冰水試驗於評估慢性脊髓病變患者之逼尿肌收縮

冰水試驗長期被用來評估神經性膀胱功能障礙患者之逼尿肌反射存在與否。本研究的目的在於探討慢性脊髓病變併神經性膀胱功能障礙的患者，以冰水試驗偵測逼尿肌反射有無之準確性。共有220名脊髓病變的患者，在本部接受動態排尿功能檢查。其中105名為發病少於六個月之急性期，其餘115名則為慢性期。利用二氧化碳氣式膀胱壓力檢查來測定逼尿肌的收縮，以檢視冰水試驗在脊髓病變患者的急性期與慢性期，偵測逼尿肌收縮的敏感性與特異性。研究結果顯示，冰水試驗對逼尿肌反射存在與否之推測，在急性期，敏感度為90.2%，特異性為70.3%，而在慢性期，則分別為87.8%與31.7%；其中，在慢性期的24位假陽性患者中，最多為低適應性膀胱，佔了75% （18/24）。因此，以冰水試驗推測慢性脊髓病變患者之逼尿肌反射存在與否，其正確性值得進一步探討。低適應性膀胱可能是影響慢性脊髓病變患者冰水試驗不可靠的主要原因。

關鍵字

冰水試驗；逼尿肌反射；脊髓病變；低適應性膀胱

並列摘要

This study attempts to define the reliability of ice-water test (IWT) in detecting the detrusor reflex in patients with chronic spinal cord lesion (SCL) and further explore its clinical application. 220 patients with SCL over a period of four years were included in this study. 105 of the patients were rated as the acute group with the injury less than six months. 115 patients with lesions over six months were grouped as the chronic one. All the patients underwent gas cystometrogram (CMG) and IWT within 48 hours. CMG revealed the presence of detrusor reflex. Comparing the results of CMG and IWT allowed us to determine the sensitivity and specificity of IWT. In addition, the high predictive values of IWT in detecting the detrusor reflex both at acute and chronic groups were obtained with a sensitivity of 90.2% in the acute group and 87.8% in the chronic group. However, the specificity of IWT in the chronic group was only 31.7% while it was relatively high in the acute group with 70.3%. Among the chronic SCL patients with the false positive IWT, the high proportion (75%) was diagnosed as a low compliance bladder. Based on the results in this study, we conclude that the reliability of IWT in detecting the detrusor reflex in chronic SCL is still inclusive and requires further study. Low compliance of the bladder might contribute to its uncertainty.

並列關鍵字

ice-water test ； detrusor reflex ； spinal cord lesion ； low compliance bladder

國際替代計量

冰水試驗於評估慢性脊髓病變患者之逼尿肌收縮

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