摘要
目的回顾性分析脑性瘫痪患儿尿流动力学结果特点及膀胱功能障碍的发生情况并分析相关危险因素,为临床预防和治疗脑性瘫痪膀胱功能障碍患儿评估其预后、指导治疗方案提供客观依据。方法选取2009年8月-2017年1月期间明确诊断脑性瘫痪患儿159例,收集一般资料、神经系统相关专科情况并详细了解排尿日记、既往病史,根据自由尿流率及超声测量最大膀胱容量及残余尿量判断患者有无膀胱功能障碍及其类型,以脑性瘫痪患儿是否发生膀胱功能障碍为标准分组,运用多因素Logistic回归分析对脑性瘫痪患儿发生膀胱功能障碍进行相关危险因素分析,运用单因素分析判断尿流动力学参数与上尿路扩张之间的关系。结果脑性瘫痪患儿中有35.84%患儿合并下尿路症状,症状由多到少依次为:尿失禁、尿等待、尿频、尿急、尿潴留。言语认知功能障碍组与无障碍组下尿路症状发生率存在统计学差异(χ2=18.683,P<0.05),障碍组下尿路症状发生率是无障碍组的1.8倍(RR=1.8)。改良Ashworth痉挛分级≥3级者下尿路症状发生率与≤2级者下尿路症状发生率存在统计学差异(χ2=16.832,P<0.05),≥3级者下尿路症状发生率是≤2级者的1.2倍(RR=1.2)。经Logistic回归分析发现发病年龄较大、病灶多发和重度脑室旁白质软化是脑性瘫痪患儿膀胱功能障碍发生的危险因素。尿动力学检查发现残余尿量、相关安全容量、膀胱顺应性及逼尿肌漏尿点压在对照组与上尿路扩张组的差异有显著性(P<0.05)。结论尿流动力学参数有助于预测上尿路扩张的潜在危险因素,合并下尿路症状的患儿常伴随言语认知功能障碍及双下肢肌张力增高。发病年龄、多发病灶和重度脑室旁白质软化对脑性瘫痪患儿膀胱功能障碍发生有预测价值。尿流动力学参数改变原因多为逼尿肌-括约肌失调,逼尿肌不稳定,膀胱顺应性下降。
Objective A retrospective analysis was made on characteristics of urodynamic results of children with cerebral palsy and the occurrence condition of bladder dysfunction, and relevant risk factors were analyzed, thus providing objective evidence for treating children with cerebral palsy and bladder dysfunction clinically, evaluating its prognosis and instructing treatment scheme. Methods 159 patients which diagnosed with cerebral palsy from August 2009 to January 2017 were recruited in the study and their general materials,relevant conditions about nerve system, voiding diary and medical history were collected. Free urine flow rate and maximum cystometric capacity, residual urine volume detected by ultrasound were used to judge whether patients had bladder dysfunction and determine their types. Patients with cerebral palsy were grouped based on the occurrence of bladder dysfunction. Relevant risk factor analysis was carried out on the occurrence of bladder dysfunction among children with cerebral palsy by using multi-factor logistic regression analysis and single factor analysis was used to define the relation between urodynamics parameters and upper urinary tract expansion. Results Among cerebral palsy children, 35.84% of them had lower urinary tract symptom and the symptoms were（from most to least） uracratia, urine waiting, frequent micturition, urgent urination and uroschesis. The words cognition dysfunction group and the normal group had statistical difference in the occurrence rate of lower urinary tract symptom（X2=18.683, P〈0.05）, and the occurrence rate in the words cognition dysfunction group was 1.8 times as that in the normal group（RR=1.8）. Patients with ashworth spasm grading ≥3 and patients with ashworth spasm grading ≤2 had statistical difference in the occurrence rate of lower urinary tract symptom（X2=16.832, P〈0.05） while the occurrence rate of lower urinary tract symptom among patients ≥3 level was 1.2 times as that of patients ≤ 2 level（RR=1.2）. Logistic regression
出处
《新疆医学》
2017年第10期1129-1133,共5页
Xinjiang Medical Journal
基金
乌鲁木齐市卫生局科学技术计划项目(201507)
关键词
小儿脑性瘫痪
膀胱功能障碍
尿流动力学
上尿路扩张
Pediatric Cerebral Palsy
Bladder Dysfunction
Urodynamic
Upper Urinary Tract Dilatation
