脊髓损伤后神经源性膀胱的综合康复护理

目的探讨针对脊髓损伤神经源性膀胱患者的有效康复护理模式。方法将84例脊髓损伤患者按对等原则分为常规康复护理组和综合康复护理组各42例,常规组给予间歇性清洁导尿及膀胱功能训练指导;综合组除间歇性清洁导尿外,给予膀胱功能训练、功能性电刺激、生物反馈等综合康复护理。连续8周后评价效果。结果综合组日排尿频次、膀胱容量、残余尿量及导尿间隔时间4项指标均显著优于常规组(P0.05,P0.01)。结论对脊髓损伤后神经源性膀胱患者采取综合康复护理有利于其膀胱功能的恢复。     

神经源性膀胱患者住院健康教育路径的制订与实施

目的探讨健康教育路径管理在神经源性膀胱患者实施间歇性导尿中的应用效果。方法将60例脊髓损伤致神经源性膀胱患者随机分为对照组和观察组各30例,对照组采用常规健康教育方法,观察组应用健康教育路径表实施健康教育,于出院前1周评价效果。结果观察组患者健康知识掌握程度、护理满意度及膀胱管理的依从性显著优于对照组(P0.05,P0.01)。结论针对神经源性膀胱患者制定健康教育路径并实行有效管理,可提高健康教育效果,从而提高患者自护依从性,有利于改善患者预后。     

脊髓损伤神经源性膀胱临床评估及治疗的研究进展

脊髓损伤患者经常合并有不同程度的神经源性膀胱症状，由此产生的各种泌尿系统并发症最终可能会导致肾功能衰竭，甚至死亡，不断的优化脊髓损伤神经源性膀胱患者的康复护理等治疗措施，对于提高患者生存质量，降低患者远期的死亡率，有重要的临床和社会意义。本文通过回顾文献，首先总结了神经源性膀胱在脊髓损伤不同阶段的表现，介绍了神经源性膀胱的临床评估，并详细概述了该类患者保守治疗，康复护理及手术治疗等措施，以便为此类患者的诊治提供参考。     

康复护理在神经源性膀胱功能重建中的应用

目的探讨康复护理在神经源性膀胱功能重建的应用效果。方法对22例神经源性膀胱功能重建患者给予间歇导尿、自主排尿等康复护理措施,观察护理后患者膀胱容量、残余尿量、并发症情况。结果本组患者均成功拔管,治疗后患者膀胱容量明显大于治疗前,残余尿量明显小于治疗前,比较差异有统计学意义(P0.05)。结论做好康复护理措施能有效促进神经源性膀胱功能重建患者增加膀胱容量,减少残余尿量,并发症发生率低,效果满意。     

综合康复训练在重建脊髓损伤患者膀胱功能的临床研究

【摘要】 目的 探讨综合康复训练对促进脊髓损伤患者神经源性膀胱功能重建的临床疗效。方法〓选择71例神经源性膀胱患者,分成实验组(36例)和对照组(35例),实验组采用间歇性导尿和综合康复训练,包括Crede手法按摩、耻骨上区轻叩法、扳机点法及电针刺激法等康复训练,对照组则采用留置导尿法和综合膀胱功能训练,并进行比较两组患者疗效比较。结果〓与对照组相比,实验组的尿路感染较明显减少,膀胱容量与残余尿量亦接近正常水平。结论〓脊髓损伤患者采取神经源性膀胱的综合康复功能训练和间歇性导尿的等模式,有助于提高脊髓损伤患者的生存质量。     

脊髓损伤患者个体化膀胱功能锻炼联合饮水计划的实施

目的探讨对脊髓损伤患者实施个体化膀胱功能锻炼联合饮水计划的效果。方法将58例脊髓损伤患者按入院时间分为实验组(30例)及对照组(28例),两组患者均接受临床康复治疗,对照组按常规进行膀胱功能锻炼,实验组采取个体化膀胱功能锻炼联合饮水计划分阶段进行锻炼,16周后评估膀胱功能康复效果。结果实验组膀胱功能康复效果显著优于对照组(P0.05),尿路感染发生率显著低于对照组(P0.01)。结论对脊髓损伤患者实施个体化分阶段膀胱功能锻炼联合饮水计划,可提高膀胱功能康复效果,降低尿路感染发生率。     

膀胱穿刺造瘘术结合康复功能训练对脊髓损伤后神经源性膀胱患者的效果分析

目的探讨膀胱穿刺造瘘术结合康复功能训练对脊髓损伤后神经源性膀胱患者的效果。方法回顾性分析本院2014年1月至2018年1月接诊的80例脊髓损伤后神经源性膀胱患者的诊疗及护理情况。根据护理方法的不同,将其分为对照组和观察组。对照组采取常规治疗及处理,观察组采取膀胱穿刺造瘘术结合康复功能训练。比较分析两组患者治疗后的临床疗效、治疗前后的残余尿量、膀胱压力、膀胱容量以及自行排尿率。结果观察组总有效率(97.50%)明显高于对照组(85.00%),两组比较差异有统计学意义(P0.05)。治疗后,两组患者的膀胱压力均明显降低,残余尿量明显减少,膀胱容量明显升高,治疗前后比较差异有统计学意义(P0.05)。治疗后,观察组残余尿量明显少于对照组,膀胱压力明显低于对照组,膀胱容量明显高于对照组,两组比较差异有统计学意义(P0.05)。观察组的自行排尿率(70.00%)明显高于对照组(57.50%),两组比较差异有统计学意义(P0.05)。结论膀胱穿刺造瘘术结合康复功能训练,能够有效提高脊髓损伤后神经源性膀胱患者的治疗效果,改善排尿状况,值得临床上广泛应用。     

系统健康教育对神经源性膀胱患者自我管理能力的影响

目的 目的 提高神经源性膀胱患者的自我管理能力.方法 将60例脊髓损伤后神经源性膀胱患者随机分成观察组和对照组各30例,观察组采用系统健康教育,对照组采用一般健康教育及常规护理,比较两组对疾病知识的掌握情况、自我管理能力及并发症发生率.结果 观察组患者对疾病知识的掌握率及自我管理能力良好率显著高于对照组(P<0.05,P<0.01),泌尿系感染发生率显著低于对照组(P<0.05).结论 系统健康教育能促进神经源性膀患者对膀胱的自我管理能力,减少并发症发生率,提高其生活质量.     

脊髓损伤患者行间歇性导尿对膀胱功能康复的影响

目的:探讨对脊髓损伤患者行间歇性导尿(IC)在膀胱功能康复中的意义.方法:选取脊髓损伤后膀胱功能障碍患者160例,按随机化原则将其分为试验组(康复护理组,n=81)和对照组(传统护理组,n=79),对照组患者仅采取传统护理模式进行护理,康复护理组患者在此基础上采取间歇性导尿结合膀胱功能训练的护理方式进行康复护理.分别于入院时、病后一个月、病后六个月评估两组患者膀胱功能和泌尿系并发症的发生率.结果:康复组患者膀胱功能康复情况明显优于对照组(P＜0.01),其并发症的发生率均明显低于对照组(P＜0.01),两组差别有高度显著性意义.结论:间歇性导尿有益于脊髓损伤患者膀胱功能的恢复,且并发症发生率明显低于对照组.     

基于目标控制的康复训练对脊髓损伤神经源性膀胱患者预后的影响

目的探讨基于目标控制的系统康复训练对脊髓损伤(SCI)神经源性膀胱患者膀胱功能、自我效能、目标希望的影响。方法将64例SCI神经源性膀胱患者随机分为两组,两组均在常规病变干预的同时行功能性物理治疗和生物反馈治疗,在此基础上,对照组(n=32)配合常规康复护理支持,观察组(n=32)则启动基于目标控制的SCI膀胱功能康复治疗方案。干预8周后,采用慢病自我效能量表(SECD6)、希望水平量表(HHI)对两组进行评估;同时通过自行排尿频次、膀胱残余尿及膀胱容量指标的检测,评价膀胱功能状态。结果干预8周后观察组自我效能评分、希望水平总分及各维度得分显著高于对照组(均P0.01);两组在自行排尿频次、膀胱残余尿量及膀胱容量等相关膀胱功能指标较干预初期明显改善,而观察组改善更为显著,与对照组比较,差异有统计学意义(均P0.01)。结论对SCI神经源性膀胱患者执行基于目标控制的康复训练策略,有利于患者自我效能的提高和康复计划的稳步推进,促进尽早恢复膀胱功能。     

Pattern of recurrence changes in noninvasive bladder tumors observed during 2 decades

PURPOSE: Previously published data on the 25-year outcome of G1Ta and G2Ta bladder tumors demonstrated that both tumors have a similarly low risk of recurrence in cases in which no tumor was detected in the first 5 years after presentation. A further 4 prospectively maintained cohorts were available for comparison between institutions or across time periods. MATERIALS AND METHODS: Review of a prospectively kept, computerized record of patients with bladder cancer allowed analysis of the long-term outcome of 4 further cohorts of bladder cancer presenting in 1978 to 1986 or 1991 to 1996. RESULTS: A total of 325 patients with G1Ta and 190 with G2Ta bladder tumors had up to 25 years of followup. The risk of recurrence in the first 5 years was identical in all cohorts from the 1980s. However, in those patients without recurrence in the initial 5 years, the subsequent risk of recurrence (in G1 and G2Ta tumors) was 3.2% in the earlier cohorts but increased 3-fold to 10.8% in the cohorts from the early 1990s (RR 3.3, 95% CI 1.2-9.5, p=0.016). CONCLUSIONS: A difference was observed in the pattern of late biopsy proven recurrence in the more contemporary cases. Increased use of prophylactic intravesical chemotherapy does not seem to be a strong factor. Changes in the ability to detect lesions and the readiness to biopsy suspicious lesions may be responsible for this difference.     

Combination of CK20 and Ki-67 Immunostaining Analysis Predicts Recurrence,Progression, and Cancer-Specific Survival in pT1 Urothelial Bladder Cancer

Background

The prognostic value of CK20, Ki-67, and p53 has been investigated for non–muscle-invasive urothelial bladder cancers but not for the distinct and clinically challenging subset of pT1 bladder cancers.

Objective

To evaluate the prognostic value of CK20, Ki-67, and p53 within the largest series of pT1 urothelial bladder cancers.

Design, setting, and participants

Data from 309 patients with pT1 urothelial bladder cancer from one single urologic centre were collected.

Intervention

Adjuvant instillation of bacillus Calmette-Guérin was performed in each patient. A second resection was performed after 4–8 wk. A total of 76 patients underwent cystectomy.

Outcome measurements and statistical analysis

We conducted histomorphologic analysis; immunohistochemistry for CK20, Ki-67, and p53; and univariate and multivariate Cox regression models including recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS).

Results and limitations

At a median follow-up of 49 mo, we found recurrence and progression and disease-specific mortality rates of 22.7%, 20.1%, and 15.9%, respectively. CK20 expression was significantly correlated with RFS in multivariate analysis (hazard ratio [HR]: 5.89; 95% confidence interval [CI], 1.44–24.15; p = 0.014). In multivariate analysis, Ki-67 was the only marker significantly correlated with PFS (HR: 2.80; 95% CI, 1.45–5.43, p = 0.002). Ki-67 (HR: 3.83; 95% CI, 1.59–9.26; p = 0.003), and CK20 (HR: 8.44; 95% CI,1.16–61.34; p = 0.035) were significantly correlated with CSS in multivariate analysis. The combination of CK20 and Ki-67 showed significantly worse RFS (p = 0.026), PFS (p = 0.003), and CSS (p < 0.001) in tumours with a high proliferation index and abnormal CK20 expression. A retrospective study design was the major limitation of this study.

Conclusions

Our present analysis of the largest series of patients with pT1 urothelial bladder cancer published to date found Ki-67 and CK20 to be potential prognostic markers improving the risk stratification of pT1 bladder tumours. They are reliable indicators of biologic aggressiveness and may contribute to decision making on therapeutic strategy for pT1 bladder carcinomas.