- 期刊
以膀胱超音波掃描神經性膀胱病人餘尿之準確性
Accuracy of Residual Urinary Volume Measurements in Patients with Neurogenic Bladder when using a Portable Ultrasound Bladder Scanner
摘要
在神經性膀胱的病人中時常需要測量餘尿量以判定是否有效把尿液排空，膀胱超音波掃描（ultrasound bladder scanning）是一種簡便的方式去了解病人的餘尿量，並且可以有效減少不必要的導尿次數，降低包含尿道損傷、感染以及病患不適感，本研究旨在釐清各種不同的疾病以及病人型態，膀胱超音波掃描是否皆可適用。本研究採回溯性研究的方法，回顧2015年8月至2016年8月復健科病房內經膀胱超音波掃描（BVI6100）後立即導尿的神經性膀胱患者，共有39位患者（14位男性以及25位女性）進行共144次超音波測量後立即導尿。結果發現超音波測量三次平均餘尿量及導尿量兩者之間有顯著相關（ρ=0.698, p＜0.001），進一步將不同導尿量分成五組（＜150, 150-250, 250-350, 350-450, ＞450mL），發現導尿量誤差率與組別有顯著相關（p=0.047），事後分析發現在導尿量＜150 mL這組誤差率顯著大於導尿量＞450 mL這組（中位數31.3% vs 9.0%, p=0.007），且在導尿值＜150 mL的膀胱超音波掃描量會顯著高估餘尿量（中位數147.2 vs. 100.0, p＜0.001）。本實驗顯示雖然導尿量與膀胱超音波測得之餘尿量高度相關，但在導尿量小於150 mL之病人，膀胱超音波掃描顯著地高估病人餘尿量，導致部分病人可能接受到不必要的導尿，建議未來設計前瞻性實驗探討高估的原因及使用附影像的掃描儀是否能降低誤差。
並列摘要
Estimating the post-voiding residual urine amount is essential for managing patients with neurogenic bladder. Accurate post-voiding residual urine estimation provides guidance for the appropriate frequency of catheter drainage and reduces the rate of urinary tract infection. Although urethral catheterization is the most accurate method of estimating post-voiding residual urine, a bladder scanner-a noninvasive portable ultrasound device-constitutes an alternative method. In this study, we retrospectively reviewed the residual urine amount in patients with neurogenic bladder of different etiologies using a bladder scanner and urethral catheterization. Data for 144 bladder scans and urethral catheterizations in 39 patients were analyzed, revealing that the residual urine measured by both methods was highly significantly correlated (ρ=0.698, p ＜0.001). The data were divided into five groups according to the amount of residual urine measured through urethral catheterization (i.e., ＜150, 150-250, 250-350, 350-450, and ＞450 mL). The generalized estimating equation model showed that the residual urine amount had a robust effect on the error rate (p=0.047) after adjusting for body mass index, age, and sex. The error rate in the group with＜150 mL of residual urine was significantly higher than that in the group with ＞450 mL of residual urine (median: 31.3% vs. 9.0%, p = 0.007). Moreover, the bladder scanner overestimated residual urine in the ＜150 mL group (median: 147.2 mL vs. 100.0 mL, p＜ 0.001). Although the residual urine estimated using a bladder scanner was highly correlated with that measured by urethral catheterization, the bladder scanner significantly overestimated the residual urine volume for patients with ＜150 mL, which might result in unnecessary catheterization. A further prospective study is warranted to reveal the cause of error in bladder scanner estimation for patients with small bladders and to determine whether use of a bladder scanner with image assistance can reduce this error.