CAJ | 학술논문

目的回顾性分析我院神经源性膀胱患儿经间歇性清洁导尿(CIC)治疗和长期随访的临床资料,总结这一方法的治疗效果.方法 2001年1月至2006年5月共治疗57例.男38例,女19例,年龄3个月至17岁.反复尿路感染病例35例,尿失禁45例.上尿路扩张积水SFU分级3～4级38侧,0～2级39侧.尿动力检查逼尿肌无收缩或功能低下12例,逼尿肌过度活动10例,括约肌关闭功能不全39例.逼尿肌括约肌不协调或括约肌过度活动20例.结果 57例中36例获长期随访.完全采用CIC排尿27例,采用crede动作辅助排尿4例.两者均有5例.导尿2～3次2例,4～6次25例.6次以上5例.每次尿量80～400 ml.36例患儿中31例治疗前有反复发热性尿路感染,导尿后21例有菌尿,8例出现发热性尿路感染.治疗前尿失禁Likert评分平均为2.25,治疗后为4.04,t检验差别有统计意义.治疗前SFU分级2级以下为30侧,3级以上为42侧,治疗后2级以下40侧,3级以上32侧.卡方检验差别有统计学意义.结论CIC在神经源性膀胱的治疗中有重要意义,它对控制尿路感染.缓解尿失禁,改善上尿路扩张积水都有明显效果.
목적 회고성분석아원신경원성방광환인경간헐성청길도뇨(CIC)치료화장기수방적림상자료,총결저일방법 적치료효과.방법 2001년1월지2006년5월공치료57례.남38례,녀19례,년령3개월지17세.반복뇨로감염병례35례,뇨실금45례.상뇨로확장적수SFU분급3～4급38측,0～2급39측.뇨동력검사핍뇨기무수축혹공능저하12례,핍뇨기과도활동10례,괄약기관폐공능불전39례.핍뇨기괄약기불협조혹괄약기과도활동20례.결과 57례중36례획장기수방.완전채용CIC배뇨27례,채용crede동작보조배뇨4례.량자균유5례.도뇨2～3차2례,4～6차25례.6차이상5례.매차뇨량80～400 ml.36례환인중31례치료전유반복발열성뇨로감염,도뇨후21례유균뇨,8례출현발열성뇨로감염.치료전뇨실금Likert평분평균위2.25,치료후위4.04,t검험차별유통계의의.치료전SFU분급2급이하위30측,3급이상위42측,치료후2급이하40측,3급이상32측.잡방검험차별유통계학의의.결론CIC재신경원성방광적치료중유중요의의,타대공제뇨로감염.완해뇨실금,개선상뇨로확장적수도유명현효과.
Objective To retrospectively study the treatment of neuropathic bladder with clean intermittent catheterization (CIC). Methods From Jan. 2001 to May. 2006, 57ases were recruited in this research, including 38 males and 19 females, aged from 3mo to 17yr. Thirtyfive of the patients had repetitive urinary tract infection(UTI), and 45 patients had urinary incontinence. Hydronephrosis was evaluated using the Society of Fetal Urology (SFU) grading based on the long-axis sonographic appearance of the renal parenchyma and pelvicalyceal system. Thirty-eight kidneys had SFU grade 3 to 4hydronephrosis, and 39 had 0 to 2. Urodynamic study revealed hypocontractile bladder in 12 cases, hyper-reflexive bladder in 10 cases, sphincter function failure in 10 cases and dyssynergia in 20 cases. Results Thirty-six of the patients had been followed up for a long term. Out of the 36 patients, 27 patients underwent CIC, 5 patients underwent CIC combined with crede maneuver, the other 4 patients just underwent crede maneuver. CIC was performed 2-3 times daily on 2 patients, 4-6 times daily on 25 patients and more than 6 times daily on 5 patients. The volume of expelled urine was 80-400 ml. Thirty-one patients had repetitive UTI before treatment. Mter CIC treatment, 25 had bacteriuria, and only 8 had episode of febrile UTI For urinary incontinence, Likert score was 2. 25 before treatment, and was significantly improved comparing with 4. 04 of post-treatment score. For hydronephrosis, 30 kidneys were degraded as SFU stage 2, and 42 kidneys were SFU stage 3 or 4 before treatment. After CIC treatment, 40 were below stage 2 and 32 were above stage 3. There was significant difference between the two groups. Conclusions CIC is an important modality for neuropathic bladder. It is effective in controlling UTI and improving incontinence.