中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2015年
10期
779-784
,共6页
石秀秀%秦江%胡鸢%唐金树%张铁松%王晓晶%原艳丽%郭继东%侯树勋
石秀秀%秦江%鬍鳶%唐金樹%張鐵鬆%王曉晶%原豔麗%郭繼東%侯樹勛
석수수%진강%호연%당금수%장철송%왕효정%원염려%곽계동%후수훈
脊髓损伤%膀胱,神经原性%设备和供应%康复
脊髓損傷%膀胱,神經原性%設備和供應%康複
척수손상%방광,신경원성%설비화공응%강복
Spinal cord injuries%Urinary bladder,neurogenic%Equipment and Supplies%Rehabilitation
目的:评价我院自行研制的膀胱安全测定装置在诊治脊髓损伤后神经源性膀胱患者的应用。方法2012年1月至2014年1月,我院共收治40例脊髓损伤后神经源性膀胱患者,其中男28例,女12例;年龄22~65岁,平均(37.52±8.67)岁。所有患者入院后经实验室及生化检查排除上尿路积水、尿路感染及结石等并发症,使用膀胱安全测定装置检查后,给予分型,依据分型结果给予个体化口服药物对症治疗;再行间歇导尿配合行为疗法、扳机点叩击排尿法,并做好排尿日记。在治疗结束后从导尿至首次反射排尿用时、平衡膀胱建立的时间、生化及影像学检查等方面对患者进行功能评价,对资料进行整理分析。结果40例入院即给予膀胱安全测定装置检查,将神经源性膀胱分型,I 型(逼尿肌过度活跃伴括约肌过度活跃)5例,II 型(逼尿肌活动不足伴括约肌活动不足)16例,III 型(逼尿肌活动不足伴括约肌过度活跃)14例, IV 型(逼尿肌过度活跃伴括约肌活动不足)5例,不同的分型采用不同的膀胱康复方案。造瘘术后2例中1例建立反射性排尿,2例可自主排尿但排尿困难者排尿较治疗前明显改善,其余36例均将留置尿管拔除,采用间歇导尿,且均建立反射性膀胱,达到有效排尿,至统计时30例每天导尿残余尿量均<80 ml,不行间歇导尿。患者从导尿至首次反射排尿用时(4.20±7.08)天,平衡膀胱建立用时(32.12±21.19)天,残余尿仍>100 ml 或>最大膀胱容量20%的患者共6例,有效建立平衡膀胱率85%。在评价菌尿的指标中,WBC 及 BAC 检出率均明显降低,分别由治疗前81.80%、90.90%降低到治疗结束时的36.37%、18.18%,且差异均有统计学意义(P<0.05);而尿路出血指标 RBC 检出率及 B 超显示上尿路积水情况治疗前、治疗结束时的变化都不明显,差异均无统计学意义( P>0.05)。结论膀胱安全测定装置能有效将膀胱分型,从而制订个性化膀胱管理方案,使患者日常生活能力提高。对有效排尿、减少残余尿、减少尿路感染具有积极作用。
目的:評價我院自行研製的膀胱安全測定裝置在診治脊髓損傷後神經源性膀胱患者的應用。方法2012年1月至2014年1月,我院共收治40例脊髓損傷後神經源性膀胱患者,其中男28例,女12例;年齡22~65歲,平均(37.52±8.67)歲。所有患者入院後經實驗室及生化檢查排除上尿路積水、尿路感染及結石等併髮癥,使用膀胱安全測定裝置檢查後,給予分型,依據分型結果給予箇體化口服藥物對癥治療;再行間歇導尿配閤行為療法、扳機點叩擊排尿法,併做好排尿日記。在治療結束後從導尿至首次反射排尿用時、平衡膀胱建立的時間、生化及影像學檢查等方麵對患者進行功能評價,對資料進行整理分析。結果40例入院即給予膀胱安全測定裝置檢查,將神經源性膀胱分型,I 型(逼尿肌過度活躍伴括約肌過度活躍)5例,II 型(逼尿肌活動不足伴括約肌活動不足)16例,III 型(逼尿肌活動不足伴括約肌過度活躍)14例, IV 型(逼尿肌過度活躍伴括約肌活動不足)5例,不同的分型採用不同的膀胱康複方案。造瘺術後2例中1例建立反射性排尿,2例可自主排尿但排尿睏難者排尿較治療前明顯改善,其餘36例均將留置尿管拔除,採用間歇導尿,且均建立反射性膀胱,達到有效排尿,至統計時30例每天導尿殘餘尿量均<80 ml,不行間歇導尿。患者從導尿至首次反射排尿用時(4.20±7.08)天,平衡膀胱建立用時(32.12±21.19)天,殘餘尿仍>100 ml 或>最大膀胱容量20%的患者共6例,有效建立平衡膀胱率85%。在評價菌尿的指標中,WBC 及 BAC 檢齣率均明顯降低,分彆由治療前81.80%、90.90%降低到治療結束時的36.37%、18.18%,且差異均有統計學意義(P<0.05);而尿路齣血指標 RBC 檢齣率及 B 超顯示上尿路積水情況治療前、治療結束時的變化都不明顯,差異均無統計學意義( P>0.05)。結論膀胱安全測定裝置能有效將膀胱分型,從而製訂箇性化膀胱管理方案,使患者日常生活能力提高。對有效排尿、減少殘餘尿、減少尿路感染具有積極作用。
목적:평개아원자행연제적방광안전측정장치재진치척수손상후신경원성방광환자적응용。방법2012년1월지2014년1월,아원공수치40례척수손상후신경원성방광환자,기중남28례,녀12례;년령22~65세,평균(37.52±8.67)세。소유환자입원후경실험실급생화검사배제상뇨로적수、뇨로감염급결석등병발증,사용방광안전측정장치검사후,급여분형,의거분형결과급여개체화구복약물대증치료;재행간헐도뇨배합행위요법、반궤점고격배뇨법,병주호배뇨일기。재치료결속후종도뇨지수차반사배뇨용시、평형방광건립적시간、생화급영상학검사등방면대환자진행공능평개,대자료진행정리분석。결과40례입원즉급여방광안전측정장치검사,장신경원성방광분형,I 형(핍뇨기과도활약반괄약기과도활약)5례,II 형(핍뇨기활동불족반괄약기활동불족)16례,III 형(핍뇨기활동불족반괄약기과도활약)14례, IV 형(핍뇨기과도활약반괄약기활동불족)5례,불동적분형채용불동적방광강복방안。조루술후2례중1례건립반사성배뇨,2례가자주배뇨단배뇨곤난자배뇨교치료전명현개선,기여36례균장류치뇨관발제,채용간헐도뇨,차균건립반사성방광,체도유효배뇨,지통계시30례매천도뇨잔여뇨량균<80 ml,불행간헐도뇨。환자종도뇨지수차반사배뇨용시(4.20±7.08)천,평형방광건립용시(32.12±21.19)천,잔여뇨잉>100 ml 혹>최대방광용량20%적환자공6례,유효건립평형방광솔85%。재평개균뇨적지표중,WBC 급 BAC 검출솔균명현강저,분별유치료전81.80%、90.90%강저도치료결속시적36.37%、18.18%,차차이균유통계학의의(P<0.05);이뇨로출혈지표 RBC 검출솔급 B 초현시상뇨로적수정황치료전、치료결속시적변화도불명현,차이균무통계학의의( P>0.05)。결론방광안전측정장치능유효장방광분형,종이제정개성화방광관리방안,사환자일상생활능력제고。대유효배뇨、감소잔여뇨、감소뇨로감염구유적겁작용。
Objective To summarize the experience in the diagnosis and treatment of 40 cases with neurogenic bladder after spinal cord injury by bladder safety measuring device developed in our hospital.Methods A retrospective analysis of the clinical diagnosis and treatment of 40 cases of neurogenic bladder after spinal cord injury from January 2012 to January 2014 in our hospital were conducted. There were 28 males and 12 females. The mean age was ( 37.52±8.67 ) years old ( range: 22-65 years ). Complications such as upper urinary hydrops, urinary tract infections and calculi were excluded by laboratory and biochemical examinations, and then bladder safety measuring device was performed. Patients were classiifed. Individual oral drugs for the symptomatic treatment were given on the basis of the classiifcation results. Intermittent catheterization combined with behavior therapy, triggering toilet were carried out, and a voiding diary was recorded. At the end of the treatment, patients were evaluated in respects of the time of establishing a balanced bladder, ratio of voiding and residual urine volume, biochemical examination and imaging examination to analyze the collected data.Results Forty cases received safety measuring device check when admitted. Neurogenic bladder type: 5 cases were of type I ( detrusor overactivity associated with sphincter overactivity ),16 cases of type II ( detrusor activity insufifciency with sphincter inactivity ), 14 cases of type III ( detrusor activity not foot with sphincter overactivity ), 5 cases of type IV ( detrusor overactivity, insufifcient with sphincter activity ), different types of bladder with different rehabilitation program. In 2 cases of ifstulas, 1 case established relfex micturition, 2 cases of autonomous urination associated with dysuria dififculty in micturition were signiifcantly improved. Thirty-six cases underwent indwelling catheter extraction and intermittent catheterization. Relfex bladder was established with effectively voiding. Daily catheterization residual urine of 30 patients was less than 80 ml, without intermittent catheterization. The ifrst effective micturition: ( 4.20±7.08 ) days after catheterization. Balanced bladder establishing time: ( 32.12±21.19 ) days. Six cases: residual urine >100 ml or >20% of maximum cystometric capacity. The effective rate in the reconstruction of a balanced bladder was 85%. The detection rates of bacteriuria indicators of white blood cell ( WBC ) and bacteria ( BAC ) were obviously reduced from 81.80% and 90.90% before the treatment to 36.37%and 18.18% at the end of the treatment with statistical signiifcance (P<0.05 ). Based on the detection rates of urinary tract bleeding index of red blood cell ( RBC ) and B ultrasound images, no obvious changes in the hydronephrosis were detected pre-treatment and post-treatment without statistical signiifcance (P>0.05 ).Conclusions Bladder safety measuring device can effectively classify bladder types so as to formulate individualized bladder management scheme, and to improve the daily living ability of patients. Effective urination, reduction of residual urine and urinary tract infection can be achieved.