Fung L C, Khoury A E, McLorie G A, Chait P G, Churchill B M
Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
J Urol. 1995 Aug;154(2 Pt 2):671-6. doi: 10.1097/00005392-199508000-00089.
In pursuit of a diagnostic modality better able to assess collecting system urine transport characteristics while operating within physiological ranges, a new set of guidelines for the pressure flow study was proposed. An infusion rate individualized for each patient was chosen based on a calculated estimate of the maximum physiological urine output, adjusted for patient size and age. The upper limit of normal renal pelvic pressure used was 14 cm. water. We evaluated 37 renal units with grade 3 or 4 hydronephrosis with the individualized pressure flow study. Patient age ranged from 0.2 to 12 years (median 1.1). Calculated individualized infusion rates ranged from 1.3 to 12.5 ml. per minute and resulting renal pelvic pressures ranged from 7 to greater than 40 cm. water. In each patient the corresponding renal pelvic pressure resulting from a fixed 10 ml. per minute infusion rate was uniformly equal to or higher than the corresponding individualized study pressures (p < 0.0001). Disagreement between the individualized and fixed rate pressure flow studies was highest in the younger patients. The correlation coefficient between diuretic nuclear renography half-times and individualized pressure flow results was 0.09, indicative of a random association between the 2 variables. By using individualized infusion rates based on the calculated estimate of the maximum physiological urine output, much of the falsely high pressures induced by nonphysiologically high fixed infusion rates in pediatric patients can be avoided.
为了寻求一种能在生理范围内更好地评估集合系统尿液输送特征的诊断方法，提出了一套新的压力流研究指南。根据对最大生理性尿量的计算估计值，并针对患者的体型和年龄进行调整，为每位患者选择个性化的输注速率。所使用的正常肾盂压力上限为14厘米水柱。我们采用个性化压力流研究对37个患有3级或4级肾积水的肾单位进行了评估。患者年龄范围为0.2至12岁（中位数为1.1岁）。计算得出的个性化输注速率范围为每分钟1.3至12.5毫升，由此产生的肾盂压力范围为7至大于40厘米水柱。在每位患者中，固定的每分钟10毫升输注速率所产生的相应肾盂压力始终等于或高于相应的个性化研究压力（p<0.0001）。个性化和固定速率压力流研究之间的差异在较年轻患者中最为明显。利尿肾图半值与个性化压力流结果之间的相关系数为0.09，表明这两个变量之间存在随机关联。通过基于最大生理性尿量的计算估计值使用个性化输注速率，可以避免儿科患者因非生理性高固定输注速率导致的许多假性高压。
