摘要
目的探讨清洁间歇导尿（clean intermittent self-catheterization，CIC）联合膀胱灌注辣椒辣素类似物（resiniferatoxin，RTX）治疗儿童神经源性膀胱（neurogenic bladder，NB）并逼尿肌过度活动（detrusoroveractivity，DO）的疗效。方法将NB并DO患儿38例，按随机数字表法分为CIC联合RTX灌注组（实验组，20例）和CIC联合30％乙醇灌注组（对照组，18例）。采用前瞻性双盲平行对照试验，所有患儿在CIC期间每4周行1次灌注治疗，每3个月行尿动力学检查随访，治疗1年后对比两组患儿尿动力学参数异同。结果治疗后3个月及12个月实验组患儿逼尿肌过度活动的发生率（40.0％和10.0％）明显低于对照组（94.4％和88.9％），差异有统计学意义（P〈0.01）。治疗12个月后实验组首次过度活动膀胱容量明显增大[（107.8±46．3）ml vs （68.2±31.5）m1]，膀胱安全容量明显增多[-（206.8±50.6）ml vs（166.3±54.2）m1]，与对照组比较，差异有统计学意义（P〈0.01）。但实验组和对照组比较，膀胱顺应性艮20.8±11.5）ml／cmH2O vs （24±15.4）ml／cmH2O]，最大尿流率[（9.5±5.1）ml／s vs （8.2±3.2）ml／s]差异均无统计学意义（P〉0.05）。结论CIC联合RTX膀胱灌注能显著控制神经源性膀胱患儿的逼尿肌过度活动，改善神经源性逼尿肌过度活动患儿的生活质量。
Objective To explore the effects of clean intermittent catheterization （CIC） coupled with resiniferatoxin （RTX） intravesical instillations in children with neurogenic detrusor overactivity （DO）. Methods A total of 38 patients with neurogenic detrusor overactivity were enrolled and randomly divided into experimental （.n = 20） and control （n = 18） groups . The experimental group underwent CIC and 4 weekly intravesical instillations of 10 nmol/L resiniferatoxin while the control group CIC and 4 weekly intravesical instillations of 300% ethanol. The urodynamic parameters were assessed after 1 year follow-up. Results The resiniferatoxin treatment group had a significantly lower percent of DO compared to the control group （3 months：40% vs 94. 4% ;12 months：10% vs 88.9%, P〈0.01）. Bladder capacity for the first DO [（107.8 ± 46.3）vs （68.2 ± 31.5）ml] and safety bladder capacity （SBC） [（206.8 ± 50.6）vs （166.3 ± 54.2）ml] significantly increased 12 months after treatment in the resiniferatoxin group than ]n the control group while the bladder compliance （BC） [（20.8 ±11.5）vs （24 ± 15.4）ml/cmH2O] and maximum flow rate （MFR） [（9.5 ± 5.1）ml/s vs （8.2 ± 3.2）ml/s] had no statistical significance between two groups （P〉0.05）. Conclusions Intermittent catheterization .plus resiniferatoxin intravesical instillations can reduce DO in children with neurogenic bladder.
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第9期652-655,共4页
Chinese Journal of Pediatric Surgery
