后生活质量 (quality of life,QOL)评分平均为(3.4±1.0)分,与干预前\[平均(4.4±0.6)分\]比较差异有统计学意义(P＜0.01)；临床干预3个月后QOL评分平均为(2.9±0.8)分,与干预前和干预2周后比较,差异均有统计学意义(均P＜0.01)。结论 脑卒中后下尿路功能障碍患者的主要尿动力学改变是逼尿肌过度活动,较少出现逼尿肌-尿道外括约肌协同失调、输尿管反流、上尿路积水等并发症。根据尿动力学检查结果指导临床干预措施,可以保护肾功能,改善患者生活质量。 |
| 关键词: 神经源性膀胱 尿动力学 卒中 |
| DOI：10.3724/SP.J.1008.2013.00318 |
| 投稿时间：2013-01-11修订日期：2013-02-20 |
| 基金项目: |
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| Urodynamic characteristics and clinical interventions of neurogenic bladder following cerebrovascular accident |
| LI Jia-yi,L Jian-wei,LENG Jing,BO Juan-jie*,HUANG Yi-ran |
(Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
*Corresponding author.) |
| Abstract: |
| Objective To explore the urodynamic characteristics of neurogenic bladder caused by cerebrovascular accident and to evaluate its clinical intervention efficacy. Methods From March 2007 to July 2011, 40 patients with cerebrovascular accident-associated neurogenic bladder underwent a complete urodynamic study with electromyography. Their clinical data were analyzed retrospectively and the urine dynamics characteristics were summarized. Clinical interventions were given to the patients based on the urine dynamics characteristics and the clinical efficacies were observed. Results Twenty-three patients (57.5%) had detrusor overactivity, 5 (12.5%) had acontractile detrusor, 36 (90%) had security bladder, 2 (5%) had upper urinary tract dilation, and no patients had detrusor-external sphincter dyssynergia. After clinical interventions based on urodynamic characteristics, water disappeared in 1 patient with upper urinary tract dilation and reduced in the other. The quality of life (QOL) score was 3.4±1.0 at 2 weeks after clinical interentions, which was significantly lower than that before intervention (4.4±0.6, P＜0.01). QOL score was 2.9±0.8 at 3 months after interventions, which was significantly lower than those before and at 2 weeks after interventions (all P＜0.01). Conclusion Detrusor overactivity is the main urodynamic characteristic of cerebrovascular accident-associated neurogenic bladder, and detrusor-external sphincter dyssynergia, reflux and upper urinary tract dilation are rarely seen.Clinical interventions based on urodynamic characteristics can protect renal function and improve the QOL of the patients. |
| Key words: neurogenic urinary bladder urodynamics stroke |
