居家自我清洁间歇导尿在脊髓损伤患者中的应用

目的 探讨脊髓损伤膀胱功能障碍患者居家实施自我清洁间歇导尿的效果.方法 选取脊髓损伤膀胱功能障碍患者68例,住院期间实施无菌间歇导尿,出院后实施自我清洁间歇导尿,收集两种方法6周间歇导尿期间每周1次尿常规、尿培养检查结果和膀胱容量、残余尿量的测定数据,并进行统计分析.结果 出院后3周,7例终止导尿.61例患者在实施无菌间歇导尿和居家自我清洁间歇导尿期间的泌尿系感染、膀胱容量、残余尿量比较,差异无统计学意义（P＞0.05）.结论 脊髓损伤膀胱功能障碍患者可居家实施自我清洁间歇导尿,是一种方便、经济、有效的膀胱管理方法.     

两种导尿方法在脊髓损伤患者中的应用效果比较

目的:比较清洁间歇导尿法和留置导尿法在脊髓损伤患者中的应用效果。方法:将100例脊髓损伤致排尿障碍患者随机分为甲组和乙组各50例,甲组采用清洁间歇导尿法,乙组采用留置导尿法,比较两组临床效果。结果:两组患者尿路感染发生率、护理满意度以及干预后生活质量评分比较差异有统计学意义(P0.05)。结论:采用清洁间歇导尿法能够降低脊髓损伤致排尿障碍患者的尿路感染发生率,提高护理满意度和生活质量。     

盆底表面肌电评估与脊髓损伤患者下尿路功能恢复的相关性研究

目的 探究盆底表面肌电（sEMG）在脊髓损伤患者下尿路功能障碍转归中的预测作用。 方法 纳入39例符合入选条件的脊髓损伤患者，使用脊髓损伤神经学分类国际标准（ISNCSCI）评估神经损伤平面及损伤程度，并完成sEMG评估及简易膀胱压力-容量测定，评估所有患者的下尿路功能状态，内容包括排尿方式（自主排尿、反射性排尿、间歇清洁导尿、留置导尿、膀胱造瘘等）、漏尿情况（有或无漏尿、漏尿量及漏尿次数）、残余尿量（通过排尿后清洁导尿或超声等方式确定）。出院3个月后随访，根据患者的两种预后将39例患者分为预后一组(21例)和预后二组(18例)，其中预后一组包括完全恢复自主排尿、大部分恢复自主排尿但偶有失禁、自主排尿且清残余尿＜1次/24 h、自主排尿但需要清残余尿＞2次/24 h；预后二组包括间歇清洁导尿、间歇清洁导尿伴漏尿、留置导尿、反射性排尿；随访评估2组患者的ISNCSCI分级及膀胱功能状态。 结果 预后一组(21例)患者的ISNCSCI分级A级、B级、C级、D级和其它损伤类型（包括圆锥和马尾综合征等）例数分别为0例、1例、4例、5例和11例，而预后二组(18例)的分别为4例、3例、3例、0例和8例，且组间差异有统计学意义（P＜0.05）。预后一组和预后二组两组患者耐力收缩阶段的后10 s/前10 s比值的平均值分别为（0.82±0.30）和（1.14±0.47），患者尿意感正常例数占比分别为14.29%和5.56%，尿意感异常例数占比分别为52.38%和27.78%，尿意感消失例数占比分别为33.33%和66.67%，膀胱总容量平均值分别为（456.19±137.57）ml和（362.50±149.31）ml，且2组间比较，差异均有统计学意义（P＜0.05），其中sEMG耐力收缩阶段后10 s/前10 s比值（OR=13.956）与膀胱功能恢复呈显著相关（P＜0.05）。 结论 sEMG可以作为预测脊髓损伤患者下尿路功能转归的一个客观指标。     

无菌间歇导尿对脊髓损伤尿潴留患者恢复自主排尿功能的影响

目的 探讨无菌间歇导尿与常规留置尿管行膀胱训练对脊髓损伤尿潴留患者排尿功能的影响.方法 将67例脊髓损伤尿潴留患者分为对照组和观察组,对照组33例采用传统的留置尿管下膀胱训练方法,观察组34例采用拔除尿管间歇导尿方法,2个月后分析两组患者恢复自主排尿时间、残余尿量、每日自排尿量及泌尿系感染发生率.结果 观察组患者较对照组恢复自主排尿时间早,残余尿量少,每日自排尿量多,泌尿系感染发生率低,差异均有统计学意义.结论 对于脊髓损伤尿潴留患者损伤4周后即使未出现拔管指征,也可以将尿管拔除采用间歇导尿的方法继续训练膀胱功能,间歇导尿可使患者较快地恢复自主排尿功能,减少残余尿量,增加每日自主排尿量,降低泌尿系感染发生率.     

脊髓损伤患者间歇导尿时的尿路感染及预防

间歇导尿对于脊髓损伤患者可减少膀胱残余尿量 ,促进膀胱储尿和排尿功能的恢复[1 3 ] 。本文探讨了间歇导尿前及导尿期间下尿路感染 (ｌｏｗｅｒｕｒｉｎａｒｙｔｒａｃｔｉｎｆｅｃｔｉｏｎ ,ＬＵＴＩ)和菌尿的防治。1临床资料10 0例脊髓损伤患者 ,其中男性 82例 ,女性 18例 ,年龄 12— 6 6岁 ,平均 35 .6岁。颈髓损伤 4 2例 ,胸腰髓损伤 5 8例。病程 10天— 2 .3年 ,采用留置导尿开放引流者 94例 ,叩击排尿者 6例。导尿管留置最长时间2年。2方法与结果ＬＵＴＩ的诊断标准 :①发热 ;②尿常规检查 ,ＷＢＣ>10 /高倍镜视野 ;③细菌培养有致病…     

清洁间歇导尿技术在脊髓损伤排尿障碍病人中的应用研究

指导40例脊髓损伤排尿障碍病人或家属掌握清洁间歇导尿技术,定时观察尿常规、自主排尿能力、残余尿量、并发症和洗手前后细茵培养.36例病人经过3 d～12 d治疗能自行排尿,4例病人出院后仍需清洁间歇导尿;出院时自行排尿病人中34例残余尿量<100 mL,2例残余尿量100 mL～150 mL,治疗期间无一例发生并发症.提示,脊髓损伤排尿障碍病人应用清洁间歇导尿技术可促进病人的临床康复.     

清洁间歇性导尿对脊髓损伤患者自主排尿功能恢复的影响

选择92例脊髓损伤患者为研究对象,采用随机数字表法分为观察组和对照组各46例,对照组采用传统的留置尿管下膀胱训练方法,观察组采用采用清洁间歇导尿方法。随访2个月,观察两组患者残余尿量、恢复自主排尿时间、自主排尿量、泌尿系感染及生活质量。结果观察组残余尿量与对照组比较明显较少,恢复自主排尿时间较早,每日自排尿量较多,泌尿系感染发生率较低,生活质量与对照组比较明显较高(P<0.05)。清洁间歇性导尿可使脊髓损伤患者自主排尿功能尽快恢复,降低泌尿系感染发生几率,可使患者生活质量明显提高。     

间歇导尿在降低脊髓损伤排尿障碍患者尿路感染的效果观察

目的:探讨间歇导尿在控制脊髓损伤排尿功能障碍患者尿路感染的效果。方法:将符合纳入标准的30例脊髓损伤患者随机分为对照组和观察组各15例,对照组采用留置导尿管的方法进行护理,观察组采用间歇导尿的方法进行干预护理,2组分别在干预的第1周和第2周行尿常规和中段尿培养检查,了解尿路感染的情况,并观察其对生存质量的影响。结果:间歇导尿患者尿路感染率明显低于留置尿管的患者,生存质量明显改善(P0.05)。结论:采用间歇导尿的方法进行干预护理,能更好的降低脊髓损伤排尿障碍的尿路感染发生率,从而更好的提高其生存质量。     

清洁间歇导尿技术在脊髓损伤排尿障碍病人中的应用研究

指导40例脊髓损伤排尿障碍病人或家属掌握清洁间歇导尿技术,定时观察尿常规、自主排尿能力、残余尿量、并发症和洗手前后细菌培养。36例病人经过3d-12d治疗能自行排尿,4例病人出院后仍需清洁间歇导尿;出院时自行排尿病人中34例残余尿量〈100mL,2例残余尿量100mL-150mL,治疗期间无一例发生并发症。提示,脊髓损伤排尿障碍病人应用清洁间歇导尿技术可促进病人的临床康复。     

间歇导尿术在脊髓损伤患者中的应用

目的探讨间歇导尿术在脊髓损伤患者中的应用及护理。方法本组76例脊髓损伤患者，均施行无菌间歇导尿，根据患者膀胱残余尿量调整间歇导尿次数，配合膀胱功能训练，加强会阴部清洁护理。结果本组膀胱容量均正常或接近正常，残余尿量均小于100ml，10例残余尿量小于30ml；52例形成反射性膀胱，24例膀胱充盈后可自行排尿，无严重尿路感染和肾积水等并发症。结论间歇导尿操作简便、效果可靠、减少了逆行感染，配合膀胱功能训练，是解除脊髓损伤患者膀胱排尿功能障碍的有效方法。     

不同部位电针刺激对脊髓损伤逼尿肌无反射型神经源性膀胱逼尿肌压力的影响

目的通过观察电针刺激不同部位对脊髓损伤后逼尿肌无反射型神经源性膀胱逼尿肌压力的影响,寻求最佳刺激部位。方法选择符合脊髓损伤神经学分类国际标准第6 版(ASIA 2006)残损诊断和分级标准的108 例不完全性脊髓损伤患者为研究对象,随机分为导尿组、对照组和试验组,每组36 例。导尿组只行间歇导尿;对照组采用电针刺激八髎和会阳等穴,并进行间歇导尿;试验组采用经颅电针刺激足运感区、腹六区等穴,并进行间歇导尿。检测治疗前后的逼尿肌压力,并比较三组疗效。结果治疗后,三组自主排尿、导尿量、残余尿比较均有显著性差异(P<0.05);对照组和试验组治疗前后逼尿肌压力和逼尿肌反射比较均有显著性差异(P<0.05),导尿组治疗前后比较无显著性差异(P>0.05);治疗后对照组和试验组与导尿组比较均有显著性差异(P<0.05);对照组和试验组有显著性差异(P<0.05)。结论电针刺激能改善不完全性脊髓损伤后逼尿肌无反射型神经源性膀胱患者自主排尿功能。     

Clean intermittent self-catheterization in neuro-urology

Neurogenic lower urinary tract dysfunction (NLUTD) is commonly encountered in rehabilitation settings, and is caused by a variety of pathologies. The management of spinal cord injury (SCI) has been the model of reference for the management of other pathologies with NLUTD. The introduction of intermittent catheterization (IC) led to decline in renal related mortality in SCI patients and allowed an improvement of quality of life (QoL) in all neurogenic patients with NLUTD. IC could be sterile, aseptic or clean. Sterile intermittent catheterization (SIC) is the preferred method of bladder drainage in emergency medicine units and during spinal shock in SCI patients, but it is costly and time-consuming. Catheterizations performed in institutions, such as rehabilitation hospitals and nursing homes, are done aseptically. Clean intermittent catheterization (CIC), i.e. self-catheterization (CISC) or third party catheterization, represents the "gold standard" method for bladder emptying in all neuropathic patients with NLUTD: the technique is safe and effective and results in improved kidney and upper urinary tract status, lessening of vesico-ureteral reflux and amelioration of urinary continence. CISC is mandatory in patients with NLUTD secondary to detrusor areflexia/hypocontractility and in patients suffering from neurogenic detrusor overactivity with detrusor external sphincter dyssynergia and high post void residual of urine, often in combination with antimuscarinics/bladder relaxants. The review summarizes the most important aspects of IC and CISC. Attention was focused on the history of urethral catheterization, aims, materials, advantages, indications, and present-day techniques of CISC, emphasizing the importance of teaching in order to perform correctly the catheterization technique.     

脊髓损伤致截瘫患者导尿方式的选择及其影响因素

目的调查脊髓损伤导致截瘫患者导尿方式的选择及其影响因素。方法方便性抽样选取2011年1-8月上海市部分医疗机构脊髓损伤致截瘫患者91例,采用自制调查表对其进行问卷调查。结果本组91例患者中,选择留置导尿者61例占67.03%,选择间歇导尿者30例占32.97%。患者性别、年龄、文化层次、月收入、截瘫部位等对截瘫患者选择导尿方式的影响无差异(均P>0.05);截瘫时间以及泌尿系并发症出现频率对截瘫患者选择导尿方式有影响,差异均具有统计学意义(均P<0.05);93.44%的截瘫患者接受专业的泌尿系管理知识培训。结论间歇导尿(clean intermittent catheterization,CIC)是保护脊髓损伤后膀胱功能障碍的比较安全有效的方法,可明显降低尿路感染的发生率,提高排尿功能障碍患者的生存质量。截瘫时间较长和频繁发生泌尿系感染是截瘫患者更容易接受清洁间歇导尿方法的主要影响因素。提示医护人员有责任和义务为患者提供专业化的培训,帮助指导截瘫患者正确使用间歇清洁导尿,减少泌尿系问题出现的频率,提高生存质量。     

延续性护理在神经源性膀胱行清洁间歇导尿患者中的应用

目的:探讨延续性护理在神经源性膀胱行清洁间歇导尿(CIC)患者中的应用方法及效果。方法:将47例神经源性膀胱行CIC患者随机分为对照组23例和观察组24例,对照组给予出院常规护理,观察组在此基础上给予以专科护士为主导的延续性护理服务,比较两组护理效果。结果:观察组患者出院后3个月CIC依从性优于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。观察组出院3个月残余尿量少于出院当天及对照组出院后3个月(P<0.05)。两组患者出院后1、3个月健康调查简表(SF-36)评分高于对照组(P<0.05)。结论:延续性护理可提高神经源性膀胱行CIC患者的依从性,减少膀胱残余尿量,降低并发症发生率,提高患者的生活质量。     

Intermittent versus indwelling catheters for older patients with hip fractures

Nursing staff identified postoperative urinary tract infection (UTI) in patients with hip fracture as an increasing problem. A quality improvement project was carried out to investigate the problem and to reduce the incidence. The aim of the study was to describe the occurrence of UTI among patients with hip fracture before and after surgery, to assess whether the decision to use intermittent catheters instead of indwelling catheters was adopted and to test the hypothesis that hospital stay is significantly longer for patients with UTI than for those without infection. One hundred and forty-four patients were investigated for bacteriuria before the first catheterization and 1 week after the last catheterization. Positive urine cultures on admission to hospital were found in 38% of patients. Among those free from bacteria on admission, 61% had a positive urine culture after indwelling catheterization compared with 32% in the group treated with intermittent catetherization. A significantly longer hospital stay (P 相似文献   

便携式膀胱扫描仪与尿流动力学联合检查在患者间歇导尿中的应用分析

目的探讨便携式膀胱扫描仪结合尿流动力学检查在患者间歇导尿中的应用效果。方法选取四川大学华西医院拟行间歇导尿患者60例,按随机数字表法分为对照组和试验组各30例。对照组在尿流动力学检查指导下进行饮水计划和间歇性导尿,试验组在对照组基础上应用便携式膀胱扫描仪监测患者尿量并开展间歇性导尿,观察两组治疗前后膀胱容量及残余尿量变化,记录两组尿液导出量、遵循饮水计划及规范化间歇导尿,比较两组不良事件发生率和尿路感染发生率。结果治疗前后两组膀胱容量比较差异无统计学意义(P>0.05),治疗后试验组残余尿量低于对照组,尿液导出量、遵循饮水计划、规范化间歇导尿占比高于对照组(P<0.05);试验组不良事件总发生率及治疗后4周尿路感染率低于对照组(P<0.05)。结论便携式膀胱扫描仪结合尿流动力学检查在脊髓损伤患者间歇导尿指导中有明确的应用效果,对提高导尿效果和降低患者未执行正确导尿、尿路感染等发生率方面有积极意义。     

A Comparison of Open and Closed Catheterization Techniques in Rehabilitation Patients

An effective method was sought to decrease the incidence of urinary tract infections acquired by hospitalized rehabilitation patients requiring catheterization. The purpose of this study was to determine whether there was a difference in the incidence of urinary tract infections that occurred following use of two types of intermittent catheterization techniques: open catheterization and closed catheterization. The incidence of infection in both the control (open catheterization) and experimental (closed catheterization) groups was analyzed. In the control group, 9 of 14 patients (5 stroke, 4 spinal cord injured [SCI]) completed all four urine tests. Two patients developed a 20,000 colony count of enterococcus on the fourth urine sample using open catheterization. In the experimental group, 11 (4 stroke, 7 SCI) out of 16 patients maintained colony counts below 100,000 organisms per ml; one patient had a 16,000 colony count using closed catheterization. Qualitative data revealed that patients had a positive response to the closed system.     

Routine Urine Testing at the Spinal Cord Injury Annual Evaluation Leads to Unnecessary Antibiotic Use: A Pilot Study and Future Directions

Objectives

To measure the prevalence of asymptomatic bacteriuria (ASB) in persons with spinal cord injury (SCI) at the time of their annual examination and to examine the effect on urine testing during the annual examination on subsequent antibiotic use.

间歇导尿对不完全性脊髓损伤患者膀胱功能恢复的作用及护理

目的:观察应用间歇导尿技术在不完全性脊髓损伤患者膀胱功能恢复中的作用及其护理对策。方法:将104例病情基本相同的不完全性脊髓损伤患者随机分为观察组和对照组各52例。观察组应用间歇导尿技术进行护理,对照组应用传统的保留尿管方法进行护理。治疗1个月后比较两组尿常规、尿培养、膀胱残余尿量的情况。结果:观察组建立反射性膀胱者(膀胱残余尿量≤100 ml)明显高于对照组,具有明显差异,P<0.05;观察组尿路感染发生率明显低于对照组,具有差异性,P<0.05。结论:应用间歇导尿技术和积极的护理措施对于促进不完全性脊髓损伤患者膀胱功能的恢复有积极的作用,并且可以减少并发症的发生率。     

Nonvalue of Neomycin Instillation after Intermittent Urinary Catheterization

This study evaluated weekly urine cultures of patients with neurogenic bladder disease who underwent intermittent urinary catheterization for bladder retraining. One group of 53 patients in 1974 received regular instillations of 0.1% neomycin after each catheterization. A similar group of 55 patients in 1975 did not receive neomycin and constituted a control group. Distribution of age, sex, diagnosis, and duration of bladder retraining was comparable in both groups. Quantitative bacterial colony counts of 10(4) to 10(5) or greater per ml of urine were considered significant. There was no difference in the incidence of bacteriuria between the neomycin-treated group and the control group (53 versus 49%, respectively), and most patients in each group had colony counts >10(5)/ml. Escherichia coli was seen less frequently in neomycin-treated patients (43.4 versus 62.5%), but a greater percentage of infections due to Pseudomonas aeruginosa, group D streptococci, and yeasts was noted in the neomycin-treated group than in the control group (41.5 versus 22.5%).