阻塞性睡眠呼吸暂停低通气综合征合并夜间多尿患者尿动力学改变情况分析

目的 观察存在夜间多尿的OSAHS患者的尿动力学变化.方法 前瞻性纳入武汉大学人民医院2002年9月至2008年6月存在夜间多尿、并经多导睡眠监测(PSG)诊断的OSAHS患者,共入选患者23例,其中男19例,女4例,年龄46～81岁,中位年龄68岁.记录患者夜晚及持续气道正压(CPAP)压力滴定夜晚的夜尿次数、夜尿量、夜尿渗透压和尿钠浓度,于研究当夜11时和次晨7时留取静脉血测定脑钠肽及心房利钠肽(ANP)水平.同时对每位患者进行尿动力学检查,包括尿流率,充盈期膀胱压,压力-流率及尿道压测定,并在使用CPAP治疗3个月后再次进行尿动力学检查.结果 PSG检查结果显示,本组患者均存在中重度OSAHS,平均睡眠呼吸暂停低通气指数(AHI)为(48±15)次/h.OSAHS患者夜间尿量明显增多,尿钠浓度增加,尿渗透压降低,次晨7时ANP水平升高,CPAP治疗3个月后可恢复正常.患者行CPAP压力滴定当夜排尿次数明显少于PSG监测当夜排尿次数.尿动力学检查显示本组患者尿动力学主要特征是逼尿肌收缩无力、膀胱感觉迟钝、低顺应性膀胱、逼尿肌尿道外括约肌协同失调.CPAP治疗后,逼尿肌收缩力增强,并恢复膀胱顺应性.结论 CPAP可有效减少OSAHS患者的夜间多尿症状,OSAHS患者夜尿量增多、尿渗透压下降及尿钠浓度增高症状可能与ANP升高有关,OSAHS病程可能损害膀胱逼尿肌功能.CPAP治疗可减少ANP分泌,同时改善膀胱逼尿肌收缩力.

Abstract：

Objective To investigate the urodynamic changes in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and nocturnal polyuria. Methods From Sept. 2002 to Jun. 2008, 23 patients with nocturnal polyuria were diagnosed as having OSAHS by polysomnography(PSG). The number and output of nocturia, the osmotic pressure and the excretion of Na + were recorded during both the PSG night and CPAP titrating night. Plasma levels of brain natriuretic peptide (BNP) and atrial natriuretic peptides (ANP) were also measured at IIPM in the 2 nights and 7AM in the next mornings. Urodynamic studies including urine flow, bladder pressure during filling, pressure-flow study during voiding and urethral pressure were carried out in these patients. Urodynamic studies were performed again after treatment with CPAP for 3 months. Results PSG showed that the patients with nocturnal polyuria had moderate to severe OSAHS, in which the apnea-hypopnea index (AHI) being 48 ± 15 events per hour. The number of nocturnal voiding during the PSG night was more than that during the CPAP titrating night. During the PSG night, the output of nocturia, the nocturia excretion of Na+, ANP levels (at 7am in the next morning after PSG night)increased and the osmotic pressure of nocturia decreased. CPAP therapy could reverse these abnormalities.The main characteristics of urodynamics in these patients included weak detrusor contraction, hypoesthesia in filling cystometry, and decreased bladder compliance, and detrusor ex-ternal sphincter dyssynergia. After 3 months of CPAP treatment, both the myotility of the detrnsor of bladder and the bladder compliance improved. Conclusions CPAP therapy can effectively reverse the nocturnal polyuria in OSAHS patients. In OSAHS patients, the features of nocturia, including the changes of output, osmotic pressure and the excretion of Na+ , may be related to the secretion of high-level of ANP. During the course of chronic progressively OSAHS pathophysiology, detrusor function of bladder may be damaged. CPAP therapy could decrease the nocturnal excretion of ANP, and improve the myotility of the detrusor of bladder.     

Fish bone migration to the urinary bladder after rectosigmoid colon perforation

Fish bones are the most common foreign objects leading to bowel perforation.Most cases are confined to the extraluminal space without penetration of an adjacent organ.However,abscess formation due to the perforation of the rectosigmoid colon by a fish bone can lead to the penetration of the urinary bladder and may subsequently cause the fish bone to migrate into the urinary bladder.In the presented case,a 42-yearold female was admitted for lower abdominal pain.The computed tomography(CT)demonstrated a 5cm pelvic abscess containing a thin and curvilinear foreign body.After conservative management,the patient was discharged.After 1 mo,the subject developed a mechanical ileus.Surgery had to be delayed due to her hyperthyroidism.Migration of the foreign body to the urinary bladder was shown on additional CT.A Yellowish fish bone 3.5 cm in size was removed through intraoperative cystoscopy.The patient was discharged 8 d after the operation without any unexpected event.     

Relation Between Night Urinary Free Cortisol and Hypertension in Youth

Objectives To study the relation between night urinary free cortisol (UFC) excretion and hypertension in youth. Methods Night urinary free cortisol excretion and blood pressure & its related factor were measured in 188 young people. Results In young men with hypertension the 8 h's night UFC excretion was significantly higher than that in the group with normal blood pressure 21. 57±6. 28μg/8 h vs 10. 54 ± 5. 46 μg/8 h ( P < 0. 05) . In a group of young people with positive family history of hypertension, the night UFC excretion was much higher than that in the group with negative family history of hypertension. Men excrete much more night UFC than women (12. 73 ± 5. 85 μg/8 h vs 7. 80 ± 4. 15 μg/8 h, P < 0. 05). Conclusions There is an association between hypertension and high 8h's night UFC excretion; furthermore, there is gender difference in night UFC excretion.     

2007年重庆市云阳县和璧山县8～10岁儿童尿碘水平分析

Objective To determine the urinary iodine level of people in Yunyang and Bishan County of Chongqing and explore into its influencing factors. Methods Using multistage cluster stratified simple random sample method, Yunyang and Bishan County were chosen as research spots, then thirty children aged 8-10 in each 3 primary school of the 2 counties were selected using stratified randomization sampling method to inspected their urine and household salt for iodine and the iodine content in drinking water. Results Five hundred and seventy-one urine samples were inspected and the urinary iodine median was 261.47 μg/L. 5.78% (33/571) and 37.48%(214/571) of samples had an urinary iodine median less than 100 μg/L and more than 300 μg/L. The urinary iodine median of Yunyang County was higher than that of Bishan (H = 7.42, P < 0.01). The iodine salt coverage rate, the qualified rate and edible qualified iodine salt rate respectively were 99.64%(554/556), 94.22% (522/554) and 93.88% (522/556) in 556 samples of family table salt. Eighty-seven samples of drinking water were inspected, resulting an averaged iodine content of 8.81 and 2.97 μg/L, respectively in the 2 counties. Conclusions The 2 counties are all the area of iodine deficiency. The urinary iodine level, although meeting the demand of eliminating iodine deficiency diseases, is a little bit higher given that iodized salt of present doage has been taken for a long time. The content of iodized salt should be adjusted accordingly.     

2007年重庆市云阳县和璧山县8～10岁儿童尿碘水平分析

Objective To determine the urinary iodine level of people in Yunyang and Bishan County of Chongqing and explore into its influencing factors. Methods Using multistage cluster stratified simple random sample method, Yunyang and Bishan County were chosen as research spots, then thirty children aged 8-10 in each 3 primary school of the 2 counties were selected using stratified randomization sampling method to inspected their urine and household salt for iodine and the iodine content in drinking water. Results Five hundred and seventy-one urine samples were inspected and the urinary iodine median was 261.47 μg/L. 5.78% (33/571) and 37.48%(214/571) of samples had an urinary iodine median less than 100 μg/L and more than 300 μg/L. The urinary iodine median of Yunyang County was higher than that of Bishan (H = 7.42, P < 0.01). The iodine salt coverage rate, the qualified rate and edible qualified iodine salt rate respectively were 99.64%(554/556), 94.22% (522/554) and 93.88% (522/556) in 556 samples of family table salt. Eighty-seven samples of drinking water were inspected, resulting an averaged iodine content of 8.81 and 2.97 μg/L, respectively in the 2 counties. Conclusions The 2 counties are all the area of iodine deficiency. The urinary iodine level, although meeting the demand of eliminating iodine deficiency diseases, is a little bit higher given that iodized salt of present doage has been taken for a long time. The content of iodized salt should be adjusted accordingly.     

2007年重庆市云阳县和璧山县8～10岁儿童尿碘水平分析

Objective To determine the urinary iodine level of people in Yunyang and Bishan County of Chongqing and explore into its influencing factors. Methods Using multistage cluster stratified simple random sample method, Yunyang and Bishan County were chosen as research spots, then thirty children aged 8-10 in each 3 primary school of the 2 counties were selected using stratified randomization sampling method to inspected their urine and household salt for iodine and the iodine content in drinking water. Results Five hundred and seventy-one urine samples were inspected and the urinary iodine median was 261.47 μg/L. 5.78% (33/571) and 37.48%(214/571) of samples had an urinary iodine median less than 100 μg/L and more than 300 μg/L. The urinary iodine median of Yunyang County was higher than that of Bishan (H = 7.42, P < 0.01). The iodine salt coverage rate, the qualified rate and edible qualified iodine salt rate respectively were 99.64%(554/556), 94.22% (522/554) and 93.88% (522/556) in 556 samples of family table salt. Eighty-seven samples of drinking water were inspected, resulting an averaged iodine content of 8.81 and 2.97 μg/L, respectively in the 2 counties. Conclusions The 2 counties are all the area of iodine deficiency. The urinary iodine level, although meeting the demand of eliminating iodine deficiency diseases, is a little bit higher given that iodized salt of present doage has been taken for a long time. The content of iodized salt should be adjusted accordingly.     

2007年重庆市云阳县和璧山县8～10岁儿童尿碘水平分析

Objective To determine the urinary iodine level of people in Yunyang and Bishan County of Chongqing and explore into its influencing factors. Methods Using multistage cluster stratified simple random sample method, Yunyang and Bishan County were chosen as research spots, then thirty children aged 8-10 in each 3 primary school of the 2 counties were selected using stratified randomization sampling method to inspected their urine and household salt for iodine and the iodine content in drinking water. Results Five hundred and seventy-one urine samples were inspected and the urinary iodine median was 261.47 μg/L. 5.78% (33/571) and 37.48%(214/571) of samples had an urinary iodine median less than 100 μg/L and more than 300 μg/L. The urinary iodine median of Yunyang County was higher than that of Bishan (H = 7.42, P < 0.01). The iodine salt coverage rate, the qualified rate and edible qualified iodine salt rate respectively were 99.64%(554/556), 94.22% (522/554) and 93.88% (522/556) in 556 samples of family table salt. Eighty-seven samples of drinking water were inspected, resulting an averaged iodine content of 8.81 and 2.97 μg/L, respectively in the 2 counties. Conclusions The 2 counties are all the area of iodine deficiency. The urinary iodine level, although meeting the demand of eliminating iodine deficiency diseases, is a little bit higher given that iodized salt of present doage has been taken for a long time. The content of iodized salt should be adjusted accordingly.     

2007年重庆市云阳县和璧山县8～10岁儿童尿碘水平分析

Objective To determine the urinary iodine level of people in Yunyang and Bishan County of Chongqing and explore into its influencing factors. Methods Using multistage cluster stratified simple random sample method, Yunyang and Bishan County were chosen as research spots, then thirty children aged 8-10 in each 3 primary school of the 2 counties were selected using stratified randomization sampling method to inspected their urine and household salt for iodine and the iodine content in drinking water. Results Five hundred and seventy-one urine samples were inspected and the urinary iodine median was 261.47 μg/L. 5.78% (33/571) and 37.48%(214/571) of samples had an urinary iodine median less than 100 μg/L and more than 300 μg/L. The urinary iodine median of Yunyang County was higher than that of Bishan (H = 7.42, P < 0.01). The iodine salt coverage rate, the qualified rate and edible qualified iodine salt rate respectively were 99.64%(554/556), 94.22% (522/554) and 93.88% (522/556) in 556 samples of family table salt. Eighty-seven samples of drinking water were inspected, resulting an averaged iodine content of 8.81 and 2.97 μg/L, respectively in the 2 counties. Conclusions The 2 counties are all the area of iodine deficiency. The urinary iodine level, although meeting the demand of eliminating iodine deficiency diseases, is a little bit higher given that iodized salt of present doage has been taken for a long time. The content of iodized salt should be adjusted accordingly.     

2007年重庆市云阳县和璧山县8～10岁儿童尿碘水平分析

Objective To determine the urinary iodine level of people in Yunyang and Bishan County of Chongqing and explore into its influencing factors. Methods Using multistage cluster stratified simple random sample method, Yunyang and Bishan County were chosen as research spots, then thirty children aged 8-10 in each 3 primary school of the 2 counties were selected using stratified randomization sampling method to inspected their urine and household salt for iodine and the iodine content in drinking water. Results Five hundred and seventy-one urine samples were inspected and the urinary iodine median was 261.47 μg/L. 5.78% (33/571) and 37.48%(214/571) of samples had an urinary iodine median less than 100 μg/L and more than 300 μg/L. The urinary iodine median of Yunyang County was higher than that of Bishan (H = 7.42, P < 0.01). The iodine salt coverage rate, the qualified rate and edible qualified iodine salt rate respectively were 99.64%(554/556), 94.22% (522/554) and 93.88% (522/556) in 556 samples of family table salt. Eighty-seven samples of drinking water were inspected, resulting an averaged iodine content of 8.81 and 2.97 μg/L, respectively in the 2 counties. Conclusions The 2 counties are all the area of iodine deficiency. The urinary iodine level, although meeting the demand of eliminating iodine deficiency diseases, is a little bit higher given that iodized salt of present doage has been taken for a long time. The content of iodized salt should be adjusted accordingly.     

2007年重庆市云阳县和璧山县8～10岁儿童尿碘水平分析

Objective To determine the urinary iodine level of people in Yunyang and Bishan County of Chongqing and explore into its influencing factors. Methods Using multistage cluster stratified simple random sample method, Yunyang and Bishan County were chosen as research spots, then thirty children aged 8-10 in each 3 primary school of the 2 counties were selected using stratified randomization sampling method to inspected their urine and household salt for iodine and the iodine content in drinking water. Results Five hundred and seventy-one urine samples were inspected and the urinary iodine median was 261.47 μg/L. 5.78% (33/571) and 37.48%(214/571) of samples had an urinary iodine median less than 100 μg/L and more than 300 μg/L. The urinary iodine median of Yunyang County was higher than that of Bishan (H = 7.42, P < 0.01). The iodine salt coverage rate, the qualified rate and edible qualified iodine salt rate respectively were 99.64%(554/556), 94.22% (522/554) and 93.88% (522/556) in 556 samples of family table salt. Eighty-seven samples of drinking water were inspected, resulting an averaged iodine content of 8.81 and 2.97 μg/L, respectively in the 2 counties. Conclusions The 2 counties are all the area of iodine deficiency. The urinary iodine level, although meeting the demand of eliminating iodine deficiency diseases, is a little bit higher given that iodized salt of present doage has been taken for a long time. The content of iodized salt should be adjusted accordingly.     

Volume capacity and pressure characteristics of the continent ileostomy reservoir

The volume capacity and the pressure characteristics of the ileal reservoir were studied at intervals postoperatively in 28 patients with continent ileostomy. The reservoir volume increased during the first 6 months from 100 ml to approximately 700 ml, after which it remained stable. The basal pressure increased during filling to a maximum of roughly 10 cm H2O. Under 'physiological conditions' the basal pressure was around 4 cm H2O before emptying. Two types of pressure waves occurred, small pressure fluctuations with a frequency of 7-8/min and larger phasic waves appearing when approximately 40% of the reservoir volume capacity had been reached. The occurrence of both types of pressure waves decreased with time. The total motor activity, expressed as the area underneath the pressure waves, decreased considerably during the 1st year after operation, indicating an adaptation of the intestinal smooth muscle to distension. The results confirm the original concept proposed by Kock that the ileal reservoir constructed in this manner is a low-pressure reservoir.     

The effects on vesicourethral function following laparoscopic hysterectomy

The aim of our study is to determine whether laparoscopic hysterectomy is associated with increased postoperative urinary symptoms and to assess the change in urodynamic parameters after operation. Forty-five women were arranged for laparoscopic hysterectomy (LH). Each patient received urinalysis, interview, and urodynamic study including uroflowmetry, filling and voiding cystometry and urethral pressure profilometry before and after hysterectomy. A total of 27 patients (60%) had urinary symptoms preoperatively. After operation, only 22 patients (48.9%) remained symptomatic. There was no significant change in the number of women with one or more voiding symptoms before and after surgery, but the incidence of urinary frequency and stress incontinence decreased significantly after laparoscopic hysterectomy (P < 0.05). In addition, maximal urethral closure pressure and maximal cystometric capacity showed significant increases after operation. They were 73.1 cm H2O (range: 49-114) vs 104.4 cm H2O (range: 60-147) (P < 0.001), and 363.3 ml (range: 287-423) vs 396.1 ml (range: 265-515) (P < 0.001), respectively. The result indicated that laparoscopic hysterectomy did not significantly increase the subjective or objective incidence of vesicourethral dysfunction. On the contrary, some patients might be cured of urinary frequency or stress incontinence postoperatively.     

Urodynamic testing, continence, and the patient with myelomeningocele

The primary goal in neurourologic management of patients with myelomeningocele is the preservation of renal function. In addition, achieving continence or at least improving urinary incontinence becomes imperative given the impact of continence on quality of life. Initial neurourologic and urodynamic examination of children with myelomeningocele is strongly recommended as early as possible, ideally on the day of birth or within 2 weeks after closure of the myelomeningocele defect. Examination is decisive for the therapeutic strategy as it allows definition of the dysfunctional pattern of the lower urinary tract and detection of risk factors (low bladder compliance, intravesical pressure > 40 cm H₂O, detrusor sphincter dyssynergia) before major upper urinary tract changes occur. Thereby, the appropriate treatment can be initiated to preserve both upper and lower urinary tract function and to achieve urinary continence.     

超声测量逼尿肌厚度预测老年男性下尿路梗阻

目的 探讨老年良性前列腺增生(BPH)患者膀胱逼尿肌厚度与膀胱出口梗阻的相关性.方法 106例BPH患者行尿动力学检查,以尿动力学检查结果作为膀胱出口梗阻的诊断依据,梗阻标准:Abrams-Griffiths(A-G)指数≥40,LinPURR梗阻分级≥Ⅱ级.经腹B超在膀胱充盈量至150 ml时测定逼尿肌厚度.结果 最大尿流率和平均尿流率梗阻组[(10.1±3.0)ml/s、(5.5±2.2)ml/s]均明显低于非梗阻组[(17.4±3.1)ml/s、(11.2±2.2)ml/s](t=10.26和11.03,均P<0.01),而残余尿量、逼尿肌最大收缩压力梗阻组[(47.6±24.3)ml、(39.3±14.4)cm H2O]高于非梗阻组[(17.0±5.6)ml、(26.8±8.0)cm H2O,t=6.32和4.07,P<0.01和0.05].逼尿肌厚度与逼尿肌最大收缩压力呈正相关(r=0.419,P<0.01),与最大尿流率(r=-0.749,P<0.01)、平均尿流率(r=-0.853,P<0.01)和排尿量(r=-0.556,P<0.01)呈负相关.逼尿肌厚度梗阻组(3.0±0.2)mm,高于非梗阻组(2.5±0.2)mm(t=11.2,P<0.05).以逼尿肌厚度≥3.0 mm为标准诊断男性下尿路梗阻的灵敏度为90%,特异性为84.6%,阳性预测值93.1%,阴性预测值为78.6%.结论 逼尿肌厚度大于3 mm可预测老年男性膀胱出口梗阻.     

Preservation of complete anal sphincteric proprioception in restorative proctocolectomy: the inhibitory reflex and fine control of continence need not be impaired.

This study evaluates whether reflux function of the anal sphincter remains unchanged after restorative proctocolectomy, provided that the sphincter remaining is kept intact, without mucosal stripping or endo-anal anastomosis. Paired tests of anorectal function were performed before, and a median of 6 (range 2-12) months after restorative proctocolectomy with stapled, end to end pouch-anal anastomosis. Beforehand, distension of the rectum with 50 ml of air produced a median (interquartile range) increase in pressure within the rectum of 22 (15-29) cm H2O and reflex inhibition of the anal sphincter from a pressure of 76 (62-106) cm H2O to a pressure of 34 (15-52) cm H2O. After the procedure, distension of the ileal pouch with 50 ml of air produced an increase in pressure within the pouch of only 5 (4-8) cm H2O (p < 0.001 compared with beforehand) and reflex inhibition of the anal sphincter from a pressure of 62 (25-79) cm H2O to 37 (17-68) cm H2O. Maximal reflex inhibition of the upper third if the anal sphincter to a pressure of 26 (15-48) cm H2O was observed when pressure within the pouch increased by 16 (11-22) cm H2O. After restorative proctocolectomy, all patients were continent (two experienced minor nocturnal leakage of mucus) and 25 could discriminate between flatus and faeces. Thus, reflux function was preserved in response to changes in pressure, ensuring that the subtler aspects of anal continence were preserved.     

The perfect pelvic pouch--what makes the difference?

The aim of this study was to determine what factors are important for the achievement of perfect anal continence after restorative proctocolectomy. One hundred patients underwent paired studies of anorectal physiology before and one year after restorative proctocolectomy with pelvic ileal reservoir (11 S, 25 J, 64 W) with stapled ileoanal anastomosis, without mucosectomy. Fifty seven patients attained perfect anal continence and were able to discriminate flatus from faeces with such confidence that they were able to release flatus safely without fear of faecal soiling. The remaining 43 patients experienced minor problems in this regard. Four factors were found to correlate significantly with a perfect functional result (median, perfect v imperfect): maximum resting anal pressure (72 v 57 cm H2O, p < 0.02), the sensory threshold in the upper and mid-anal canal (7.3 v 8.6 and 5.3 v 7.0 mA, p < 0.05 and p < 0.02), compliance of the ileal reservoir (12.4 v 7.6 ml/cm H2O, p < 0.01), and the presence of a pouch-anal inhibitory reflex (56 of 57 patients v 29 of 43 patients, p < 0.01). The quality of anal continence depends on several factors: a complaint ileal reservoir, a strong sensitive anal sphincter, and normal reflex coordination of the activities of the reservoir and the sphincter. Excellent pouch-anal coordination is obtainable irrespective of the design of the reservoir, provided that these criteria are satisfied.     

Volume Capacity and Pressure Characteristics of the Continent Ileostomy Reservoir

The volume capacity and the pressure characteristics of the ileal reservoir were studied at intervals postoperatively in 28 patients with continent ileostomy. The reservoir volume increased during the first 6 months from 100 ml to approximately 700 ml, after which it remained stable. The basal pressure increased during filling to a maximum of roughly 10 cm H₂O. Under ‘physiological conditions’ the basal pressure was around 4 cm H₂O before emptying. Two types of pressure waves occurred, small pressure fluctuations with a frequency of 7–8/min and larger phasic waves appearing when approximately 40% of the reservoir volume capacity had been reached. The occurrence of both types of pressure waves decreased with time. The total motor activity, expressed as the area underneath the pressure waves, decreased considerably during the 1st year after operation, indicating an adaptation of the intestinal smooth muscle to distension. The results confirm the original concept proposed by Kock that the ileal reservoir constructed in this manner is a low-pressure reservoir.     

Anal manometry with microtransducer technique before and after restorative proctocolectomy. Sphincter function and clinical correlations

Anal manometry, with microtransducer technique, was performed in 55 patients after restorative proctocolectomy. Forty-two patients were followed regularly from before surgery until 12 months after surgery, and 23 patients until 24 months of function. Postoperatively, sphincter function was severely impaired. At 12 months, the mean height was less than 60 percent, mean area less than 50 percent, and mean length less than 90 percent of the preoperative values of the high pressure zone. There was no improvement between 12 and 24 months. Mean maximal squeeze pressure was restored at 12 months. Rectoanal inhibitory reflex was constantly present preoperatively, but in only 4 of 30 patients, postoperatively. Those patients with preoperative resting pressure 100 cm H2O or greater had significantly higher resting tones at 12 months than those with less than 100 cm H2O. Patients with 5 or fewer bowel movements every 24 hours had significantly higher resting tones than those with more than 6 movements every 24 hours (66 vs. 45 cm H2O). Patients with deferral 60 minutes or greater had significantly higher resting pressures than those with deferral less than 30 minutes (65 vs. 44 cm H2O). No correlation was found between resting pressure and state of continence.     

老年膀胱颈硬化症的诊断与治疗

目的 探讨老年膀胱颈硬化症的诊断方法和比较经尿道电切术、开放性手术的治疗效果。方法 对１９８４年５月～１９９９年５月经手术治疗的老年膀胱颈硬化症进行回顾性分析,以手术前后残祭余尿、尿流率、术后留置导尿时间、患者出院为评价指标。结果 ２２例开放性手术,１９例能自行排尿,其中２例术后仍有排尿困难。术后３ｗ１７例复查尿流率为６．９～２３．６ｍｌ／ｓ,１９例复查残尿,其中１２例无残余尿,４例残余尿量１５～     

Distal lung dysfunction at night in nocturnal asthma

We have previously shown that patients with nocturnal worsening of asthma (nocturnal asthma) exhibit increased parenchymal inflammation at night. To evaluate the functional significance of this parenchymal inflammation, 10 subjects with nocturnal asthma (NA), four subjects with non-nocturnal asthma (NNA), and four normal control subjects underwent bronchoscopy with measurement of peripheral airways resistance (Rp) at 4:00 P.M. and at 4:00 A.M. Employing a wedged bronchoscope technique, Rp was measured. Flow was stopped, and the pressure reached after 10 s of decay was termed the plateau pressure. The time constant of this decay (tau) was measured, and the peripheral compliance (Cp) was calculated as tau/Rp. The NA group exhibited the highest Rp values at 4:00 P.M. and at 4:00 A.M. as compared with the NNA and control groups, but all groups were significantly different from each other at 4:00 P.M.: NA, 0.113 +/- 0.02 cm H(2)O/ml/min; NNA, 0.033 +/- 0.005 cm H(2)O/ml/min; Control subjects, 0.010 +/- 0.001 cm H(2)O/ ml/min; p = 0.0001; and at 4:00 A.M.: NA, 0.129 +/- 0.023 cm H(2)O/ ml/min; NNA, 0.035 +/- 0.007 cm H(2)O/ml/min; Control subjects, 0.009 +/- 0.002 cm H(2)O/ml/min; p = 0.0003. None of the groups exhibited statistically significant differences in Rp between 4:00 P.M. and 4:00 A.M. The plateau pressure increased significantly from 4:00 P.M. to 4:00 A.M., but only in the NA group (7.7 +/- 0.9 cm H(2)O at 4:00 P.M. versus 16.9 +/- 4.6 cm H(2)O at 4:00 A.M.; p = 0.0004). Cp was decreased in the NA group as compared with the NNA and control groups at both 4:00 P.M. (p = 0.0003) and 4:00 A.M. (p = 0.003). The Rp positively correlated with the residual volume at both 4:00 P.M. (r = 0.71, p = 0.004) and 4:00 A.M. (r = 0.59, p = 0.03). We conclude that the distal lung units, specifically the collateral channels, and may be functionally altered at night in NA.