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目的 探讨脊髓发育不良患儿影响上尿路功能的高危因素。方法 6 0例患儿行常规尿流动力学检查和静脉肾盂造影、排尿时膀胱尿道造影。按漏点压高低分成两组 ,32例漏点压高于40cmH2 O为高压组 ,漏点压低于 40cmH2 O 2 8例为低压组。 2 2例年龄小于 1岁的患儿仅做尿流动力学检查。结果 出现上尿路功能损伤 ,高压组患儿中 17例 (5 3.1% ) ,低压组 5例 (17.9% ) ,P <0 .0 5 ;逼尿肌括约肌不协调的患儿出现上尿路损害的比率更高 ,占总反流患儿的 86 .4% (19/ 2 2 )。 2 2例年龄小于 1岁的患儿中 12例漏点压高于 40cmH2 O。结论 脊髓发育不良患儿大多早期既出现下尿路功能的病理变化 ;膀胱高压和逼尿肌括约肌不协调是造成上尿路功能损伤的高危因素。应早期治疗 ,以保护上尿路功能。
Objective To investigate the risk factors of upper urinary tract dysfunction in children with spinal dysplasia. Methods Sixty children underwent routine urodynamic examination and intravenous pyelography, urinary bladder and urethra. Divided according to the level of leakage point into two groups, 32 cases of leakage pressure higher than 40cmH2O for the high-pressure group, leakage pressure below 40cmH2O8 8 cases for the low-pressure group. Twenty-two children younger than 1 year old had only urodynamic tests. Results Upper urinary tract injury was found in 17 cases (5 3.1%) in the high-pressure group and 5 cases (17.9%) in the low-pressure group, P <0. 05; children with uncoordinated detrusor sphincter had upper urinary tract The damage rate was higher, accounting for 86.4% (19/22) of the total reflux children. Twelve cases of children younger than 1 year old had a leak pressure of more than 40 cmH2O in 12 children. Conclusions Most of children with spinal dysplasia have pathological changes of lower urinary tract function in most of the early stages. Uncoordinated bladder pressure and detrusor sphincter are risk factors of upper urinary tract injury. Early treatment should be to protect the upper urinary tract function.