医药前沿
醫藥前沿
의약전연
YIAYAO QIANYAN
2014年
22期
110-111,112
,共3页
脊髓损伤%上尿路功能%排尿方式%神经源性膀胱
脊髓損傷%上尿路功能%排尿方式%神經源性膀胱
척수손상%상뇨로공능%배뇨방식%신경원성방광
Spinal cord injury%Upper urinary tract function%Bladder management%Neurogenic bladder dysfunction
目的：对比研究不同排尿方式对脊髓损伤患者上尿路功能的影响。方法2009～2011年对112例脊髓损伤患者平均随访24个月，将排尿方式分为四组，对比分析耻骨上膀胱造瘘、经尿道留置尿管、清洁间歇导尿、自主排尿（包括腹压排尿、漏尿和可控排尿）这四种排尿方式对上尿路功能的影响。以血清肌酐值代表肾功能，泌尿系B超、CT或MRI评估上尿路形态。结果耻骨上膀胱造瘘、经尿道留置尿管、清洁间歇导尿、自主排尿（包括腹压排尿、漏尿和可控排尿）上尿路损害的发生率分别为87.5%(7/8)、78.9%(15/19)、20%(10/50)和65.7%(23/35)，（P＜0.001)，膀胱造瘘组出现上尿路损害事件最多，清洁间歇导尿组最少。将排尿方式分为无尿管组（自主排尿+清洁间歇导尿）和留置尿管组（经尿道留置尿管+膀胱造瘘）进行两两比较，后者上尿路损害率显著高于前者（分别为38.3%和81.5%，P＜0.001）。结论长期留置尿管和耻骨上膀胱造瘘可损害脊髓损伤患者的正常上尿路功能，清洁间歇导尿是理想的保护上尿路功能的排尿方式。
目的：對比研究不同排尿方式對脊髓損傷患者上尿路功能的影響。方法2009～2011年對112例脊髓損傷患者平均隨訪24箇月，將排尿方式分為四組，對比分析恥骨上膀胱造瘺、經尿道留置尿管、清潔間歇導尿、自主排尿（包括腹壓排尿、漏尿和可控排尿）這四種排尿方式對上尿路功能的影響。以血清肌酐值代錶腎功能，泌尿繫B超、CT或MRI評估上尿路形態。結果恥骨上膀胱造瘺、經尿道留置尿管、清潔間歇導尿、自主排尿（包括腹壓排尿、漏尿和可控排尿）上尿路損害的髮生率分彆為87.5%(7/8)、78.9%(15/19)、20%(10/50)和65.7%(23/35)，（P＜0.001)，膀胱造瘺組齣現上尿路損害事件最多，清潔間歇導尿組最少。將排尿方式分為無尿管組（自主排尿+清潔間歇導尿）和留置尿管組（經尿道留置尿管+膀胱造瘺）進行兩兩比較，後者上尿路損害率顯著高于前者（分彆為38.3%和81.5%，P＜0.001）。結論長期留置尿管和恥骨上膀胱造瘺可損害脊髓損傷患者的正常上尿路功能，清潔間歇導尿是理想的保護上尿路功能的排尿方式。
목적：대비연구불동배뇨방식대척수손상환자상뇨로공능적영향。방법2009～2011년대112례척수손상환자평균수방24개월，장배뇨방식분위사조，대비분석치골상방광조루、경뇨도류치뇨관、청길간헐도뇨、자주배뇨（포괄복압배뇨、루뇨화가공배뇨）저사충배뇨방식대상뇨로공능적영향。이혈청기항치대표신공능，비뇨계B초、CT혹MRI평고상뇨로형태。결과치골상방광조루、경뇨도류치뇨관、청길간헐도뇨、자주배뇨（포괄복압배뇨、루뇨화가공배뇨）상뇨로손해적발생솔분별위87.5%(7/8)、78.9%(15/19)、20%(10/50)화65.7%(23/35)，（P＜0.001)，방광조루조출현상뇨로손해사건최다，청길간헐도뇨조최소。장배뇨방식분위무뇨관조（자주배뇨+청길간헐도뇨）화류치뇨관조（경뇨도류치뇨관+방광조루）진행량량비교，후자상뇨로손해솔현저고우전자（분별위38.3%화81.5%，P＜0.001）。결론장기류치뇨관화치골상방광조루가손해척수손상환자적정상상뇨로공능，청길간헐도뇨시이상적보호상뇨로공능적배뇨방식。
Objective To investigate the influence between different bladder management and upper urinary tract function in patients after spinal cord injury. MethodsFrom 2009 to2011 reviewed the medical records and upper tract imaging studies of 112 patients with a mean folow up of 24 months. Bladder management method were divided into four group, and the effects of suprapubic Foley catheterization, indweling urethral catheterization, clean intermittent catheterization, spontaneous voiding group on upper urinary function were compared. Total renal function was assessed by serum creatinine. Upper urinary tract abnormalities were evaluated by renal ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI). Results The mean folow-up length was 24 months (from 6 to 36 months), The frequency of Upper tract abnormalities in the suprapubic Foley catheterization, indweling urethral catheterization, clean intermittent catheterization, spontaneous voiding group was 87.5%(7/8),78.9%(15/19),20%(10/50) and 65.7%(23/35)(p<0.001),respectively. The largest amount of upper urinary deterioration happened in the suprapubic Foley catheterization and the least in clean intermittent catheterization. When dividing bladder management methods into two groups, catheter-free (spontaneous and intermittent voiding) and indweling catheter (urethral and suprapubic catheterization), there were upper urinary tract dysfunction in 33(38.3%) and 22(81.5%), respectively (p<0.001).ConclusionsChronic indweling urethral catheterization and suprapubic Foley catheterization may damage to upper urinary tract. Clean intermittent catheterization was considered as the ideal bladder management for the protection of upper urinary function.
