健康成人膀胱適應力的量化分析

在尿動力學檢查的評估中，膀胱適應力(bladder compliance)爲一項重要的參數，至今沒有特定的量化分析模式，能夠應用在健康成年人與排尿障礙患者的評估。因此本研究以健康成年人爲對象，量測膀胱容量與膀胱壓力在特定時間區間內的改變量做爲運算基礎，目的比較不同運算方法之間的差異性，並探討及建立最適當的膀胱適應力的量化分析模式。共有24名健康成年人參與研究，男性與女性各半，平均年齡爲25.2±3.1歲，均無排尿異常病史，平均膀胱最大容量爲393±59毫升。受測者接受流程標準一致的錄影尿動力學檢查之後，擷取五個檢查時間點，記錄膀胱容量與膀胱壓力的對應值，分別是灌注量零點、灌注量爲100毫升、灌注量爲平時最大容量的50%、灌注量爲逼尿肌開始收縮之前、灌注量在漏尿之前所達到的最大容量。再以膀胱容量改變量除以逼尿肌壓力改變量(ΔV/ΔP)，作爲計算膀胱適應力的理論基礎，選擇五種常用來計算膀胱適應力的方法，分別計算並分析數據。結果顯示，分析比較五種方法所得的數據之後，其中採計膀胱逼尿肌開始收縮之前的膀胱容量改變量，除以相對應的逼尿肌壓力改變量，這種運算模式的四分位數離散係數(quartile coefficient of dispersion)爲0.11，分佈離散率爲五種方法之中最低；膀胱適應力數值絕大多數位在53至68ml/cm H2O之間(interquartile range)，數據分佈是五種運算方法中受測者間的差異變化最小。根據本研究結果，膀胱適應力的量化分析模式，建議採計膀胱逼尿肌開始收縮之前的膀胱容量改變量，及相對應時間區間的逼尿肌壓力改變量，所得運算結果變異性最小，將可有效應用在健康成年人與神經性膀胱患者的評估。

關鍵字

膀胱；適應力；尿動力學

並列摘要

Bladder compliance expresses the relationship between bladder volume and detrusor pressure and is generally regarded as a measure of bladder stiffness or distensibility. Based on the varied selection criteria during the urodynamic study, differences in bladder compliance often exist. The objective of this study was to provide reference ranges for ”normal” variability in bladder compliance among healthy subjects. A total of twenty-four healthy subjects, twelve men and twelve women with mean age of 25.2 years and estimated maximal capacity (EMC) of 393 ml, were enrolled in this study. During the standardized procedures of urodynamic study, pairs of data on bladder volume and detrusor pressure were simultaneously recorded at five infusion stages, including at the beginning of examination, infusing at 100 ml, infusing up to half of EMC, infusing at initial detrusor contraction, and infusing at EMC. The calculation of bladder compliance was based on a theoretical equation (△V/△P). Because there is no standard, variability ranges for mean, median, 25th to 75th percentiles (interquartile range), and quartile coefficient of dispersion were calculated for choice. The results showed the least variable range was obtained in the method, where △V is the capacity change between the beginning of examination and the initial detrusor contraction and △P is the detrusor pressure change between the beginning of examination and the initial detrusor contraction. These values and ranges of variability are as follows: mean value, 61; median value, 61; interquartile range, 53-68; quartile coefficient of dispersion, 0.11. The measurements of bladder compliance have variability in different urodynamic studies. Knowing the least range of variability can be helpful for assessment in patients with voiding dysfunction in future.

並列關鍵字

bladder ； compliance ； urodynamics

國際替代計量

健康成人膀胱適應力的量化分析

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