CAJ | 학술논문

目的：观察膀胱水扩张结合视觉反馈排尿训练用于脊髓损伤后神经源性膀胱的疗效。方法2011年1月至2013年1月，我院收治脊髓损伤的神经源性小容量低顺应性膀胱患者15例。其中男10例，女5例，年龄32(18～64)岁。初期采用膀胱水扩张方法，在膀胱安全压力(＜40 cm H2O )监测下，逐渐将小膀胱扩张到有效膀胱容量后开始视觉反馈排尿训练。膀胱水扩张前后，视觉反馈排尿训练后，均记录膀胱安全容量、基础和最高膀胱内压、自主排尿量、残余尿量、排尿时程等数据，并行泌尿系B 超及简易尿流动力学检查。结果经过2～12周膀胱水扩张训练后，除1例损伤时间较长外，其余患者膀胱均达到有效安全容量≥300 ml。经过2～6周视觉反馈排尿训练，无自主排尿者(12例)均建立反射排尿，且残余尿＜80 ml。平均最大膀胱压力：水扩张前、后变化不明显( P＞0.05)；视觉反馈训练后有明显改善为(65.24±16.37)，与水扩张后(43.12±18.64)( cm H2O )相比，差异有统计学意义( P＜0.05)。所有患者平均日排尿次数治疗后(9.67±4.25)明显小于治疗前(17.5±5.64)，且平均单次排尿量治疗后(160.50±25.31) ml明显多于治疗前(70.25±23.18) ml，差异有统计学意义( P＜0.05)。所有漏尿频繁者的尿失禁次数，治疗后(5.36±3.21)明显小于治疗前(12.73±3.74)次，差异有统计学意义(P＜0.05)。结论膀胱水扩张可以有效将脊髓损伤后该类型膀胱小容量低顺应性膀胱功能改善，达到一定储尿功能；后期视觉反馈排尿训练，可以有效提高膀胱容量，增加顺应性，为膀胱功能的恢复创造良好的条件，为后期患者有效排尿提供基础。
목적：관찰방광수확장결합시각반궤배뇨훈련용우척수손상후신경원성방광적료효。방법2011년1월지2013년1월，아원수치척수손상적신경원성소용량저순응성방광환자15례。기중남10례，녀5례，년령32(18～64)세。초기채용방광수확장방법，재방광안전압력(＜40 cm H2O )감측하，축점장소방광확장도유효방광용량후개시시각반궤배뇨훈련。방광수확장전후，시각반궤배뇨훈련후，균기록방광안전용량、기출화최고방광내압、자주배뇨량、잔여뇨량、배뇨시정등수거，병행비뇨계B 초급간역뇨류동역학검사。결과경과2～12주방광수확장훈련후，제1례손상시간교장외，기여환자방광균체도유효안전용량≥300 ml。경과2～6주시각반궤배뇨훈련，무자주배뇨자(12례)균건립반사배뇨，차잔여뇨＜80 ml。평균최대방광압력：수확장전、후변화불명현( P＞0.05)；시각반궤훈련후유명현개선위(65.24±16.37)，여수확장후(43.12±18.64)( cm H2O )상비，차이유통계학의의( P＜0.05)。소유환자평균일배뇨차수치료후(9.67±4.25)명현소우치료전(17.5±5.64)，차평균단차배뇨량치료후(160.50±25.31) ml명현다우치료전(70.25±23.18) ml，차이유통계학의의( P＜0.05)。소유루뇨빈번자적뇨실금차수，치료후(5.36±3.21)명현소우치료전(12.73±3.74)차，차이유통계학의의(P＜0.05)。결론방광수확장가이유효장척수손상후해류형방광소용량저순응성방광공능개선，체도일정저뇨공능；후기시각반궤배뇨훈련，가이유효제고방광용량，증가순응성，위방광공능적회복창조량호적조건，위후기환자유효배뇨제공기출。
Objective To observe the hyaluronate irrigation combined with visual feed back in the treatment of neurogenic bladder after spinal cord injury ( SCI ).Methods Fifteen patients who suffered from neurogenic bladder following SCI were involved in this study. Early hyaluronate irrigation was used in the bladder under safety pressure ( < 40 cm H2O ). Under supervision, visual feedback urination training began when the small bladder gradually expanded up to effective capacity. Before and after the hyaluronate irrigation, safe bladder capacity, urine output, urine residue, micturition time history, etc were recorded after the visual feedback training.Results After 2 to 12 week’s hyaluronate irrigation training, except for 1 case of with longer time of damage, all the rest patients’ safe bladder capacity were more than 300 ml. After 2 to 6 weeks’ visual feedback training, urinary relfex was established in patients without automatic micturition relfex ( 12 cases ). The residual urine was less than 80 ml. The average time of urinating each day was 9.67±4.25 after the treatment, which was obviously lower than 17.5±5.64 before the treatment. The average urination volume each time was ( 160.50±25.31 ) ml after the treatment, which was obviously more than ( 70.25±23.18 ) ml before the treatment, with statistically signiifcant differences between them (P<0.05 ). The average time of urinary incontinence was 5.36±3.21 before the treatment in the patients with frequent urine leakage, which was obviously lower than 12.73±3.74 before the treatment, with statistically significant differences between them (P<0.05 ).Conclusions Hyaluronate irrigation can effectively improve the bladder functions of small capacity and low compliance, reaching a certain urinary storage function. Combined with later visual feedback bladder training,the bladder after spinal cord injury can effectively increases the capacity and decrease the compliance, creating good conditions for the recovery of bladder functions and providing the basis for patients with late effective micturition.