原發單一性尿床兒童的尿動力研究分析

研究目的: 尿動力檢查普遍應用於泌尿系統疾病的分析，此項檢查可提供許多寶貴及實用的數據應用於評估及診斷泌尿系統功能和疾病。我們分析過去接受尿動力檢查的尿床兒童，評估尿床兒童的膀胱功能，分析膀胱容量、最大尿液流速、餘尿、膀胱內壓力和年齡、性別、藥物治療的關聯性。探討尿床的病理生理學及其相關因素。材料與方法: 本次研究收集從2000年至2005年於彰化基督教醫院接受尿動力檢查的尿床兒童資料，這273位兒童皆有接受尿流速檢查，其中有240位兒童有接受進一步的膀胱容積功能評估及尿道括約肌等檢查。藉由尿動力檢查結果分析膀胱容量、最大尿流速、膀胱餘尿、膀胱內壓力、膀胱肌功能和年齡、性別、藥物治療的關聯性。結果: 273位(平均年齡 9.5 2.7歲)接受尿流速檢查的兒童中，男生有142人( 52.0%)，女生131人( 48.0%)。男生平均年齡為9.3 2.3歲，女生為9.7 3.1歲。年齡的分佈在男女性別上並無顯著差異。最大尿流速和年齡可見呈現正向線性迴歸的關係( P<0.001) ，其公式為 5.58 ml/sec +年齡× 1.41 ml/sec。最大排尿量和年齡亦呈現正向的線性迴歸關係( P<0.001) ，其公式為13.10 ml +年齡× 17.77 ml。膀胱容量和年齡亦呈現正向的線性迴歸關係( P<0.001)，其公式為4.50ml +年齡× 19.72 ml。最大排尿量和膀胱容量之間無顯著差異，可是最大排尿量和估計正常膀胱容量（Expected bladder capacity）有顯著差異( P<0.001)，膀胱容量和估計正常膀胱容量亦有顯著差異( P<0.001) 。在240位兒童當中有 141位(58.8%)屬於小膀胱容量，95位(39.6%)為正常膀胱容量，另外 4位(1.7%)則為大膀胱容量。可知大部份尿床兒童的膀胱容量較估計正常膀胱容量小。這些兒童分別服用Imipramine和Desmopressin藥物治療，兩者皆有很好的療效，每月尿床次數減少 50%以上的在Imipramine組有81.7%，Desmopressin組則有77.6%。兩種藥物的治療成效和性別並無顯著的差異。結論: 根據我們的資料顯示，尿床兒童的最大尿流速、最大排尿量和膀胱容量皆與年齡成正比的關係。我們的研究亦發現，尿床兒童的最大排尿量和膀胱容量皆比估計正常膀胱容量小，有高達六成的尿床兒童屬於小膀胱容量（<65% Expected bladder capacity），而且有四成兒童有膀胱過動的情形，因此可推論尿床兒童的膀胱容量比正常兒童膀胱容量小，所以小膀胱容量和膀胱過動是導致尿床的因素之一。而藥物的治療成效並不受膀胱容量影響。

Objectives: Urodynamic examinations were widely used to detect lower urinary tract disease. It also yields valuable information in infants and children in several clinical situations. We reported our experience for analysis of urodynamic study in children with primary monosymptomatic nocturnal enuresis.Materials and Methods: We collect the report of urodynamic study in child with primary monosymptomatic nocturnal enuresis from 2000 to 2005. 273 children (142 boys and 131 girls, aged 5 years to 18 years, mean age 9.5 2.7 years) were included to the criteria. Bladder capacity, maximum voiding pressure, detrusor pressure on voiding, post-void residual urine volume, bladder compliance, sex and age were analyzed.Results: The mean maximum flow rate was 18.1 8.0 ml/sec. The maximum flow rate increase with age. The equation of the straight line relating maximum flow rate and age is estimated as: 1.41 × age + 5.58 in ml/sec. The mean maximum voided volume was 167.0 97.5 ml. The mean maximum voided volume increase with age. The equation of the straight line relating maximum voided volume and age is estimated as: 17.77 × age + 13.10 in ml. The mean bladder capacity was 193.1 101.8 ml. The bladder capacity increase with age. The equation of the straight line relating bladder capacity and age is estimated as: 19.72× age + 4.50 in ml. When compared with the most widely used Hjalmas’ formula(30× age + 30) for expected bladder capacity, there are significant difference in bladder capacity (p<0.001). There are 71 children accepted Imipramine and 125 children accepted Desmopression therapy. But we didn’t found any correlation between medicine response and bladder capacity.Conclusions: Our data showed nocturnal enuretic children had smaller bladder capacity than normal children. The maximum flow rate, maximum voided volume and bladder capacity increase with age. The medicine effect do not influenced by the bladder capacity. The children with higher maximum flow rate had better response to Desmopressin.