脊髓损伤患者上尿路功能损害的相关因素分析

摘要/Abstract

摘要： 目的：探讨脊髓损伤患者上尿路功能损害的相关因素。方法：回顾性分析2002年1月至2009年12月期间于中国康复研究中心住院的脊髓损伤患者病历记录，根据诊断标准分为上尿路功能损害组和无上尿路功能损害组，比较两组之间人口学资料（性别、年龄）、脊髓损伤资料（损伤原因、损伤节段、损伤程度）、一般泌尿系统情况（膀胱管理方式、尿常规、尿培养、症状性泌尿系感染、B超、血肌酐）、影像尿动力学资料（膀胱顺应性、膀胱稳定性、膀胱感觉、逼尿肌括约肌协同性、逼尿肌漏尿点压力、最大膀胱测压容积、相对安全膀胱容量、最大尿流率、最大尿道闭合压）等指标之间的差异，进行多因素非条件Logistic回归模型分析，筛选出脊髓损伤患者上尿路损害的危险因素。结果：上尿路功能损害组与无上尿路功能损害组比较，两组患者在脊髓损伤节段（χ²=8.840, P=0.031）、膀胱管理方式（χ²=11.362, P=0.045）、尿常规（χ²=17.983, P=0.000）、症状性泌尿系感染（χ²=64.472, P=0.000）、膀胱顺应性（χ²=6.531, P=0.011）、膀胱感觉（χ²=11.505, P=0.009）、最大膀胱测压容积（t =2.209, P=0.043）、逼尿肌括约肌协同失调（χ²=4.247, P=0.039）等方面差异有统计学意义。多因素非条件Logistic回归分析结果显示：膀胱管理方式(OR=1.114，P=0.006)、症状性泌尿系感染(OR=1.018，P=0.000)、膀胱顺应性(OR=1.588，P=0.040)、逼尿肌括约肌协同失调（OR=1.023，P=0.034）等指标是影响脊髓损伤患者上尿路功能的关键因素。结论：症状性泌尿系感染、膀胱低顺应性、逼尿肌括约肌协同失调及不合理的膀胱管理方式等是脊髓损伤患者上尿路功能损害的危险因素。

关键词: 脊髓损伤, 泌尿道, 排尿障碍, 危险因素

Abstract: Objective：To evaluate the related factors of upper urinary tract deterioration in spinal cord injured patients. Methods: Medical records of spinal cord injured patients from Jan.2002 to Sep.2009 were retrospectively reviewed. All the patients were divided into the upper urinary tract deterioration group and non-deterioration group according to the diagnostic criteria. Indexes such as demographic characteristic (gender, age), spinal cord injury information (cause, level, completeness), statuses of urinary tract system (bladder management, urine routine, urine culture, ultrasound, serum creatinine, fever caused by urinary tract infection) and urodynamics information(bladder compliance, bladder stability, bladder sensation, detrusor sphincter dyssynergia, detrusor leak point pressure, maximum cystometric capacity, relative safe bladder capacity, maximum flow rate, maximum urethra closure pressure) were compared between the two groups.Then Logistic regression analysis were performed.Results: There was significantly difference between the two groups in spinal cord injury level（χ²=8.840, P=0.031）,bladder management（χ²=11.362, P=0.045）,urinary rutine（χ²=17.983, P=0.000）, fever caused by urinary tract infection（χ²=64.472, P=0.000）, bladder compliance（χ²=6.531, P=0.011）, bladder sensation（χ²=11.505, P=0.009）, maximum cystometric capacity（t=2.209,P=0.043）, and detrusor-sphincter dyssynergia（χ2=4.247, P=0.039）. The multiplefactor non-conditional Logistic regression analysis showed that bladder management (OR=1.114，P=0.006), fever caused by urinary tract infection(OR=1.018，P=0.000)， bladder compliance(OR=1.588，P=0.040) and detrusor-sphincter dyssynergia（OR=1.023，P=0.034） were the key factors of upper urinary tract deterioration in spinal cord injured patients.Conclusion: Urinary tract infection, lower bladder compliance, detrusor-sphincter dyssynergia and unreasonable bladder management are the risk factors of upper urinary tract deterioration in spinal cord injured patients.

Key words: Spinal cord injuries, Urinary tract, Urination disorders, Risk factors

靖华芳, 廖利民, 付光, 吴娟, 鞠彦合, 陈国庆. 脊髓损伤患者上尿路功能损害的相关因素分析[J]. 北京大学学报（医学版）, 2014, 46(4): 544-547.

JING Hua-Fang, LIAO Li-Min, FU Guang, WU Juan, JU Yan-He, CHEN Guo-Qing. Analysis for related factors of upper urinary tract deterioration in patients with spinal cord injury[J]. Journal of Peking University(Health Sciences), 2014, 46(4): 544-547.

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