逼尿肌收缩力:男性下尿路功能障碍测定的新指标
Detrusor contraction force: A new urodynamic parameter in the evaluation of lower urinary tract dysfunction in men
瞿创予 1徐丹枫 1郑军华 1任吉忠 1熊林平2
作者信息
- 1. 第二军医大学长征医院泌尿外科,中国,上海,200003
- 2. 第二军医大学卫生统计学教研室
- 折叠
摘要
目的研究逼尿肌收缩力测定的可行性及其意义.方法推导出逼尿肌收缩力测定的公式,逼尿肌收缩力由其压力(Pdet)及膀胱内体积(V)决定,等于0.05×Pdet×V0.667,单位为牛顿(N).回顾性分析逼尿肌收缩力在379例不同梗阻分级下尿路功能障碍男性的数值及其与其他尿动力学指标的关系.结果1、在379例病人中,除前列腺增生外,发现失调性排尿44例(12%),内括约肌痉挛症13例(3%).2、随膀胱出口梗阻分级增加,病人年龄、逼尿肌压及收缩力逐渐增加,均有极显著性意义(P＜0.01及＜0.001).但在逼尿肌压及收缩力两两比较中,梗阻1、2级及4、5级间Fiso(等容性逼尿肌最大收缩力)差异无显著性意义(P=0.055及P=0.052),其余差异均有极显著性意义(P ＜0.001).3、多变量判别分析法结果:Qmax(最大尿流率)、Fiso、pdetQmax(最大尿流率时逼尿肌压)组合对梗阻诊断价值最大,无梗阻判别正确率100%,梗阻的判别正确率为76.5%,总的判别正确率80.5%.结论以膀胱容量及膀胱逼尿肌压间接推算逼尿肌收缩力是合理和可行的,对逼尿肌生物力学及病理生理学研究有显而易见的意义,值得临床采用.
Abstract
Objective To study the rationality and potential use of a new urodynamic parameter-detrusor contraction force. Methods The detrusor contraction force (Fdet) is calculated from the detrusor pressure (pdet) and the bladder volume (V) obtained during the cystometry and pressure-flow study. The equation is Fdet= 0. 05 × pdet ×V0.667 , and its unit is Newton (N). A total of 379 cases with lower urinary tract dysfunction, expressed as different degrees of bladder outlet obstruction graded according to Schafer definition,were analysed retrospectively. Results Besides benign prostatic hyperplasia as the main obstruction cause, there were 44 cases of dysfunctional voiding, approximately 12% of the group, and 13 cases of internal sphincter spasticity, approximately 3% of the group. The obstruction grades correlated well to the age, detrusor pressure and force ( P ＜0.01, and P ＜0. 001 respectively), but the differnces of isometric detrusor contraction force (Fiso) between grade 2 and 3, and between grade 4 and 5 were not of significance (P = 0. 055, and P = 0. 052, respectively). Using the method of multivariate discriminant analysis, we confirmed that the combination of Qmax, Fiso, and pdetQmax criteria predicted obstructive and non-obstructive voiding dysfunction with a general correctivity of 80.5 % (non-obstruction 100%, obstruction 76.5 %). Conclusion The calculation of detrusor contraction force from the detrusor pressure and bladder volume is rational and feasible. This parameter is helpful for the estimation of detrusor biomechanics and pathophysiology, and should be used in diagnosis of lower urinary tract dysfunction in men.
关键词
逼尿肌收缩力/膀胱出口梗阻/下尿路功能障碍Key words
detrusor contraction force/bladder outlet obstruction/lower urinary tract dysfunction引用本文复制引用
出版年
2004
NETL
NSTL
维普
万方数据