尿动力学检查中的常见问题和影响因素

尿动力学检查越来越多地应用于临床，为临床诊断、制订治疗方案和客观评估疾病转归提供客观依据。研究发现，临床尿动力学检查结果受多个因素影响，如精神因素、环境因素、尿管因素，以及体位、逼尿肌收缩力、尿道阻力、尿量、操作技术问题等。作者对2008年6月至2009年10月189例患者进行尿动力学检查中发现的问题和影响因素进行分析，报告如下。     

液体和气体尿动力学测压导管的比较

尿动力学检查可以再现患者的下尿路症状并且能客观解释患者的膀胱问题。目前,临床最常用的尿动力学测压导管是液体传导导管,由于经济、卫生等优点,受到广泛认可。然而,液体传导导管中气泡及患者活动会影响信号传导质量。气体传导导管操作简便易行,测量值不受气泡和患者活动的影响,已逐渐在某些地区开始用于尿动力学测压。气体传导系统与液体传导系统在很多方面存在差别,在流体力学原理、调零方法和操作细节等方面的差异直接或间接影响测压结果。国内外对气体传导系统的研究还不完善。本文综述国内外研究现状,从基本构造、发展沿革、零压力点设置、频率响应、膀胱测压、尿道压力描记、压力值转换算法和检查后的感染发生率等方面进行分析。     

非完全同步影像尿流动力学检查的配合与护理

影像尿动力学检查是用于检查复杂膀胱尿道功能障碍、下尿路梗阻及压力性尿失禁的主要技术。它将膀胱、尿道的解剖形态通过透视、拍片记录下来，与尿动力学检查记录的膀胱内压力变化有机地结合在一起，能更准确形象地反映患者下尿路的功能状态。由于该检查技术条件要求高，而影响检查结果的因素又很多，如尿量、性别、年龄、体位、尿管及各器械物品的插入与连接等正确与否、测定环境和心理等，因此检查是否能顺利进行以及检查结果是否满意，做好检查前、中、后的配合与护理是关键。我院自2005年3月-2008年11月共行450例非完全同步影像尿动力学检查，现将检查时的护理配合体会总结如下。     

尿动力检查316例护理配合

近年来,我院利用流体力学原理和电生理学方法对316例泌尿外科患者行尿动力学检查,经充分的检查前准备和熟练正确的操作配合,效果满意。现将护理配合报告如下。1资料与方法1.1临床资料本组316例,男264例,女52例,14~83岁。单纯行自由尿流率测定21例,进行尿动力学联合检查295例。1.2检查方法使用尿动力学检查仪和专用尿动力学检查导管、生理盐水。单纯行自由尿率测定者,嘱患者憋尿,达最大膀胱容量时尽全力将尿全部排于集尿器,测定单位时间内经尿道排出尿量等多项尿流率指标。进行尿动力学联合检查者,亦嘱患者憋尿,达到最大膀胱容量时尽全力排尿…     

应用SMART原则培训护士床旁漂浮导管检查配合技能

漂浮导管检查是通过尖端带有气囊的四腔或六腔SWAN-GANZ导管,由颈静脉或锁骨下静脉穿刺,依次进入右心房、右心室、肺动脉测量患者血流动力学指标的检查方法.通过这些参数医生可以了解患者的心肺功能状况,也可以帮助鉴别诊断和选择心血管药物及干预措施.以往漂浮导管检查主要用于抢救监测危重患者,如心肌梗死、心力衰竭(心衰)、严重创伤、各类休克等,所以大部分操作在导管室和监护室进行.但随着漂浮导管技术的成熟,临床医生对漂浮导管作用的认同和接受,它已经被视为心排血量及其他血流动力学参数监测的"金标准"[1].一些心衰的患者需要通过漂浮导管检查选择用药、判断疗效.心脏移植术前的患者也需要通过漂浮导管检查判断适应证.所以越来越多的患者在普通病房床旁接受漂浮导管的检查.但是对于心内科病房的护士来说,如何配合漂浮导管的置入操作,如何测量各项参数,如何安全的护理导管就成为迫切需要学习的问题.监护室床护配比相对病房充足,护士培训可以采用一带一的学徒式方法.     

尿动力学中心护理工作的实施

尿动力学检查是下尿路功能障碍诊断的标准方法,因其为功能性检查,检查结果受到多种因素的影响。加强尿动力学中心护理工作、改善检查环境、保护患者隐私、积极健康教育和正确引导,从多方面对患者进行心理护理,有助于提高尿动力学检查结果的准确性和可重复性,并可促进尿动力学中心发展。     

女性盆底肌肉松弛的尿动力学特点及其检查的护理体会

目的 探讨女性盆底肌肉松弛致压力性尿失禁(stress urinary incontinence,SUI)的尿动力学特点,总结SUI尿动力学检查的护理方法.方法 对33例女性盆底功能障碍致SUI患者(病例组)及33例正常女性(对照组)进行尿动力学检查,包括腹压漏尿点压(abdominal leak point pressure,ALPP)、最大尿道关闭压(maximum urethral closure pressure,MUCP)、功能尿道长度(fuctional urethral length,FUL),检查过程中加强护理干预.结果 (1)在尿动力学检查过程中许多因素可影响结果的准确性,分析影响因素并加强护理干预,可提高检查结果的准确性;(2)病例组的ALPP、MUCP及FUL检测值与对照组差异有统计学意义(P＜0.05).结论 (1)SUI患者同时存在尿道关闭压减弱和尿道功能长度减少的情况;(2)尿动力检查的操作者应具备熟练的操作技术,护理人员在检查前、检查中做好患者心理护理和配合指导,才能获得可靠的检查结果.     

尿动力学检查的临床操作体会

尿动力学是泌尿外科中的新兴学科 ,尿动力学检查像心电图、脑电图一样是以高科技为基础的研究器官功能的一种检测方法。尿动力学检查的主要目的是将病人下尿路症状的主诉用图像和数字表现出来 ,对病人的痛苦提供病理生理的解释[1] 。我院于 1995年组建尿动力学研究室 ,截至目前为止 ,已经进行了 2 5 0 0多例的临床检查。现就尿动力学检查的临床操作体会总结如下。1　尿道插管的麻醉女性尿道短、直 ,不需要局部麻醉 ,但应当将导管适当润滑 ,以免使病人感到不适。有少数女病人的尿道非常敏感 ,这种病人应采用局部麻醉 ,否则会出现膀胱刺激症状…     

CT增强检查中碘对比剂外渗的原因分析及护理对策

分析45例CT增强检查中碘对比剂外渗的原因,提出护理对策。碘对比剂外渗与患者年龄、全身性疾病、合作性、导管留置位置、导管与流速匹配等因素有关。护理对策为重视对患者的评估和宣教,提高护士操作技术,做好导管型号与碘对比剂注射速率的选择,以减少碘对比剂外渗发生率。     

尿动力学检查300例的护理

目的：探讨对尿动力学仪器及其检查的护理。方法：总结300例尿动力学检查的护理及其检查后1周的随访结果。结果：所有患者均能积极配合检查，无尿路感染并发症。结论：维护尿动力仪器的灵敏度、测压管道的充分消毒、正确熟练的操作、积极的心理护理是确保高质量、可信的尿动力学检查的必备条件。     

《护理美学》课程教学改革探讨

目的更好地塑造护生护理职业形象美。方法以508名护生为研究对象,对《护理美学》课程进行教学内容和教学方法的改革。结果实验组护生正确姿势考试和情景演示测试的平均成绩明显优于对照组;实验组在2次护士节礼仪表演比赛中获多数奖项;实验组对该课程的兴趣,对护士的仪表、语言、体势等规范的掌握程度,对护士职业的自豪感,审美能力等均有显著的提高。结论进行《护理美学》课程教学改革有利于护生塑造护理职业形象美,能提高护生学习兴趣和学习效果。     

尿液标本采集方法对尿镉检测结果的影响

目的 探讨镉作业人员尿液标本采集方法对尿镉含量检测结果的影响，为探讨准确的尿液标本采集方法提供依据。方法 对某厂同一组镉作业人员分别在不同环境下、用不同方法采集尿液标本，并进行检测。（1）常规法：采集尿液时被检测人员要脱离工作场所，换下工作服，洗净手等部位后，进行采集。（2）改良法：与常规法不同的是被检测人员要彻底更换服装，全身沐浴后，进行采集。结果常规法采集尿液标本超标率为36．9％，改良法采集尿液标本超标率为15．1％，两种尿液标本采集方法检测结果对比，差别有统计学意义（P〈0．05）。结论 对于职业性镉从业人员尿镉水平检测，收集尿液标本是最为关键的一个环节，只有正确选择采集方法，严格把好质量关，才能保证检测结果的准确性。     

Successful treatment of nocturnal enuresis: a practical approach

In this article, the emphasis is on formulating a correct diagnosis when the symptom of nocturnal enuresis is present, so that an effective treatment plan can be initiated. Diagnosis may relate to structural, urodynamic, psychologic, dietary, nephrologic, or neurologic problems. The authors present the format for successful treatment of nocturnal enuresis used at the Center to Assist the Regulation of Enuresis at the Children's Memorial Hospital in Chicago.     

Pyrogallol red technique is an alternative to routine urinary protein-determining methods

The paper presents the basic urinary protein-determining methods, such as turbidimetric and colorimetric ones and provides their brief analytical characterization. The authors consider the sulfosalicylic technique as most universally employed by clinical diagnostic laboratories and the pyrogallolic one as most promising. The comparative characteristics of both techniques are described and their advantages and disadvantages are noted. In terms of correct estimation and reproducibility of the results of an analysis, the pyrogallic technique is superior to the sulfosalicylic and other methods for protein determination; it can identify microproteinuria and thus a better alternative to the routine methods for urinary protein determination.     

俯卧位脊柱手术患者的护理

通过对128例俯卧位脊柱手术护理的总结,阐述这类病人术中的主要护理诊断：焦虑;有潜在的呼吸功能异常的危险;有围手术期体位性损伤的危险;有体液不足的危险;有潜在的损伤的危险。根据护理诊断,在手术护理中正确安置体位,避免体位性损伤;严密观察病人的生命体征变化;注意观察术野的出血情况;保持术中体位稳定。有效提高了手术护理质量。     

Localized harmonic motion imaging for focused ultrasound surgery targeting

Recently, an in vivo real-time ultrasound-based monitoring technique that uses localized harmonic motion (LHM) to detect changes in tissues during focused ultrasound surgery (FUS) has been proposed to control the exposure. This technique can potentially be used as well for targeting imaging. In the present study, we evaluated the potential of using LHM to detect changes in stiffness and the feasibility of using it for imaging purposes in phantoms and in vivo tumor detection. A single-element FUS transducer (80 mm focal length, 100 mm diameter, 1.485 MHz) was used for inducing a localized harmonic motion and a separate ultrasound diagnostic transducer excited by a pulser/receiver (5 kHz PRF, 5 MHz) was used to track motion. The motion was estimated using cross-correlation techniques on the acquired radio-frequency (RF) signal. Silicon phantom studies were performed to determine the size of inclusion that was possible to detect using this technique. Inclusions were discerned from the surroundings as a reduction on LHM amplitude and it was possible to depict inclusions as small as 4 mm. The amplitude of the induced LHM was always lower at the inclusions compared with the one obtained at the surroundings. Ten New Zealand rabbits had VX2 tumors implanted on their thighs and LHM was induced and measured at the tumor region. Tumors (as small as 10 mm in length and 4 mm in width) were discerned from the surroundings as a reduction on LHM amplitude.     

齿状突骨折前路中空螺钉固定术的护理

目的总结齿状突骨折前路中空螺钉固定术的护理要点。方法对8例枢椎齿状突骨折患者使用四钉头架实施中空螺钉固定术，护士做好术前、术中护理工作。结果8例患者术中体位调节、固定确切，手术时间平均45min，出血平均50mL，术后X线平片及CT扫描证实骨折均解剖复位，内固定位置优良。结论应用四钉头架调节、固定体位在齿状突中空螺钉固定术中简单、安全、可靠。术前耐心探访，取得患者的配合；术中正确的头架安装和熟练的体位调节护理，保持术中X光透视清晰无遮挡，为顺利手术提供良好保障；术后做好颈部固定，预防并发症的发生，是手术成功的重要因素。     

Dynamic morphological changes in the anterior vaginal wall before and after laparoscopic Burch colposuspension in primary urodynamic stress incontinence.

OBJECTIVE: To evaluate dynamic morphological changes in the anterior vaginal wall in primary urodynamic stress incontinence before and after laparoscopic Burch colposuspension and to explore the related effects on urethral and voiding functions. METHODS: Ultrasound cystourethrography and urodynamic study were performed in 112 patients with primary urodynamic stress incontinence before and 3 months after laparoscopic Burch colposuspension. Ultrasound assessment included measurement of the bladder neck positions at rest and during straining, the bladder wall thickness at the dome and trigone, and observation of the motion of the bladder neck in addition to the development of cystocele on Valsalva maneuver. On ultrasonography, a cystocele was defined as prolapse or descent of the bladder base below the bladder neck at rest, on Valsalva, or both. RESULTS: After laparoscopic Burch colposuspension, ultrasound cystourethrography revealed significant differences in the bladder neck position at rest and during stress (preoperative median 93 degrees vs. postoperative 70 degrees at rest and preoperative 160 degrees vs. postoperative 81 degrees during stress, P < 0.001, respectively) and rotational angle (preoperative median 58 degrees vs. postoperative 10 degrees , P < 0.001). A laparoscopic Burch operation corrected 50% (5/10) of the preoperative cystoceles. However, a residual cystocele developed postoperatively in 29% (30/102) of the women who did not have one previously. Postoperative ultrasonographic and urodynamic studies did not reveal any differences between those women with or without postoperative cystocele except for the residual urine volume, detrusor opening pressure, and straining and rotational angles of the bladder neck (P < 0.001, 0.032, 0.010 and < 0.001, respectively). CONCLUSIONS: Laparoscopic Burch colposuspension may correct a pre-existing cystocele, but in other patients a cystocele may persist or be disclosed. After laparoscopic Burch operation a persistent cystocele is not associated with urethral compression or voiding impairment.     

手术患者应用自制多功能体位支持垫的效果

目的探讨使手术患者舒适,手术野暴露充分,避免因体位摆放不妥引起并发症的方法。方法采用自制的棉质外套内置硬海绵制成三角形、长方体形、圆柱体形、半圆形体位支持垫,分别垫于手术患者背后、臂下、胸前、腕部、膝下、踝部等部位,保持有效正确的手术体位。结果手术体位稳定性、医生满意度、患者舒适度明显提高,减少术中更换体位时间和并发症发生。结论自制多功能体位支持垫是手术患者体位安置的理想的辅助工具。     

Development of real-time image sequence analysis for evaluating posture change and respiratory rate of a subject in bed

An image sequence analysis technique was developed to evaluate posture change and respiratory rate of a subject in bed without any physical contact. Although the image sequence analysis requires many calculations, the system can perform them in real time. The system consisted of a CCD video camera and a PC equipped with a high-speed image processor. To evaluate the system, we tested it on five subjects at a nursing home. The system evaluated 99.4% of the movements of subjects during the total monitoring time (about 61 hours). The waveform was flat when the subject was out of view of the video camera. The system has the possibility of evaluating not only posture changes and respiratory rate. but also sleeping patterns.