脊髓损伤致神经源性膀胱患者导尿方式与体位探讨

目的 探讨不同导尿方式和不同体位对脊髓损伤致神经源性膀胱患者的影响.方法 选取2013年1月至2015年12月海南医学院第二附属医院收治的脊髓损伤致神经源性膀胱患者96例为观察对象,按照入院时间先后顺序将患者递次分为留置导尿管组(A组)、清洁间歇性导尿-平卧位组(B组)、清洁间歇性导尿-长腿坐位组(C组)、清洁间歇性导尿-短腿坐位组(D组),各24例.比较四组患者治疗4周后残余尿量和剩余尿量、膀胱最大测压容积(MCC)、最大尿流率(MFR)、尿路感染发生率及患者的生活质量评分.结果 治疗4周后,C组、D组患者治疗前和治疗后的剩余尿量与A组、B组相比均明显下降,C组、D组患者治疗后的残余尿量比A组、B组也明显减少,B组、C组、D组患者治疗后的残余尿量和剩余尿量与治疗前相比均明显减少,差异均有统计学意义(P<0.05).治疗后四组患者中以D组患者的残余尿量[(52.3±13.6)mL]和剩余尿量[(20.9±10.5)mL]最低,与其他三组差异均有统计学意义(P<0.05).B组、C组、D组患者的膀胱最大测压容积(MCC)[(285.1±39.7)mL、(288.6±38.5)mL、(292.1±36.9)mL]、最大尿流率(MFR)[(14.9±2.0)mL、(15.3±2.1)mL、(16.2±2.5)mL]均明显高于A组,尿路感染情况明显轻于A组,生存质量评分[(69.7±6.6)分、(70.3±5.9)分、(71.1±6.1)分]明显高于A组,差异均有统计学意义(P<0.05).结论 清洁间歇性导尿术对于脊髓损伤致神经源性膀胱患者来说是一种安全有效的膀胱管理方法,能够降低患者感染率,而清洁间歇性导尿术中以短腿坐位效果更好.

Urethral catheterization methods and body position of neurogenic bladder dysfunction after spinal cord injury

Objective To explore the effect of different ways of urethral catheterization and different body po-sitions on the neurogenic bladder dysfunction after spinal cord injury. Methods From January 2013 to December 2015, 96 patients with neurogenic bladder dysfunction caused by spinal cord injury were enrolled and divided into 4 groups ac-cording to the admission order:indwelling catheter group (group A), clean intermittent catheterization-the supine group (group B), clean intermittent catheterization-long legs sitting group (group C), clean intermittent catheterization-short legs sitting group (group D), with 24 cases each group. The residual urine volume, remaining urine volume, maximum cystometric capacity (MCC), maximum urinary flow rate (MFR), the incidence of urinary tract infection and the patient's quality of life scores were compared among the four groups after 4 weeks of treatment. Results After 4 weeks of treat-ment, the remaining urine volume of group C, group D before and after treatment were significantly decreased compared with those of group A and group B (P<0.05). The residual urine volume of group C, group D after treatment also de-creased significantly compared with those in group A and group B (P<0.05). The residual urine volume and remaining urine volume in group B, C, D after treatment were all significantly decreased compared with those before treatment (P<0.05). After treatment, the residual urine volume and remaining urine volume in group D were the lowest, which were (52.3 ± 13.6) mL and (20.9 ± 10.5) mL, showing statistically significant difference with those in other three groups (P<0.05). MCC and MFR in group B, C, D were (285.1±39.7) mL, (288.6±38.5) mL, (292.1±36.9) mL and (14.9±2.0) mL, (15.3±2.1) mL, (16.2±2.5) mL, significantly higher than those of group A, and the urinary tract infection status was low-er than that in group A. The quality of life score in group B, C, D were (69.7±6.6), (70.3±5.9), (71.1±6.1), significantly lower than that in group A (P<0.05). Conclusion Clean intermittent urethral catheterization for neurogenic bladder dys-function after spinal cord injury is a safe, effective bladder management method, which can reduce infection rate, and clean intermittent urethral catheterization with short legs sitting is preferred.