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目的:探讨脑梗死对前列腺增生(BPH)患者排尿功能的影响,协助医师判断膀胱功能,避免无效手术。方法:对120例BPH伴脑梗死患者行脑部CT、经直肠超声(TURS)或经腹部超声(TAS)及尿流动力学检查,并根据美国国立卫生研究院卒中量表(NIHSS),将脑梗死患者按轻重程度不同分为3组,观察不同程度脑梗死对BPH患者尿流动力学方面的影响,对检查结果进行统计学分析。结果:120例BPH患者通过NIHSS评分分为3组,其中轻度74例,中度28例,重度18例。3组患者年龄、血清总PSA和前列腺体积差异无统计学意义(P>0.05)。轻、中度脑梗死患者最大尿流率(Q_(max))和最大尿流率时逼尿肌压力(Pdet-Q_(max))均明显高于重度脑梗死患者(Q_(max):轻度vs.重度,P<0.01;中度vs.重度,P<0.05。Pdet-Q_(max):轻度vs.重度,P<0.001;中度vs.重度,P<0.01)。同时,相较于重度脑梗死患者,轻、中度脑梗死患者的残余尿量(PVR)和初始尿意膀胱容量(FDC)则明显降低(PVR:重度vs.轻度,P<0.01;重度vs.中度,P<0.01。FDC:重度vs.轻度,P<0.001;重度vs.中度,P<0.001)。结论:轻、中度脑梗死对BPH患者排尿功能基本无明显影响或影响较小,然而重度脑梗死对BPH患者的膀胱功能影响较大。因此,对于BPH合并重度脑梗死患者,建议行尿动力学检测后再决定是否行手术。本研究结论尚需大样本、前瞻性临床研究进一步验证。
Objective: To investigate the effect of cerebral infarction on urinary function in patients with benign prostatic hyperplasia (BPH) and assist physicians in judging bladder function and avoiding ineffective surgery. Methods: One hundred and twenty BPH patients with cerebral infarction underwent brain CT, transurethral ultrasound (TURS) or transabdominal ultrasound (TAS) and urodynamics. According to the National Institutes of Health Stroke Scale (NIHSS), brain Infarct patients were divided into 3 groups according to the degree of severity. The effects of cerebral infarction on urodynamics were observed, and the results were statistically analyzed. Results: 120 patients with BPH were divided into 3 groups according to NIHSS score, of which 74 were mild, 28 were moderate and 18 were severe. There was no significant difference in age, serum total PSA and prostate volume between the three groups (P> 0.05). The maximal urinary flow rate (Q max) and detrusor pressure (Pdet-Q max) in patients with mild or moderate cerebral infarction were significantly higher than those in patients with severe cerebral infarction (Q max: Degrees vs. severe, P <0.01; moderate vs. severe, P <0.05.Pdet-Q max: mild vs. severe, P <0.001; moderate vs. severe, P <0.01). At the same time, residual urine volume (PVR) and initial urinary bladder capacity (FDC) in patients with mild to moderate cerebral infarction were significantly lower than those in patients with severe cerebral infarction (PVR: severe vs. mild, P <0.01; severe vs Moderate, P <0.01.FDC: severe vs. mild, P <0.001; severe vs. moderate, P <0.001). Conclusions: The light and moderate cerebral infarction have little or no effect on urinary function in patients with BPH. However, severe cerebral infarction has a significant effect on urinary bladder function in patients with BPH. Therefore, BPH complicated with severe cerebral infarction, it is recommended to conduct urodynamic tests before deciding whether to undergo surgery. The conclusions of this study still need large sample, prospective clinical studies to further verify.