逼尿肌漏尿点压及膀胱安全容量在神经源性膀胱患者间歇性导尿中的应用价值

Application of detrusor leak point pressure and bladder safe capacity of intermittent catheterization in patients with neurogenic bladder

中文关键词:  神经源性膀胱  逼尿肌漏尿点压  膀胱安全容量  间歇导尿

英文关键词:Neurogenic bladder  Urine detrusor leak point pressure  Safety bladder capacity  Intermittent catheterization

中文摘要:

  【摘要】 目的：评估逼尿肌漏尿点压（detrusor leak point pressure，DLPP）及膀胱安全容量（safety bladder capacity，SBC）在神经源性膀胱患者间歇性导尿中的应用价值。方法：选取2015年7月~2016年7月在我院住院治疗接受间歇导尿的脊髓损伤致神经源性膀胱患者40例。根据随机数字表法分为观察组与对照组，各20例。对照组患者予以常规间歇导尿，根据残余尿量确定间歇导尿次数。观察组患者抽血查肾功能并行泌尿系B超及影像尿动力学检查，明确患者的上尿路情况，同时测量其DLPP及SBC，进行间歇导尿时，依据饮水计划及排尿日记找到排尿规律，在接近SBC的时间测量膀胱内的尿量，严格在SBC内实施间歇导尿。40例患者均有漏尿，均进行床旁盆底肌训练。对患者进行为期1年的干预，两组患者于干预前、干预1年时分别进行尿动力学检查[包括DLPP、SBC、残余尿量（residual urine volume，RUV）]、肾功能检查（包括血尿素氮、肌酐），并采用焦虑自评量表（self-rating anxiety scale，SAS）及抑郁自评量表（self-rating depressive scale，SDS）分别评估患者心理状态，采用SF-36生活质量量表（包括饮食、精神、睡眠及心理4个维度）评分评估患者的生活质量。结果：每组患者干预1年时的DLPP、SBC、RUV、血尿素氮和肌酐、SAS和SDS评分及饮食、精神、睡眠、心理评分与干预前比较均明显改善（P＜0.05）。干预前，上述各指标两组间比较均无统计学差异（P＞0.05）。干预1年时，观察组患者的DLPP、RUV均显著低于对照组，SBC显著高于对照组，血尿素氮、肌酐均显著低于对照组，SAS、SDS评分均显著低于对照组，饮食、精神、睡眠、心理评分均显著高于对照组，差异均有统计学意义（P＜0.05）。结论：对脊髓损伤致神经源性膀胱患者依据DLPP及SBC进行个性化的间歇导尿，可有效改善患者的尿动力学指标，促进其肾功能的恢复，同时消除患者心理不良情绪，且能显著提高生活质量。

英文摘要:

  【Abstract】 Objectives: To study the value of the detrusor urine leakage point pressure(detrusor leak point pressure, DLPP) and the bladder safe capacity(safe bladder capacity, SBC) in patients with neurogenic bladder undergoing intermittent catheterization. Methods: From July 2015 to July 2016 40 patients with neurogenic bladder in our hospital accept intermittent catheterization.Randomly, cases were divided into observation group and control group with 20 cases in each group. The control group were given conventional intermittent catheterization, according to the amount of residual urine to determine the number of intermittent catheterization. Observation group was processed to blood test to check kidney function by parallel urinary tract ultrasound images and urine dynamics test to determine the upper urine tract, at same time, the SBC and DLPPwere measured, intermittent catheterization, was oerformed on the basis of water project and the regularity of voiding diary, the amount of urinary bladder was measured prior to the SBC time, the intermittent catheterization was performed strictly in SBC. 40 cases with urinary leakage accepted pelvic floor muscle training on bed. All patients underwent 1 year of intervention, and all underwent the examination of the urine dynamics[including DLPP, SBC, residual urine volume(residual urine volume, RUV)], renal function examination (including blood urea nitrogen, creatinine), self-assessment lists of anxiety(self-rating anxiety scale, SAS), self rating scale for depression(self-rating depressive scale, SDS), the SF-36 quality of life scale(including diet, mental, and psychological sleep four dimensions) score to assess the patient′s quality of life prior to intervention, and intervention after 1 year respectively. Results: Patients in each group of intervention 1 year later had obviously improved of DLPP, SBC, RUV, blood urea nitrogen, creatinine, SAS and SDS scores and diet, mental, sleep, psychological score than those before intervention(P<0.05). Before intervention, the above indexes between the two groups showed no statistical difference(P>0.05). Intervention after 1 year, DLPP, RUV in observation group were significantly lower than those in the control group, SBC was significantly higher than control group; Blood urea and creatinine were significantly lower than the control group; SAS, SDS scores were significantly lower than the control group, diet, mental, sleep, the psychological scores were significantly higher than that of control group(P<0.05). Conclusions: For patients with neurogenic bladder to inspect, DLPP and SBC test are help to guide intermittent catheterization, which can effectively improve the patient′s urine dynamics index, promote the recovery of renal function, while eliminating patients psychological feelings, and can significantly improve the quality of life.