脊髄損傷者神経因性膀胱に対する膀胱内圧・尿道外括約筋筋電図同時検査と膀胱内圧・尿流量率・尿道外括約筋筋電図同時検査の検討

Abstract

脊髄損傷による神経因性膀胱患者20例に対し, CMG・EMG検査とCMG・UFM・EMG検査を, 同一症例に連続して施行し, 両検査による自然排尿時と手圧排尿時測定結果を比較することにより, 尿道内留置カテーテル(12F)が患者排尿に与える影響および脊髄損傷者のおこなう手圧排尿について検討した.1)尿道にカテーテル(12F)が留置された状態のCMG・EMG検査の場合は, 非留置の状態でのCMG・UFM・EMG検査に比較し, micturition pressure, opening pressureが有意(P<0.05, P<0.01)に高値を示した.2) CMG・EMG検査ではCMG・UFM・EMG検査に比較し, detrusor hyperreflexia症例の排尿筋・括約筋共調運動不全出現率が大きかった.3)自然排尿時に比較し, 手圧排尿時には, opening pressure micturition pressure, peak flowrate, PF maxが大きくなったが, flow time, voided volumeには差を認めなかった.4)自然排尿時に比較し, 手圧排尿時には排尿筋・括約筋共調運動不全の出現率が大きくなった

Simultaneous recording of intravesical pressure, sphincter electromyography and uroflowmetry (CMG.UFM.EMG study) was performed following cystometry simultaneously with electromyography (CMG.EMG study) on 20 patients with spinal cord injuries. Differences in the influence to micturition between the CMG.EMG study and CMG.UFM.EMG study is thought to be due to whether the catheter is indwelling in the urethra or not. We examined those differences and patient's rehabilitation maneuver (Cred'e maneuver). Micturition pressure and opening pressure measured by the CMG.EMG study were larger than that measured by the CMG.UFM.EMG study (P less than 0.05, P less than 0.01 respectively). Incidence of detrusor-sphincter dyssynergia measured by the CMG.EMG study was greater than that measured by the CMG.UFM.EMG study in the detrusor hyperreflexic cases. The Cred'e maneuver caused increase in opening pressure, micturition pressure and peak flow rate, but the voiding volume and voiding time did not increase to any effective extent. The Cred'e maneuver exaggerated the detrusor sphincter dyssynergia.