評論:
尿路動力學檢查的結果對於下尿路功能障礙可以提供重要的資訊。但是尿路動力學檢查是一種侵入性且花時間的檢查，因為病人會被放置一些導管，所以過程是不舒服且令人焦慮的。研究指出，做檢查的病人中有一半的疼痛指數大於3分，且和本身的焦慮有關，對於心理的不適感又以女性比男性嚴重。在臨床上確實也常看到女性無法順利完成檢查的機會比男性病人高。在一個102位女性病人接受尿路動力學的研究統計中發現，87%病人覺得檢查過程有不適感，21%描述有嚴重的不舒服，46%覺得檢查過程很令人感到尷尬，22%在檢查前會感覺嚴重的焦慮。而這麼高比率的不適感容易導致不準確的檢查結果甚至無法提供有用的資訊，那就失去了這個檢查的用意了。

此篇研究提供一個可以緩解病人不適感的簡單方法，在2015年五月到10月期間，收納74位應力性尿失禁(Stress incontinence, SUI)且接受尿路動力學檢查的女性病人，將之分成兩組。一組37位病人在骶骨放置一個加熱墊並且在檢查過程持續加熱，另一組37位病人一樣放加熱墊但不加熱。加熱墊大小為 40 × 25 公分加熱到40-45°C。檢查前後利用State-Trait Anxiety Inventory (STAI)此測量工具來評估焦慮程度，分數越高代表病人越焦慮。檢查後利用visual analog scale (VAS, 0-10)來評估病人對檢查過程疼痛、不適感的程度。檢查前後也會測量病人的血壓和心跳速度，看看是否焦慮或痛苦也會反應在生理變化上。

研究結果顯示兩組病人的基本背景都差不多，有加熱的墊子那一組病人的焦慮程度明顯較另一組低 (30.9 ± 7.5分比上42.5 ± 10.1分; P < 0.001)，疼痛指數也是有顯著的差異 (2.7 ± 1.5分比上4.0 ± 1.6分; P < 0.001)。而以同一個病人比較檢查前後的焦慮程度差異，發現有加熱的墊子那一組病人檢查前後的焦慮程度明顯變化最多，也就是如果病人坐在加熱的墊子上做檢查，可以明顯降低病人的不安與痛苦。而對於血壓和心跳數的比較，兩組則沒有明顯的不同。

雖然這個研究個案數少，且無法達到真正的雙盲試驗，但可以提供臨床醫師一個簡單緩解病人焦慮的方法。因為在臨床上尿路動力學檢查還是有其重要性，如果可以利用加熱墊來降低病人的不安與不適感，增加病人對檢查的順從性與滿意度，進而也可以提高檢查的成功率與準確性。期許未來能進行更大型的前瞻性研究，降低環境的干擾因素。

　摘要:　
Aims: Although generally well tolerated, a urodynamic study is an unpleasant and stressful procedure for some patients. This study evaluated the effects of a heating pad on anxiety, pain, and distress during urodynamic studies in female patients with stress urinary incontinence.

Methods: A total of 74 female patients with stress urinary incontinence who underwent a urodynamic study between May 2015 and October 2015 were randomized to either the experimental group using a heating pad (n = 37) or control group (n = 37). In the experimental group, a heating pad was applied on the patient's sacrum during the urodynamic study. All patients completed the State-Trait Anxiety Inventory (20-80) before and after the procedure and assessed their degree of pain and distress after the procedure by the visual analog scale (0-10). Systolic and diastolic blood pressure and pulse rate were also checked before and after the procedure.

Results: Demographic characteristics, mean age, procedure duration, pre and postprocedural systolic, and diastolic blood pressures, and pulse rate were statistically similar between the experimental and control groups. The mean State-Trait Anxiety Inventory was significantly lower in the experimental group than in the control group (30.9 ± 7.5 vs 42.5 ± 10.1, P < 0.001). The experimental group showed significantly lower pain and distress scores (Visual Analog Scale, 2.7 ± 1.5, 3.0 ± 1.5) compared with the control group (4.0 ± 1.6, 4.7 ± 2.0, both P < 0.001).

Conclusions: Using a heating pad for female patients with stress urinary incontinence during a urodynamic study is a simple, economical, and effective therapy that enhances patient comfort and decreases anxiety, pain, and distress.