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Original Articles / œ·¡œ›r˜œo Œ´
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2550; 17(2): 37 - 42
J Thai Rehabil Med 2007; 17(2): 37 - 42
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ABSTRACT
Measurement of Residual Urine by
Portable Ultrasound Scanner Compared with Catheterization Method in
Spinal Cord Lesion Patients with
Neurogenic Bladder
Kothsompong H, Tamnanthong N.
Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen
University
Objectives: To determine the accuracy of residual urine (RU) measured
by the portable ultrasound scanner
compared with catheterization
method.
Study design: Experimental, comparative study
Setting: The rehabilitation ward,
Srinagarind Hospital
Subjects: Thirty-three spinal cord
lesion patients with neurogenic
bladder managed by intermittent
catheterization.
Methods: Initially, post-voiding
residual urine was assessed by the
first ultrasound scanner measurement
(US1) compared to catheterization
method (Cath1) with double-blind
technique. Fifty ml. of normal saline
(NSS) was introduced via foley
Correspondence to: Dr. Hathaimas
Kothsompong; Department of
Rehabilitation Medicine Maharat
Nakornratchasrima Hospital,
Changpheuk Road, Amphur Mueng,
Nakornratchasrima 30000
E-mail: [email protected]
catheter, then assessed by the
second scanner measurement (US2 ).
Thereafter, additional 50 ml. of NSS
was introduced for the third scanner
measurement (US 3). Finally, the
bladder volume was assessed by
catheterization method (Cath2) and
was compared to the constant value
of 100 ml. Accuracy and clinical
agreement of RU measured by the
ultrasound scanner and the catheterization were evaluated.
Results: Thirty-three patients were
included; 18 of all had traumatic spinal
cord injury; 21 were males and 10
were females. Average age was 40.25
years old (range 20 to 65 years old).
The Bland and Altman plot was
showed clinical agreement of US1vs
Cath1 (limit ± 50 ml. = 64.74%, 95%
CI = 51.25 - 84.23%) and US3vs Cath2
(limit ± 50 ml. = 64.52%, 95% CI =
47.67 - 81.36%). When compared US1
with Cath1and US3 with Cath2 , the sensitivities of the ultrasound scanner
were 0.8888889 and 0.5172414,
respectively. There was low agreement of US2 vs 50 ml, US3 vs100 ml,
and Cath2 vs 100 ml.
Conclusion: The portable ultrasound
scanner is useful for evaluation of RU
when compared with the catheterization method. It is more accurate
when the RU is more than 100 ml.
Key words: residual urine, neurogenic
bladder, spinal cord lesion, portable
ultrasound, intermittent catheterization
J Thai Rehabil Med 2007; 17(2): 37 - 42
- 37 -
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ŽµªœrÁž¦¸¥Áš¸¥„´„µ¦­ªœž{­­µª³
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×¥Ÿoš¼ ¶„µ¦ª·‹¥´ čoÁ‡¦º°É Š°´¨˜¦µŽµªœr¥®¸É °o
Bladder scan (US1) Áž¦¸¥Áš¸¥„´ª·›¸
­ªœž{­­µª³ (Cath1) Ž¹ŠÉ ¤¸¡¥µµ¨Ÿo¼ ªn ¥
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(US2 ) ¨oªÄ­nœÊ¶Á„¨º°Á…oµÅž°¸„ 50 ¤¨.
¨³ª´—ŽÊ¶ —oª¥Á‡¦º°É Š°´¨˜¦µŽµªœr (US3)
‹µ„œ´Êœ‹¹Š­ªœž{­­µª³°°„¤µ°¸„‡¦´ÊŠ
(Cath2) Á¡ºÉ ° œ¶‡n µ š¸É ª´ — ŗo Å žÄo Ä œ„µ¦
ž¦³Á¤· œ ‡ªµ¤Â¤n œ ¥¶ ¨³‡ªµ¤­°—
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Ÿ¨„µ¦«¹„¬µ: Ÿo¼žiª¥ ‹¶œªœ 31 ¦µ¥
°µ¥»ÁŒ¨¸¥É 40.25 že (˜´ŠÊ ˜n 20-65 že), Áž}œ
µ¥ 21 ‡œ ¨³®·Š 10 ‡œ, ¦°¥Ã¦‡
­nªœÄ®nÁž}œµ—Á‹ÈÅ…­´œ®¨´Š‹µ„°»˜´ Á· ®˜»
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2550; 17(2)
(18 ‡œ) ‹µ„ Bland and Altman plot
¡ªnµ¤¸‡ªµ¤­°—‡¨o°Š„´œ¦³®ªnµŠ US1
„´ Cath1 (š¸É limit ± 50 ml. = 64.74%,
95% CI = 51.25 - 84.23%) ¨³ US3
„´ Cath2 (š¸É limit ± 50 ml. = 64.52%,
95% CI = 47.67 - 81.36%) ×¥‡ªµ¤Åª
…°ŠÁ‡¦º°É Š°´¨˜¦µŽµªœrĜ„µ¦ª´—ž¦·¤µ–
ž{­­µª³‡oµŠ Á¤ºÉ°Áš¸¥¦³®ªnµŠ US1 „´
Cath 1 ¨³ US 3 „´  Cath 2 Ášn µ „´ 
0.8888889 ¨³ 0.5172414 ˜µ¤¨¶—´
¨³¤¸‡ªµ¤­°—‡¨o°Š„´œœo°¥ ¦³®ªnµŠ
US2 „´ 50 ¤¨., US3 „´100 ¤¨. ¨³
Cath2 „´ 100 ¤¨.
­¦»ž: ­µ¤µ¦™œ¶Á‡¦º°É Š°´¨˜¦µŽµªœr
¡„¡µ¤µÄož¦³Á¤·œž¦·¤µ–ž{­­µª³‡oµŠ
š—šœ„µ¦­ªœž{­­µª³Å—o ×¥‹³¤¸
‡ªµ¤Â¤nœ¥¶Á¤º°É œ¶¤µª´—ž¦·¤µ–ž{­­µª³
‡oµŠ¤µ„„ªnµ 100 ¤¨.
‡¶­¶‡´: residual urine, neurogenic
bladder, spinal cord lesion, portable
ultrasound, intermittent catheterization
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2550; 17(2): 37 - 42
šœ¶
ž¦· ¤ µ–ž{ ­ ­µª³‡o µ Š®¨´ Š ‹µ„„µ¦
…´™nµ¥ž{­­µª³ (post - voiding residual
urine, RU) ¤¸‡ªµ¤­¶‡´Äœ„µ¦¡·‹µ¦–µ
¨³˜´—­·œÄ‹Äœ„µ¦‹´—„µ¦„´Ÿož¼ ªi ¥£µª³
„¦³Á¡µ³ž{­­µª³¡·„µ¦ (neurogenic
bladder)(1) Ánœ Ÿož¼ ªi ¥š¸¤É ¦¸ °¥Ã¦‡Å…­´œ®¨´Š
(spinal cord lesion) ¨³¤¸£µª³„¦³Á¡µ³
ž{­­µª³¡·„µ¦°µ‹‹³ f„…´™nµ¥ž{­­µª³Ã—¥
„µ¦­ªœž{­­µª³Áž}œ¦³¥³ (intermittent
catheterization, IC) Ž¹ŠÉ ‹¶œªœ‡¦´ŠÊ …°Š„µ¦
­ªœž{­­µª³…¹œÊ „´ž¦·¤µ– RU š¸ªÉ —´ ŗo
Ĝž{‹‹»´œ „µ¦­ªœž{­­µª³Áž}œª·›¸
¤µ˜¦“µœÄœ„µ¦ª´—ž¦·¤µ–ž{­­µª³‡oµŠ
(RU)(2) ˜n„ÈÁž}œª·›¸š¸É°µ‹Á­¸É¥Š˜n°£µª³
˜·—ÁºÊ°Â¨³„µ¦µ—Á‹È˜n°šn°ž{­­µª³
Ž¹ŠÉ Ĝ„¦–¸šŸ¸É žo¼ ªi ¥¤¸ RU Ťn¤µ„ š¶Ä®o˜°o Š
™¼„­ªœž{­­µª³Ã—¥Å¤n‹¶Áž}œ(3) °¸„š´ŠÊ ¥´Š
Á­¸É¥Š˜n°£µª³—´Š„¨nµª œ°„‹µ„œ¸Ê ¥´Š¤¸
J Thai Rehabil Med 2007; 17(2)
¦µ¥Šµœš¸¡É ªnµ„µ¦­ªœž{­­µª³ Á¡º°É ª´—
ž¦·¤µ–ž{­­µª³‡oµŠ ¤¸‡ªµ¤‡¨µ—Á‡¨ºÉ°œ
ŗo™Š¹ 27%(4) š¶Ä®ož¨Ÿ¨Ÿ·—¡¨µ—Å—o
„µ¦ª´ — ž¦· ¤ µ– RU ץčo Á ‡¦ºÉ ° Š
°´¨˜¦µŽµªœr¡„¡µ (portable ultrasound scanner) ‹´—Áž}œª·›¸š¸É¤µ˜¦“µœ
čoŠµn ¥ ­³—ª„ ¨³Å¤n˜°o ŠÁ˜¦¸¥¤°»ž„¦–r
¥nŠ» ¥µ„ ¤¸¦µ¥ŠµœªnµÁº°É ™º°Å—o(1,2,3,5) ¦ª¤š´ŠÊ
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ª´—ž¦·¤µ– RU ŗo˜´ÊŠÂ˜n 50-700 ml.(5)
Ž¹ÉŠ¤¸‡nµ‡ªµ¤Â¤nœ¥¶Ã—¥¦ª¤ (overall
accuracy) 94%, ‡ªµ¤Åª (sensitivity)
97% ¨³‡ªµ¤‹¶Á¡µ³ (specificity)
91%(5) ˜nÁž}œ¦µ¥Šµœš¸ÉčoÁ‡¦ºÉ°Š°´¨˜¦µ
Žµªœrš¸É˜„˜nµŠ„´œ ¨³¤¸¤µ˜¦“µœÄœ
„µ¦‡¶œª–š¸ÂÉ ˜„˜nµŠ„´œ
Bladder Scan BVI3000 (Diagnostic Ultrasound, USA —´Š¦¼žš¸É 1) Áž}œ
Á‡¦ºÉ°Š°´¨˜¦µŽµªœrœ·— threedimensional Ž¹ŠÉ ¤¸¦µ¥Šµœ„µ¦œ¶¤µÄoĜŸož¼ ªi ¥
«´ ¨ ¥„¦¦¤ (7) Ÿo¼ ži ª ¥­¼ ˜· „ ¦¦¤Äœ…–³
‡¨°—(8) ¨³Ÿo¼žiª¥®¨´Š‡¨°—(9) Á¡ºÉ°Äo
ž¦³Á¤·œ‡ªµ¤‹»…°Š„¦³Á¡µ³ž{­­µª³Â¨³
ž¦·¤µ–ž{­­µª³‡oµŠ (RU) œ°„‹µ„œ¸Ê
¥´ Š ¤¸ ¦ µ¥Šµœ„µ¦Äo ª´ — RU „´  Ÿo¼ ži ª ¥
µ—Á‹ÈÅ…­´œ®¨´Š(10) ªnµÅ—oŸ¨œnµÁºÉ°™º°
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- 38 -
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RU ŗo  ˜„˜n µ Š„´  ‡n µ š¸É Å —o ‹ µ„ª· ›¸ ­ ªœ
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0.90
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power = 0.8
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٬ intravenous pyelography (IVP),
voiding cystourethrography (VCUG),
ultrasound KUB system, urine analysis
(UA), urine culture
®¨´Š…´™nµ¥ž{­­µª³Â¨oª ª´—ž¦·¤µ–
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Ÿo¼š¶„µ¦ª·‹´¥ÄoÁ‡¦ºÉ°Š°´¨˜¦µŽµªœr¥¸É®o°
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„n°œš¸‹É ³—¹Š­µ¥­ªœ°°„¤µ
„µ¦ª´—‡nµ RU —oª¥Á‡¦º°É Š°´¨˜¦µŽµªœr
‹³š¶Ã—¥Ÿoš¼ ¶„µ¦ª·‹¥´ Á¡¸¥Š‡œÁ—¸¥ªŽ¹ŠÉ f„
čoÁ‡¦º°É Š°¥nµŠ¶œµ ×¥‡nµš¸‹É —´œš¹„
‹³Áž}œ‡nµš¸ªÉ —´ ×¥Áš‡œ·‡š¸ÂÉ ¤nœ¥¶š¸­É —» ¨³
ª´—Å—o‡µn ÁšnµÁ—·¤˜·—˜n°„´œ 3 ‡¦´ŠÊ
Outcome measurement
US1 = ‡nµž¦·¤µ– RU š¸ªÉ —´ ‡¦´ŠÊ ¦„
—oª¥Á‡¦º°É Š°´¨˜¦µŽµªœr
Cath1 = ‡nµž¦·¤µ– RU š¸ªÉ —´ ŗo‹µ„
„µ¦­ªœž{­­µª³®¨´Šª´— US1
US2 = ž¦·¤µ–ž{­­µª³‡oµŠš¸ªÉ —´ ŗo
‹µ„Á‡¦º°É Š°´¨˜¦µŽµªœrÁ¤º°É Ä­nœÊ¶
Á„¨º°Á…oµÅž 50 ¤¨.
US3 = ž¦·¤µ–ž{­­µª³‡oµŠš¸ªÉ —´ ŗo
‹µ„Á‡¦º°É Š°´¨˜¦µŽµªœrÁ¤º°É Ä­nœÊ¶
Á„¨º°Á…oµÅž°¸„ 50 ¤¨.
Cath2 = ž¦·¤µ–ž{­­µª³š¸­É ªœÅ—o
‡¦´ŠÊ ­»—šoµ¥®¨´Š‹µ„ª´— US3
Statistical analysis
­™·˜Á· ·Š¡¦¦–œµ ­¶®¦´…o°¤¼¨š´ªÉ Ş
…°ŠŸoÁ¼ …oµ¦´„µ¦«¹„¬µ
­™·˜Á· ·Šª·Á‡¦µ³®r
- Áž¦¸¥Áš¸¥ RU š¸ªÉ —´ ŗo‹µ„„µ¦
čo°¨´ ˜¦µŽµªœr ¨³„µ¦­ªœ
ž{­­µª³ ץčoª›· „¸ µ¦ž¦³Á¤·œ
clinical agreement ¦³®ªnµŠ
­°Šª·›¸ ˜µ¤ª·›…¸ °Š Bland and
Altman(11)
- ®µ‡nµ‡ªµ¤Åª (sensitivity) ¨³
‡ªµ¤‹¶Á¡µ³ (specificity) …°Š
Á‡¦º°É Š°´¨˜¦µŽµªœr×¥Áž¦¸¥
Áš¸¥‡nµ RU š¸ÁÉ ‡¦º°É Šª´—Å—o„´ ‡nµ
š¸ÅÉ —o‹µ„ª·›­¸ ªœž{­­µª³Ã—¥
Áž¦¸¥Áš¸¥š¸‹É ¶œªœ RU š¸É
¤µ„„ªnµ®¦º°Ášnµ„´ 100 ¤¨.
¨³œo°¥„ªnµ 100 ¤¨.
„µ¦«¹„¬µœ¸Êŗo¦´­œ´­œ»œš»œª·‹´¥
‹µ„ iµ¥ª·‹´¥‡–³Â¡š¥«µ­˜¦r ¤®µª·š¥µ¨´¥…°œÂ„nœ
Ÿ¨„µ¦«¹„¬µ
…o°¤¼¨š´ªÉ Ş
Ÿož¼ ªi ¥‹¶œªœ 31 ‡œ °µ¥»˜Š´Ê ˜n 2065 že (ÁŒ¨¸¥É 40.25 že) Áž}œµ¥ 21 ‡œ,
®·Š 10 ‡œ „µ¦ª·œ‹· Œ´¥Ã¦‡Â¨³¦³—´…°Š
¦°¥Ã¦‡Å…­´œ®¨´Š—´ŠÂ­—ŠÄœ˜µ¦µŠš¸É 1
Áž}œ¦°¥Ã¦‡š¸ÉŅ­´œ®¨´Šœ·—­¤¼¦–r 19
‡œ ¨³œ·—Ťn­¤¼¦–r 12 ‡œ
Ÿ¨„µ¦«¹ „ ¬µÁž¦¸ ¥ Áš¸ ¥ ¦³®ªn µ Š
„µ¦ª´— RU —oª¥„µ¦Äo°¨´ ˜¦µŽµªœr (US)
„´„µ¦­ªœž{­­µª³ (Cath)
Ÿ¨„µ¦ª´— RU —oª¥ª·›¸ US „´ Cath
—´Šœ¸Ê
US1 ¤¸‡µn ˜´ŠÊ ˜n 0-632 ¤¨. (ÁŒ¨¸¥É
214.87 ± 154.59 ¤¨.)
Cath1 ¤¸‡µn ˜´ŠÊ ˜n 15-480 ¤¨. (ÁŒ¨¸¥É
190.07 ± 116.01 ¤¨.)
US2 ¤¸‡µn ˜´ŠÊ ˜n 0-138 ¤¨. (ÁŒ¨¸¥É
45.419 ± 38.62 ¤¨.)
US3 ¤¸‡µn ˜´ŠÊ ˜n 8-207 ¤¨. (ÁŒ¨¸¥É
99.19 ± 46.74 ¤¨.)
Cath2 ¤¸‡µn ˜´ŠÊ ˜n 92-202 ¤¨. (ÁŒ¨¸¥É
129.10 ± 26.31 ¤¨.)
Á¤ºÉ°®µ‡ªµ¤­°—‡¨o°Š Bland and
Altman agreement plot ¡ªnµ¤¸ clinical agreement ¦³®ªnµŠ‡nµ US1 „´ Cath1
¨³ US3 „´ Cath2 ˜nŤn¤¸ agreement
¦³®ªnµŠ US2 „´ 50 ¤¨., US3 „´100 ¤¨.,
¨³ Cath2 „´ 100 ¤¨. —´Š¦¼žš¸É 2, 3, 4,
5, 6
„µ¦ª·œ‹· Œ´¥Ã¦‡
Spinal cord injury
18 ‡œ
C- spondylotic myelopathy 4 ‡œ
Transverse myelitis
4 ‡œ
Spinal cord tumor
4 ‡œ
TB- spondylitis with cord compression 1 ‡œ
¦³—´…°Š¦°¥Ã¦‡Å…­´œ®¨´Š
˜´ŠÊ ˜n C8 …¹œÊ Ş
T1 - T6
T7 -T12
˜´ŠÊ ˜n L1 ¨Š¤µ
9
7
11
4
‡œ
‡œ
‡œ
‡œ
˜µ¦µŠš¸É 1 ­—Š„µ¦ª·œ‹· Œ´¥Ã¦‡Â¨³¦³—´¦°¥Ã¦‡Å…­´œ®¨´Š…°ŠŸož¼ ªi ¥š¸ÁÉ …oµ¦´„µ¦«¹„¬µ 31 ‡œ
- 39 -
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2550; 17(2)
Difference (US2-50) (ml.)
Difference (US3- 100) (ml.)
Average vol. (ml.)
Average vol. (ml.)
¦¼žš¸É 2 ­—Š Bland and Altman agreement plot ¦³®ªnµŠ US1„´
Cath1Á¤º°É ‹¶„´—Ä®o¤‡¸ µn ‡ªµ¤˜nµŠ…°Š US1„´ Cath1‹µ„‡nµÁŒ¨¸¥É ŤnÁ„·œ ±
50 ¤¨. ¡ªnµ¤¸ 21 ‹µ„ 31 ‡n¼ (67.74%) š¸¤É ‡¸ ªµ¤˜nµŠ„´œÅ¤nÁ„·œ ± 50 ¤¨.
(95%CI = 51.25-84.23%)
¦žš¸É 5 ­—Š Bland and Altman agreement plot ¦³®ªnµŠ US3„´ 100
¤¨. Á¤º°É ‹¶„´—Ä®o¤‡¸ µn ‡ªµ¤˜nµŠ…°Š US3 „´ 100 ¤¨. ‹µ„‡nµÁŒ¨¸¥É ŤnÁ„·œ
± 20 ¤¨. (‡·—Áž}œ 20% …°Š 100 ¤¨.) ¡ªnµ¤¸Á¡¸¥Š 16 ‹µ„ 31 ‡n¼
(51.61%) š¸¤É ‡¸ ªµ¤˜nµŠ„´œÅ¤nÁ„·œ ± 20 ¤¨. (95%CI = 46.16-57.07%)
Difference (US3-Cath2) (ml.)
Difference (ml.)
Average vol. (ml.)
¦¼žš¸É 3 ­—Š Bland and Altman agreement plot ¦³®ªnµŠ US3 „´
Cath2Á¤º°É ‹¶„´—Ä®o¤‡¸ µn ‡ªµ¤˜nµŠ…°Š US3 „´ Cath2‹µ„‡nµÁŒ¨¸¥É ŤnÁ„·œ ± 50
¤¨. ¡ªnµ¤¸ 20 ‹µ„ 31 ‡n¼ (64.52%) š¸¤É ‡¸ ªµ¤˜nµŠ„´œÅ¤nÁ„·œ ± 50 ¤¨. (95%CI
= 47.67-81.36%)
Difference (US2-50) (ml.)
Average vol. (ml.)
¦¼žš¸É 4 ­—Š Bland and Altman agreement plot ¦³®ªnµŠ US2 „´ 50
¤¨.Á¤º°É ‹¶„´—Ä®o¤‡¸ µn ‡ªµ¤˜nµŠ…°Š US2 „´ 50 ¤¨.‹µ„‡nµÁŒ¨¸¥É ŤnÁ„·œ ± 10
¤¨. (‡·—Áž}œ 20% …°Š 50 ¤¨.) ¡ªnµ¤¸Á¡¸¥Š 11 ‹µ„ 31 ‡n¼ (35.48%)
š¸¤É ‡¸ ªµ¤˜nµŠ„´œÅ¤nÁ„·œ ± 10 ¤¨. (95%CI = 30.26-40.71%)
J Thai Rehabil Med 2007; 17(2)
- 40 -
Average vol. (ml.)
¦¼žš¸É 6 ­—Š Bland and Altman agreement plot ¦³®ªnµŠ Cath2„´
100 ¤¨.Á¤ºÉ ° ‹¶„´ — Ä®o ¤¸ ‡n µ ‡ªµ¤˜n µ Š…°Š Cath 2„´  100 ¤¨.‹µ„
meanŤnÁ„·œ ± 20 ¤¨. (‡·—Áž}œ 20% …°Š 100 ¤¨.) ¡ªnµ¤¸Á¡¸¥Š 13Ĝ
31 ‡n¼ (41.94%) š¸É¤¸‡ªµ¤˜nµŠ„´œÅ¤nÁ„·œ ± 20 ¤¨.(95%CI = 36.5547.32%)
Á¤ºÉ°œ¶‡nµž¦·¤µ–ž{­­µª³‡oµŠš¸Éª´—
ŗo‹µ„š´ŠÊ ­°Šª·›Á¸ ¡º°É ®µ‡ªµ¤ÅªÂ¨³‡ªµ¤
‹¶Á¡µ³ …°ŠÁ‡¦º°É Š°´¨˜¦µŽµªœrĜ„µ¦ª´—
‡nµ RU š¸É¤µ„„ªnµ®¦º°Ášnµ„´ 100 ¤¨.
Ž¹ŠÉ Áž}œ‡nµ¤µ˜¦“µœÂ¨³™º°ªnµ¤¸‡ªµ¤­¶‡´
ĜšµŠž’·´˜·Á¡¦µ³¤¸Ÿ¨˜n°„µ¦˜´—­·œÄ‹
­ªœž{­­µª³ —´Š˜µ¦µŠš¸É 2
Crosstabulation
Sensitivity
(95% CI)
Specificity
(95% CI)
PPV
(95% CI)
NPV
(95% CI)
US1 vs Cath1
US3 vs Cath2
(Á¤º°É „¦³Á¡µ³ž{­­µª³¤¸‡ªµ¤‹»‹¦·Š) (Á¤º°É „¦³Á¡µ³ž{­­µª³¤¸‡ªµ¤‹» 100 ¤¨.)
0.8888889
0.5172414
(0.7084131-0.9764725)
(0.325315-0.7055144)
1
0.5
(0.3976354-1)
(0.125791-0.874209)
1
0.9375
(0.8575264-1)
(0.6976793-0.9984189)
0.5714286
0.0666667
(0.1840516-0.9010117)
(0.0016864-0.3194846)
˜µ¦µŠš¸É 2 ­—Š ‡ªµ¤Åª (sensitivity) ¨³ ‡ªµ¤‹¶Á¡µ³ (specificity) …°ŠÁ‡¦º°É Š°´¨˜¦µŽµªœr
×¥Áž¦¸¥Áš¸¥‡nµ RU š¸ÉÁ‡¦ºÉ°Šª´—Å—o „´š¸Éŗo‹µ„ª·›¸­ªœž{­­µª³Ã—¥Áž¦¸¥Áš¸¥š¸É‹¶œªœ RU
š¸¤É µ„„ªnµ®¦º°Ášnµ„´ 100 ¤¨. ¨³š¸œÉ °o ¥„ªnµ 100 ¤¨. (PPV = Positive Predictive Value, NPV =
Negative Predictive Value)
šª·‹µ¦–r
„µ¦Äo portable ultrasound ­µ¤µ¦™
nª¥ž¦³Á¤·œŸož¼ ªi ¥ªnµ‹¶Áž}œ˜o°Š­ªœž{­­µª³
®¦º°Å¤n Á¡º°É ¨—‡ªµ¤Á­¸¥É Š‹µ„„µ¦µ—Á‹È
˜n°šn°ž{­­µª³Â¨³£µª³˜·—Áº°Ê ‹µ„„µ¦­ªœ
ž{ ­ ­µª³ Ž¹É Š ¤¸ …o ° —¸ ‡º ° Šn µ ¥Â¨³­³—ª„
Ťn˜o°Š°µ«´¥Ÿo¼Á¸É¥ªµÁŒ¡µ³Äœ„µ¦Äo
Á‡¦º°É Š(6) Ťn˜°o Š‹´—Á˜¦¸¥¤»—­ªœž{­­µª³
¨³Ÿo¼nª¥Ä®o¥n»Š¥µ„ °¸„š´ÊŠ¥´Šž¦³®¥´—
Áª¨µ„ªnµÁ¡¦µ³ÄoÁª¨µÄœ„µ¦˜¦ª‹ª´—˜n¨³
‡¦´ŠÊ Á¡¸¥ŠÅ¤nÁ„·œ 2 œµš¸Ášnµœ´œÊ
„µ¦«¹„¬µœ¸¡Ê ªnµ‡nµ RU š¸ªÉ —´ ŗo‹µ„
US ¨³ Cath ¤¸ ‡ ªµ¤­°—‡¨o ° Š„´ œ
š´ÊŠ‡nµš¸Éª´—„n°œÁ˜·¤œÊ¶Á„¨º°Â¨³®¨´Š‹µ„
Á˜·¤œÊ¶Á„¨º°Á…oµÅžÄœ„¦³Á¡µ³ž{­­µª³
˜n ‡n µ š¸É ª´ — ŗo œ´Ê œ ¤¸ ‡ ªµ¤‡¨µ—Á‡¨ºÉ ° œ
Á¤º°É ¤¸ž¦·¤µ˜¦Äœ„¦³Á¡µ³ž{­­µª³œo°¥„ªnµ
100 ¤¨.
­¶®¦´Ÿo¼žiª¥µ—Á‹ÈÅ…­´œ®¨´Šš¸É¤¸
ž{ ­ ­µª³‡o µ Š¤µ„Á„· œ „ªn µ 100 ¤¨. Ž¹É Š
‹´—„µ¦„´£µª³„¦³Á¡µ³ž{­­µª³¡·„µ¦Ã—¥
čoª·›¸„µ¦­ªœž{­­µª³Áž}œ‡¦´ÊŠ‡¦µªœ´Êœ
„µ¦Äo Á ‡¦ºÉ ° Š°´ ¨ ˜¦µŽµªœr Á ¡ºÉ ° ª´ — RU
°µ‹¤¸‡ªµ¤‹¶Áž}œœo°¥„ªnµ ÁœºÉ°Š‹µ„
Ÿož¼ ªi ¥‹³˜o°ŠÅ—o¦´ „µ¦­ªœž{­­µª³°¥n¼ ¨oª
¥„ÁªoœÄœ„¦–¸š˜¸É °o Š„µ¦‡ªµ¤¦ª—Á¦ÈªÄœ„µ¦
ž¦³Á¤·œ Ánœ š¸®É °o Š˜¦ª‹Ÿož¼ ªi ¥œ°„ ®¦º°
¡š¥rš˜¸É ¦ª‹Á¥¸¥É ¤Äœ®°Ÿož¼ ªi ¥Ž¹ŠÉ ¤Á̧ª¨µ‹¶„´—
…o°­´ŠÁ„˜…°ŠŸo¼š¶„µ¦«¹„¬µ¡ªnµ
„µ¦ª´—‡nµ US2 ®¨´Š‹µ„š¸ÄÉ ­nœÊ¶Á„¨º° 50
¤¨. ¨³‡nµ US3 Á¤º°É Ä­nœÊ¶Á„¨º°Á…oµÅžÄœ
„¦³Á¡µ³ž{ ­ ­µª³Á¡·É ¤ Áž} œ 100 ¤¨.
‹³¡‡ªµ¤‡¨µ—Á‡¨º°É œÅ—o¤µ„ ĜµŠ¦µ¥
Ťn­µ¤µ¦™˜¦ª‹¡ž¦·¤µ–ž{­­µª³Äœ
„¦³Á¡µ³ž{­­µª³Å—o ‹µ„„µ¦«¹„¬µ ¡¤¸
‡nµ US2 = 0 ¤¨. ‹¶œªœ 7 ¦µ¥ Ž¹ŠÉ Áž}œ
…o°‹¶„´—…°ŠÁ‡¦º°É Š¤º°œ¸ÄÊ œ„¦–¸š‹¸É ³œ¶¤µ
čoĜŸo¼žiª¥ž¦·¤µ–ž{­­µª³‡oµŠ‹¶œªœ
œo°¥‡º°Å¤nÁ„·œ 100 ¤¨. ×¥‹µ„„µ¦
«¹„¬µœ¸Ê‹³¡ªnµª´—‡nµ US3ŗoœo°¥„ªnµ
100 ¤¨. ‹¶œªœ 15 ¦µ¥ ‡¶œª– sensitivity …°ŠÁ‡¦ºÉ°Š°´¨˜¦µŽµªœrĜ„µ¦
˜¦ª‹­°ž¦·¤µ– RU š¸É¤µ„„ªnµ®¦º°
œo°¥„ªnµ 100 ¤¨. ŗoÁž}œ 52% Ž¹ŠÉ ‹³¤¸Ÿ¨
˜n ° „µ¦˜´ — ­· œ ċš¸É ‹ ³­ªœž{ ­ ­µª³Å—o
‹µ„„µ¦«¹„¬µ…°Š Revord ¨³‡–³Äœže
1993 ץčo Á ‡¦ºÉ ° Š°´ ¨ ˜¦µŽµªœr ¥¸É ®o °
Bladder Scan  ¦nœ» BVI 2000 ¡ªnµ
™oµÄoĜ„µ¦ª´—ž¦·¤µ–ž{­­µª³‡oµŠš¸É˜É¶
„ªnµ 100 ¤¨.‹³¤¸‡ªµ¤‡¨µ—Á‡¨ºÉ°œ­¼Š
˜n™µo œ¶¤µÄoª—´ ž¦·¤µ–ž{­­µª³‡oµŠ˜´ŠÊ ˜n
200 ¤¨. …¹œÊ Ş‹³¤¸‡ªµ¤Â¤nœ¥¶¤µ„…¹œÊ (3)
œ°„‹µ„œ¸Ê „µ¦š¸‡É µn Cath2 ¤µ„„ªnµ
100 ¤¨. ¤¸™Š¹ 28 ¦µ¥ °µ‹°›·µ¥Å—o‹µ„
„µ¦­ªœž{­­µª³°°„Ťn®¤—Äœ‡¦´ÊŠÂ¦„
¤o‹³Å¤n¤¸ž{­­µª³°°„¤µ˜µ¤­µ¥­ªœ
- 41 -
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ÁœºÉ°Š‹µ„¦³¥³®nµŠ…°ŠÁª¨µŸnµœÅžÁ¡¸¥Š
ŤnÁ„·œ 2 œµš¸Ášnµœ´œÊ ‹µ„š¸É Jansen AE
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°´¨˜¦µŽµªœr˜µ¤®¨´Š„µ¦­ªœž{­­µª³
Ÿož¼ ªi ¥µ—Á‹ÈÅ…­´œ®¨´Š ¡ªnµ¦o°¥¨³ 70
(25 ‡¦´ÊŠ Ĝ„µ¦­ªœž{­­µª³ 36 ‡¦´ÊŠ)
¤¸ ž{ ­ ­µª³Á®¨º ° ‡o µ Š¤µ„„ªn µ 50 ¤¨.
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°œ¹ŠÉ „µ¦­ªœž{­­µª³—oª¥ foley catheter
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RU ™¹Š 89% Ž¹ŠÉ ™º°ªnµÁº°É ™º°Å—o ÁnœÁ—¸¥ª
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®¦º°Ÿo¼š¸É¤¸ž¦·¤µ–ž{­­µª³‡oµŠœo°¥Ç ŗo
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Ťn  ¤n œ ¥¶ ‹¹ Š Ťn ­ µ¤µ¦™Äo „´  Ÿo¼ ži ª ¥
„¦³Á¡µ³ž{­­µª³¡·„µ¦Å—oš„» „¦–¸ ‡ª¦¤¸
„µ¦«¹„¬µÄœ°œµ‡˜ªnµ™oµœ¶Á‡¦º°É Š°´¨˜¦µŽµªœrœ·—¡„¡µœ¸¤Ê µÄoĜ„µ¦˜¦ª‹ª´—„¦–¸
ž{­­µª³‡oµŠž¦·¤µ–Ťn¤µ„ ‹³­µ¤µ¦™Äo
Áš‡œ· ‡ ¨³ª· ›¸ „ µ¦Ä—š¸É n ª ¥Ä®o ¤¸ ‡ ªµ¤
¤nœ¥¶Â¨³œnµÁº°É ™º°Å—oÁ¡·¤É ¤µ„…¹œÊ
Áª«µ­˜¦r¢œg ¢¼­µ¦ 2550; 17(2)
š­¦»ž
„µ¦ž¦³Á¤· œ ž¦· ¤ µ–ž{ ­ ­µª³‡o µ Š
—oª¥„µ¦­ªœž{­­µª³Â¨³—oª¥Á‡¦º°É Š°´¨˜¦µŽµªœr¡„¡µ˜nµŠ„Ȥ‡¸ ªµ¤‡¨µ—Á‡¨º°É œ
—oª¥„´œš´ŠÊ ‡n¼ ˜nšŠ´Ê ­°Šª·›¤¸ ­¸ °—‡¨o°Š„´œ
—´Šœ´œÊ ­µ¤µ¦™œ¶Á‡¦º°É Š°´¨˜¦µŽµªœr
¡„¡µ¥¸®É °o Bladder Scan ¦nœ» BVI 3000
¤µÄoª—´ ž¦·¤µ–ž{­­µª³‡oµŠš—šœª·›„¸ µ¦
­ªœž{­­µª³Å—o „´Ÿož¼ ªi ¥„¦³Á¡µ³ž{­­µª³
¡·„µ¦‹µ„¦°¥Ã¦‡Å…­´œ®¨´Š ×¥Á‡¦º°É Š¤¸
‡ªµ¤Â¤nœ¥¶¤µ„…¹ÊœÄœ„¦–¸š¸Éž{­­µª³
‡oµŠž¦·¤µ–¤µ„„ªnµ 100 ¤¨.
Á°„­µ¦°oµŠ°·Š
1. Ireton RC, Krieger JN, Cardenas DD,
Williams BB, Kelly E, Souci T, et al.
Bladder volume determination using a
dedicated, portable ultrasound scanner.
J Urol 1990; 143: 909-11.
2. Coombes GM, Millard RJ. The accuracy
of portable ultrasound scanning in the
measurement of residual urine volume.
J Urol 1994; 152: 2083-85.
J Thai Rehabil Med 2007; 17(2)
3. Revord JP, Opitz JL, Murtaugh P,
Harrison J. Determining residual urine
volumes using a portable ultrasonographic device. Arch Phys Med Rehabil
1993; 74: 457-63.
4. Stoller ML, Millard RJ. The accuracy of
a catheterized residual urine. J Urol
1989; 141: 15-6.
5. Cardenas DD, Kelly E, Krieger JN,
Chapman WH. Residual urine volumes
in patients with spinal cord injury:
Measurement with a portable ultrasound
instrument. Arch Phys Med Rehabil
1988; 69: 514-46.
6. Massagli TL. Cardenas DD, Kelly EW.
Experience with portable ultrasound
equipment and measurement of urine
volumes: Inter-user reliability and factors
of patient position. J Urol 1989; 142: 96971.
7. Araki Y, Ishibashi N. Effectiveness of the
portable ultrasound bladder scanner in
the measurement of residual urine
volume after total mesorectal extirpation.
Taylor & Francis Health Sciences 2003;
12: 245-8.
- 42 -
8. Gyampoh B, Crouch N. Intrapartum
ultrasound estimation of total bladder
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