尿动力学检测在儿童尿频症中的应用
- 摘要:
- 目的探讨儿童白天尿频症的尿流动力学病理改变和治疗方法。方法随机选择40例白天尿频症患儿,进行尿动力学检测,观察尿流曲线、功能性膀胱容量(FBC)、逼尿肌稳定性及不稳定性指数、膀胱顺应性(BC)、最大膀胱测量容量(CBCmax)及CBCmax百分数、逼尿肌与尿道外括约肌协同性。在充盈性膀胱内压测定过程中当膀胱容量达正常CBCmax之前出现逼尿肌不稳定性收缩(DI)时嘱患儿收紧盆底肌、延长储尿时间,进行膀胱储尿功能训练,其中20例合并有DI的患儿在相同条件下间隔30min再行充盈性膀胱内压测定,比较两次测定的CBCmax百分数和不稳定指数。同期选15名排尿正常儿童做对照研究。结果膀胱充盈期出现DI17例,DI合并低顺应性膀胱15例,单纯低顺应性膀胱4例,充盈性膀胱内压测定正常4例。3例排尿期盆底肌电活动间断增强。CBCmax下降28例。第1次CBCmax与FBC比较有明显增加(P<0.05)。20例进行2次充盈性膀胱内压测定,第2次逼尿肌不稳定指数明显下降(P<0.05)、CBCmax百分数明显增加(P<0.05)。而正常对照组2次CBCmax无明显差异。结论儿童白天尿频症的主要尿动力学病理变化是DI,低顺应性膀胱和CBCmax降低是DI引起逼尿肌收缩的继发改变,均为功能性紊乱,而非膀胱壁组织结构器质性病变。行为疗法是治疗儿童尿频症的有效方法,其中以排尿训练为主,抗胆碱能药可辅助治疗儿童尿频症。
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