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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 三軍總醫院蒙恩醫師 | Differences between the data from free flow and intubated flow in women with urinary incontinence. What do they mean? | 2008/12/29 下午 01:55:57 | 0 |
| 原 文 | 題 目 | Differences between the data from free flow and intubated flow in women with urinary incontinence. What do they mean? |
| 作 者 | Valentini F, Marti B, Robain G & Nelson P. | |
| 出 處 | Neurourology and Urodynamics 27, 297-300 (2008) | |
| 出版日期 | ||
| 評 論 |
在臨床上，我們常為病人實行壓力¬-流速(pressure-flow)試驗來檢測排尿功能。在這類試驗中，病患大都在用來灌注膀胱的尿管留置狀況下測量流速，再觀察其膀胱壓力。在導管留置的狀態下，病人可能會有刺激症狀或是造成膀胱出口阻塞，進而影響排尿。導管留置對於女性病人壓力¬-流速(pressure-flow)試驗的影響曾經引起零星的討論，但其結論還有爭議。 作者們在這項研究中，利用先前所建立的尿流速數學模型(Valentini FA et al, 2000)，比較了217位女性尿失禁患者在無插管及插管時的尿流速檢查的結果，這些病患並無神經病變或嚴重骨盆腔脫垂的疾狀。他們發現，在導管留置狀態下，餘尿量及排尿時間明顯地增加，而最大尿流速則是明顯地下降。他們認為這些現象不單是導管的本身形成阻礙的問題，還加上了尿道擠壓和達到最大尿流速後逼尿肌興奮衰退的效應。尿道擠壓可能是由於導管引起的尿道反射所造成，逼尿肌興奮衰退和餘尿的產生有密切的關係。所以作者們認為在為女性患者實施壓力¬-流速(pressure-flow)試驗時，不只是有插管時的尿流速檢查結果，最好也能獲得在無插管時的尿流速數據，以利於醫師做更正確和可靠的判斷。 導管留置對於到底對女性病人壓力¬-流速(pressure-flow)試驗會不會有影響，常常是從事尿路動力學臨床醫師心中的一個疑問。此篇文章利用尿流速的數學模型，提供一個量化的答案。 |
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| abstract | To assess the effects of a urethral catheter on the urodynamic data extracted from uroflow in women, and to interpret the differences from free uroflow using the VBN mathematical micturition model.Urodynamic data of 217 consecutive (June 2002 to December 2004) women with urinary incontinence and without neurological disease or more than grade 2 prolapse were reviewed. Inclusion criteria were to perform one free flow (FF) and one intubated flow (IF) (voided volumes of at least 100 ml and continuous flow curves). Voiding parameters: volumes, maximum flow rate, detrusor pressure and flow time, were analyzed as some characteristic ratios. The VBN model was used to make simulations of various pathophysiological hypotheses.Significant increased residual volume and flow time, decreased maximum flow rate were observed during IF. Twenty five patients had a residual volume only during IF; in that group, both decrease of Qmax and increase of flow time were significant. Simulations showed that the geometrical effect of the catheter was not the only cause and allowed to propose the occurrence of a compression-like effect of the urethra and of a fading of the detrusor excitation after Qmax to explain the results.Significant differences were found between the data from a FF and an IF in women with urinary incontinence. These findings bring to the fore the impact of the transurethral catheter and underline the necessity to obtain at least one FF and one IF during a urodynamic session. | |
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