脑桥上神经损伤导致膀胱尿道功能障碍的影像尿动力学特点研究

目的探讨脑桥上神经损伤所致膀胱尿道功能障碍的影像尿动力学改变。方法回顾性分析2004年2月至2009年5月65例行影像尿动力学检查的脑桥上神经损伤患者的资料,包括临床表现、诊断、排尿方式、超声、尿流率、残余尿、充盈期膀胱压力容积测定、排尿期压力流率测定和影像学结果,并与骶上脊髓损伤患者进行比较。结果65例患者中,逼尿肌过度活动占61.5%、反射正常占24.6%、无反射占13.9%、逼尿肌-尿道外括约肌协同失调(DSD)占6.2%、输尿管返流占4.61%。脑桥上不同神经损伤类型尿动力表现无明显差异;与骶上脊髓损伤比较,DSD、输尿管返流、上尿路积水发生率少见,反射正常比例较高。结论脑桥上神经损伤所致膀胱尿道功能障碍的主要尿动力学特点是逼尿肌过度活动伴括约肌协同正常,较少出现DSD、输尿管返流、上尿路积水等并发症。     

骶髓下脊髓损伤患者尿动力学特点与处理

目的分析研究骶髓下脊髓损伤患者尿动力学特点,随访泌尿系康复治疗方法及疗效。方法回顾性分析骶髓下脊髓损伤患者169例影像尿动力检查结果和泌尿系管理方法,观察其泌尿系变化及并发症的发生情况。结果 129例(76.33%)表现为逼尿肌无反射,其中46例(27.22%)表现为膀胱顺应性增加,12例(7.10%)出现膀胱输尿管返流;21例(12.43%)表现为逼尿肌过度活动,膀胱顺应性下降,其中5例(2.96%)出现膀胱输尿管返流。根据尿动力检查结果选择不同的治疗方法,2年随访治疗效果满意,无特殊并发症。结论骶髓下脊髓损伤患者大多表现为逼尿肌无反射,膀胱顺应性增加。根据尿动力检查结果选择适当的综合康复治疗手段,能有效保护上尿路功能,预防泌尿系感染等并发症的出现。     

女性患者尿动力学检查特点及注意事项

尿动力学是生物工程的一个组成部分，下尿路尿动力学检查是了解膀胱及尿道尿功能障碍性疾病的一种重要辅助手段，尿动力学检查涉及相关学科比较广泛的知识，正确掌握尿动力学检查可以对临床诊断提供重要的参考价值。本文总结我们对女性患者下尿路尿动力学检查的体会。     

232例尿动力学检查的护理

尿动力学是泌尿外科学一个新的研究领域，是利用流体力学的基本原理研究尿路输、储存、以及尿液排除体外的动态过程。是临床上用于诊断下尿路疾病的检查方法之一。我科自1999年6月至2001年10月共做尿动力学检查232例，由于注重了检查前的准备、心理护理、检查中的密切观察和护理，以及检查后的正确指导等措施，取得了很好的临床效果。     

非完全同步影像尿动力学检查在临床诊断中的应用

目的 探讨非完全同步影像尿动力学检查的临床应用意义。方法 采用Laborie尿动力学检查仪和Toshiba放射检查床，对128例患者进行非完全同步影像尿动力学检查(一般取截石位及斜坐位)，其中脊髓损伤92例(71．9％)、骶裂5例(3．9％)、尿失禁8例(6．2％)、排尿困难2例(1．6％)、前列腺增生21例(16．4％)。灌注液中泛影葡胺含量为15％，灌注速度10—20ml／min，检查方法同普通尿动力学检查，记录膀胱压力(Pves)、直肠压力(Pabd)、逼尿肌压力(Pdet)、尿流率(Q)和肌电图等参数，采用膀胱储尿期及排尿期同步透视，点拍摄放射片4次，记录并保存影像。结果 发现膀胱输尿管返流6例(4．7％)、膀胱结石18例(14．1％)、膀胱憩室35例(27．3％)、膀胱颈开放78例(60．9％)、逼尿肌膀胱颈协同失调23例(18．0％)、逼尿肌尿道外括约肌协同失调59例(46．1％)、外括约肌痉挛31例(24．2％)。结论 非完全同步影像尿动力学检查能够利用现有设备进行影像尿动力学检查，对全面了解神经原性膀胱尿道功能障碍及LUTS患者的下尿路病理生理改变有重要价值。     

TOT手术治疗女性压力性尿失禁的影像尿动力学检查评价

目的:采用影像尿动力学检查对TOT经闭孔尿道中段吊带术治疗女性压力性尿失禁(stress urine incontinence)的临床疗效进行评价。方法:对2008年11至2010年5月28例女性压力性尿失禁患者行TOT术,治疗前、治疗后3个月及6个月均进行国际尿失禁问卷简表(ICI-Q-SF)、尿垫实验、影像尿动力学检查疗效评价。结果:28例患者随访时间6～14个月。其中27例患者术后尿控满意,1例有轻度尿失禁。尿动力学检查:术后3个月、术后6个月最大膀胱容量(MCC)、残余尿(RU)、最大尿流率时逼尿肌压力(Pdet,Qmax)与术前比较差异无统计学意义(P>0.05)。术后3个月,腹压漏点压力(ALPP)与术前比较差异有统计学意义(P值为0.000)。术后6个月,最大尿流率(Qmax)、ALPP,与术前比较差异有统计学意义(P值分别为0.012、0.000)。静态尿道压力图手术前后参数术前、术后3个月、术后6个月,最大尿道关闭压力(MUCP)分别为(35.4±19.9)、(52.5±26.7)、(51.8±18.2)cmH2O(1cmH2O=0.098kPa),功能尿道长度(FUL)分别为(3.5±1.1)、(4.2±1.3)、(4.2±1.0)cm,术后6个月MUCP、FUL与术前比较差异有统计学意义(P值分别为0.002和0.016)。影像学方面比较,术后显示在增加腹压或咳嗽试验时,膀胱颈及后尿道活动度下降,中段尿道相对固定,尿道闭合。在影像学提示,手术后显示在增加腹压或咳嗽实验时,膀胱颈及后尿道活动度下降。结论:通过影像尿动力学评价,TOT经闭孔尿道中段吊带术是治疗女性压力性尿失禁有效的方法之一,6个月内影像尿动力学评价提示手术能提高尿道压、加强控尿功能,同时对膀胱功能无显著影响。     

脑血管意外后排尿障碍患者影像尿动力学分析

目的分析脑血管意外对下尿路功能的影响。方法回顾性分析19例脑血管意外后排尿障碍患者、19例同期胸椎脊髓损伤患者的影像尿动力学检查结果,比较两组患者膀胱逼尿肌和尿道外括约肌功能障碍的特点。结果脑血管意外排尿障碍患者以逼尿肌反射亢进为主,膀胱顺应性下降,尿道外括约肌多为松弛状态,逼尿肌反射亢进患者病灶集中于基底节和额叶;胸椎脊髓损伤患者影像尿动力检查与之有差异。结论脑血管意外后排尿障碍患者影像尿动力学改变以逼尿肌反射亢进和尿道外括约肌松弛为主,与胸椎脊髓损伤后导致的神经源性膀胱影像尿动力学检查差异明显。     

尿动力学检查的配合与护理

尿动力学检查是利用流体力学的原理来研究尿路尿液排送生理和病理的一门科学 ,其特征是用图像和数字直观、量化地反应尿路功能。下尿路尿动力学检查是诊断膀胱流出道梗阻的金标准 ,也是诊断神经源性膀胱尿道功能障碍和尿失禁最可靠的诊断方法。我院 1999年 5月～ 2 0 0 2年 5月共作了 4 2 2例次检查 ,现将尿动力学检查的配合和护理体会总结如下。1　临床资料本组 4 2 2例 ,其中男 36 4例 ,女 5 8例 ,年龄 11～82岁 ,平均 6 4岁。单纯行自由尿流率测定 76例 ,进行尿动力学联合检查 346例。2　材料与方法使用荷兰ＭＭＳ -Ｌｉｂｒａ+ 尿动力学…     

疑似慢性前列腺炎的青年男性伴下尿路症状患者的尿动力学分析

目的探讨尿动力学检查在疑似慢性前列腺炎的青年男性伴下尿路症状(LUTS)患者,评价中的临床应用价值。方法我们回顾性分析了85例18～40岁的临床疑似慢性前列腺炎的青年男性伴LUTS患者的尿动力学检查资料。排除有糖尿病史、神经源性疾病、泌尿系统外伤、手术史或急性尿路感染的患者。所有患者均接受多通道的尿动力学检查。对检查前后的诊断进行比较。结果 85例患者平均年龄为(27.3±4.3)岁;76.5%(65/85例)有储尿期症状,而68.2%(58/85例)有排尿期症状。72.9%(62/85例)例患者出现异常尿动力学检查结果,包括膀胱顺应性降低21.2%(18/85例)例、逼尿肌过度活动25.9%(22/85例)例、逼尿肌-外括约肌协同失调15.3%(13/85例)、膀胱出口梗阻31.8%(27/85例)例和逼尿肌活动低下/无收缩17.6%(15/85例)例。结论临床疑似慢性前列腺炎的青年男性伴LUTS患者的流行病学病因多种多样。临床诊断和治疗常依靠经验,并不准确。尿动力学检查在评价临床疑似慢性前列腺炎的青年男性伴LUTS患者中具有重要价值。     

神经源性膀胱合并上尿路扩张患者尿动力学检查的护理

目的探讨神经源性膀胱合并上尿路扩张患者尿动力学特点及检查过程中的护理配合。方法回顾性分析150例神经源性膀胱合并上尿路扩张患者膀胱功能测定的护理配合要点、检查结果和并发症发生情况。结果上尿路扩张患者多表现为膀胱低顺应性、逼尿肌过度活动、高逼尿肌漏尿点压、相对安全容量显著降低、残余尿量显著增多、膀胱活动低下等,尿动力学检查后患者并发泌尿系感染的风险和严重程度明显增加。结论神经源性膀胱合并上尿路扩张患者行尿动力学检查时需加强相关的护理配合,如严格控制膀胱充盈速度及重复检测次数、及时留置导尿管持续引流尿液或进行清洁间歇导尿、预防性使用抗生素等,以保证检查结果的准确性,并有效预防检查后泌尿系感染的发生。     

多模式超声在胎儿非严重闭合性脊柱裂筛查中的应用

目的  研究多模式超声在胎儿非严重闭合性脊柱裂筛查中的临床应用价值。 方法  对医院2017年1月~2020年1月接收的多模式超声产前筛查并诊断为胎儿脊柱畸形的19例病例进行总结,分析多模式超声在产前筛查胎儿脊柱畸形中的价值。结果38 564例孕妇中共19例被诊断为胎儿脊柱裂,其中产前系统超声共检出18例,超声脊柱裂检出率为0.047%（18/38 564）,剩余1例因多次产前检查胎儿均为臀位,未获得可用的影像资料而漏诊,漏诊率为5.26%（1/19）。18例经超声检查提示胎儿脊柱裂者均自愿终止妊娠,并经术后尸检证实。19例脊柱裂胎儿中,开放性脊柱裂15例,闭合性脊柱裂4例。其中15例开放脊柱裂者中合并脑积水者6例,足内翻者4例,产前超声检查中有脑室扩张、颅后窝消失、柠檬头征、室间隔缺损等影像征象。4例闭合性脊柱裂均合并脊髓圆锥低位,1例同时合并椎管内脂肪瘤。 结论  多模式超声检查具有安全、可重复性强等优势,能有效筛查胎儿脊柱裂。     

Pregnancy outcomes of women with spina bifida

Purpose: To assess the pregnancy outcomes of women with spina bifida.

Materials and methods: We analyzed a population-based cohort of 397 pregnant women with spina bifida and 1,083,211 without spina bifida who delivered infants in hospitals in Quebec, Canada, 1989-2013. Outcomes included maternal and infant morbidity and mortality at delivery. We used log-binomial regression models to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for the association of maternal spina bifida with pregnancy outcomes, accounting for maternal characteristics.

Results: Women with spina bifida had a higher prevalence of several adverse outcomes compared with women who had no birth defects. Maternal risks were highest for intensive care unit admission during the delivery hospitalization (PR 3.41, CI 95% 1.56–7.43) and respiratory morbidity (PR 9.46, CI 95% 3.31–26.99). Infant risks were greatest for intracranial hemorrhage (PR 6.85, CI 95% 2.23–21.08), birth hypoxia (PR 1.64, CI 95% 1.21–2.22), and hospital length of stay?≥14 days (PR 2.56, CI 95% 1.58–4.15). After adjustment for confounders, maternal spina bifida was associated with risk of oral clefts and abdominal wall defects in infants.

Conclusions: Women with spina bifida have an increased risk of severe maternal and infant complications at delivery, compared with no spina bifida.

• Implications for Rehabilitation

• A growing number of women with spina bifida achieve pregnancy, but pregnancy outcomes are poorly understood.

• In a large pregnancy cohort, women with spina bifida had a high risk of severe maternal and infant morbidity at delivery.

• Women with spina bifida may benefit from enhanced periconceptional counseling and obstetric monitoring by health professionals.

• Guidelines should be developed for rehabilitation care providers to improve the obstetric management of women with spina bifida.

     

Obesity across the lifespan among persons with spina bifida

Purpose. Identify risk factors for obesity across the lifespan for individuals with spina bifida.

Methods. Cross sectional chart review study of 203 patients aged 6–58 years. Obesity was based on body mass index. Rates were calculated for children aged 6–11 years; adolescents aged 12–19 years and adults aged > 20 years. Chi-square analyses were used to determine differences in obesity rates among subgroups. An ordered logistic regression model was developed for the three age groups to estimate the probability of a change in BMI classification from normal weight to overweight or overweight to obese, controlling for sex, functional motor level, shunt status and insurance status.

Results. Obesity rates for children, adolescents and adults were 18, 8 and 37%, respectively. Obesity rates were higher among adults (χ² = 27, p < 0.01) and for individuals who were publicly insured (χ² = 7.2, p < 0.03). The ordered regression model for children demonstrated no independent association between sex, shunt status, functional motor level or insurance status and change in BMI category. For adolescents, lower functional motor level (i.e. sacral) increased the risk of becoming obese (Odds Ratio: 2.13; 95% CI: 1.12–4.06; p < 0.02). Among adults, female sex increased risk (OR = 2.28; 95% CI: 1.03–5.04; p < 0.04).

Conclusions. Obesity rates for children and adolescents with spina bifida are similar to the general population; however, obesity rates are higher among adults, particularly women. Risk factors are similar to those observed in the general population.     

The experience of adolescent women living with spina bifida. Part II: Peer relationships.

Relationships are much more complex for those with disabilities than for those without disabilities. This study was part of a larger mixed-method investigation that explored comprehensive aspects of adaptation in adolescents with spina bifida (SB). The purpose of this qualitative component of the study was to explore the experiences of peer relationships in 31 adolescent women with SB. The participants were interviewed, and analysis was conducted for common themes. The five major themes and one subtheme were peers without disabilities (subtheme: peers with disabilities), normalization, challenges in peer connectedness, peer connectedness with adults, and romantic connectedness. Whereas some participants voiced close connections with peers, others described prejudices, stereotyping, and limited dating experiences. Results from this study support the need for comprehensive assessment of social relationships in adolescent women with SB and active interventions to address problems identified. Rehabilitation nurses are in a key position to implement social interventions in adolescents and young women with SB.     

Assessment of social skills and problem behaviors in young children with spina bifida

The present study assessed social and emotional adjustment in young children with spina bifida. Role-play tests, and parents' and teachers' ratings of social competence and problem behaviors were utilized in this evaluation. Results indicated that children with spina bifida did not differ significantly from controls on verbal and nonverbal components of conversational skill and negative assertion. Also, spina bifida and control children were not differentiated on the basis of mothers' and teachers' reports. Further,while mothers and fathers were in agreement about their child's level of behavioral functioning, little correspondence was evident between ratings of parents and teachers. The present findings are consistent with more recent empirical investigations demonstrating that spina bifida children do not evince major deficits in adjustment as suggested in initial studies that relied on clinical interviews and self-report.     

基层医院产前超声及MRI在胎儿闭合性脊柱裂检查中应用对比

目的：探讨基层医院超声和磁共振（MRI）检查技术在产前诊断胎儿闭合性脊柱裂的价值。方法：选择26例临床确诊的闭合性脊柱裂胎儿作为研究组,38例不合并神经系统畸形的胎儿作为对照组,回顾性分析研究组和对照组产前超声、MRI和联合检查三种检查方式诊断结果,对比不同检查方式的诊断效能。结果：产后临床诊断闭合性脊柱裂26例患儿中,产前准确诊断闭合性脊柱裂24例,超声诊断20例,MRI诊断17例,联合诊断24例,漏诊2例（1例脊髓拴系和1例皮毛窦）。超声、MRI和超声联合MRI三种方法诊断闭合性脊柱裂的敏感度、特异度、阳性预测值、阴性预测值、准确率存在差异,差异有统计学意义（P<0.05）。三种方法的ROC曲线下面积分别为0.8964、0.8757、0.9120,差异有统计学意义（P<0.05）。结论：在基层医院超声作为首选的检查方式用于诊断胎儿闭合性脊柱裂,MRI可作为补充检查方式,二者联合检查能更有效检出胎儿闭合性脊柱裂。     

Validity of the WST and the WST-Q in children with spina bifida: a pilot project

Abstract

Objective: To begin exploring use of the manual wheelchair versions of the Wheelchair Skills Test (WST) and the Wheelchair Skills Test-Questionnaire (WST-Q) in children with spina bifida who use manual wheelchairs.

Design: Cross-sectional, psychometric study.

Setting: A university-based laboratory setting.

Subjects: A total of 12 children 5–21 years of age with spina bifida participated in the study.

Interventions: Assessment of manual wheelchair skills by direct observation and parent report.

Main measures: The WST, the WST-Q and the manual wheelchair short scale within the Mobility domain of the Pediatric Evaluation of Disability-Computer Adapted Test (MWC PEDI-CAT), an existing validated parent-report measure of manual wheelchair skills in children.

Results: Moderate to excellent positive associations were found amongst all test scores. Spearman’s rank order correlations were as follows: r?=?0.87 between the WST and WST-Q, r?=?0.78 between the WST-Q and MWC PEDI-CAT and r?=?0.62 between scores on the WST and MWC PEDI-CAT. These associations suggest that the WST and the WST-Q may be appropriate for use with children who have spina bifida and therefore should be further explored in this population. Using the WST-Q as a parent-report measure may help clinicians to assess manual wheelchair skills in children with spina bifida without adding additional time to an examination session.

• Implications for Rehabilitation

• The associations found in this pilot project suggest that the Wheelchair Skills Test and the Wheelchair Skills Test-Questionnaire (WST-Q) may be appropriate for use with children who have spina bifida.

• Using the WST-Q as a parent-report measure may help clinicians to assess manual wheelchair skills in children with spina bifida without adding additional time to an examination session.