急性脑卒中尿失禁的护理探讨

随着脑卒中诊断技术的不断提高，死亡率逐渐下降，存活率、致残率有所增加。尿失禁是脑卒中后常见并发症之一。但目前临床上只注意尿失禁的处理，对于尿失禁的原因却很少引起人们的重视。在非卒中专科医院中常不主动处理尿失禁，护理人员又缺乏对尿失禁患者的康复指导，而多数患者携带并发症回归家庭。故脑卒中患者急性期尿失禁的观察与护理应引起人们足够重视。本文参照了近三年来临床52例脑卒中患者尿失禁的临床观察与分析，将护理体会总结如下：     

脑卒中尿失禁及其护理

尿失禁是脑卒中严重程度的标志 ,也是预测能否康复的标志。对脑卒中尿失禁的发病率、危险因素、分类、原因、预后及护理进行论述 ,以引起医务人员的重视 ,提高老年人的生活质量。     

脑卒中后尿失禁的临床研究

目的研究脑卒中恢复期尿失禁的发生率、相关因素及不同临床表现尿失禁的比较。方法选取脑卒中恢复期患者176例,根据排尿情况分为尿失禁组和控制组,又将尿失禁患者分为有排尿意愿组和无排尿意愿组,进行回顾性分析。结果脑卒中恢复期尿失禁发生率26.1%,失禁组与控制组在性别、卒中类型及病灶侧别、部位方面无显著性差异,但在病灶单/多发方面有显著性差异（P<0.05）。有排尿意愿组和无排尿意愿组在病灶累及顶叶及认知功能方面有显著性差异（P<0.05）。结论脑卒中恢复期尿失禁高发于有多病灶患者,无排尿意愿尿失禁患者多累及顶叶,认知功能异常     

脑卒中继发尿失禁与多项临床因素的相关性

目的：探讨急性大脑半球卒中继发尿失禁的发生率及危险因素。方法：回顾分析了410例急性大脑半球卒中头颅CT或MRI检查结果，对卒中类型、部位及患年龄、性别、血压、血糖、既往有无脑卒中病史进行对比研究。结果：继发尿失禁的发生率为40．2％。老年组及高龄组尿失禁率分别为39．9％和50．0％，高于青年组21．1％（P＜0．01）。合并高血压、糖尿病以及既往有脑卒中病史尿失禁较多（P＜0．01）。左侧大脑半球病变的尿失禁率（45．2％），高于右侧大脑半球（26．7％）（P＜0．01）。脑卒中类型无明显差别。结论：急性脑卒中患尿失禁发生率较高，且左侧半球病变发生率明显高于右侧。年龄大、高血压、糖尿病以及既往有脑卒中是尿失禁有意义的危险因素。     

康复训练对急性脑卒中患者日常生活活动能力影响的效果分析

脑卒中是我国的常见病、多发病。随着诊疗技术水平的不断提高,急性脑卒中患者救治率明显得到提高,然而致残率在其存活者中却高达80％以上。脑卒中后的肢体运动功能影响患者的生活自理和参与社会能力,同时也给家庭和社会带来巨大负担。我们对40例急性脑卒中患者实施了康复训练,并与常规治疗的患者进行了对比研究。现报告如下。     

脑卒中尿失禁及其护理

尿失禁是脑卒中严重程度的标志,也是预测能否康复的标志。对脑卒中尿失禁的发病率、危险因素、分类、原因、预后及护理进行论述,以引起医务人员的重视,提高老年人的生活质量。     

神经功能重建治疗脑卒中后尿失禁的临床观察

目的探讨神经功能重建治疗脑卒中后尿失禁的疗效。方法通过人体腔内（阴道或肛门）电极探头，捕捉和测量盆底肌群肌电值，利用盆底肌肉收缩放松的机理，按照不同尿失禁类型确定盆底肌肉锻炼治疗图形，对23例脑卒中后尿失禁患者为期4周治疗。观察其治疗前后肌电值、尿失禁等级、次数的变化。结果治疗后，患者排尿、漏尿次数减少，盆底肌肉收缩力提高。结论神经功能重建治疗可以重建患者的控尿功能，提高患者的生活质量。     

早期康复对急性脑卒中ALD的促进作用

目的 探讨早期康复治疗对急性脑卒中偏瘫患者上、下肢运动功能和日常生活活动能力的影响。方法 选择急性脑卒中偏瘫患者96例,随机分为康复组和对照组（每组48例）。用前瞻性研究方法对两组进行比较分析。康复组在给予物治疗的同时,还进行正规的康复训练;对照组仅给予药物治疗。分别于入选治疗前24h和治疗后6－8周进行测评。采用Brunnstrom分级法评定运动功能,采用Barthel指数评定日常生活活动能力（ADL）。结果 经6－8周治疗后,两组在Barthel指数和Brunnstrom分级上均有一定程度的改善,康复组的改善幅度明显优于对照组（P＜0．01）。结论 急性脑卒中偏瘫患者接受早期康复治疗,能明显改善肢运动功能,提高日常生活活动能力。     

脑卒中与尿失禁

尿失禁是脑卒中重要的并发症和后遗症，病因复杂，相关因素多，各方因素相互联系，共同对脑卒中后尿失禁起作用，尿动力学检查有助于明确病因和指导治疗，目前尚无针对脑卒中后尿失禁的特效药物，仍以综合治疗为主。     

脑卒中后尿失禁临床研究进展

尿失禁是脑卒中后遗症五大功能障之一，严重影响患者的生活质量。目前对其治疗方法五花八门，然而疗效往往不能令人满意。因此对于卒中后尿失禁产生机制及治疗方法的研究，逐渐成为目前的重点。鉴于此，本文将近年来中西医对卒中后尿失禁临床研究的进展做一综述。     

76例压力性尿失禁临床分析

目的 :了解压力性尿失禁 (SUl)的发病现状及手术治疗效果。方法 :对SUI或SUI合并生殖道膨出而行手术的 6 8例患者进行回顾性分析及随访总结。结果 :4 5例SUI合并轻—中度阴道前后壁膨出者行阴道前后壁修补术 尿道膀胱筋膜缝合术 ;8例SUI合并子宫脱垂者行阴式子宫切除术十阴道前后壁修补术 尿道膀胱筋膜缝合术 :7例SUI行Burch手术 ;5例SUI行尿道紧缩术 经腹腹直肌筋膜悬吊术 ;3例单纯性尿道紧缩术。初次治愈率 83 8% (5 7/6 8) ,好转率 14 7% (10 /6 8) ,复发率 4 4 % (3/6 8) ,失败率 1 5 % (1/6 8)。手术效果与术前分度有关 ,轻度组的手术效果较中重度组好 (P <0 0 5 )。结论 :改良的Kelly术 ,Burch术及Albridge -studdiford仍不失为当前最常用的一种治疗压力性尿失禁的有效方法 ,SUI患者宜早期治疗。     

Managing Acute and Chronic Urinary Incontinence

This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline Update on Urinary Incontinence in Adults: Acute and Chronic Management , which was developed by a multidisciplinary panel of health care providers and a consumer representative. Findings and recommendations are presented for identification and evaluation of urinary incontinence (Ul); use of behavioral, pharmacologic, and surgical treatment as well as supportive devices; long-term management of chronic intractable Ul; and education of health care providers and the public. An algorithm is included to show the sequence of events related to the overall management of Ul. Tables and forms are included to outline assessment and treatment options.     

Assessment‐Guided Therapy of Urinary Incontinence After Stroke

Urinary incontinence (UI) frequently occurs after stroke and often remains an extensive problem for these patients and their relatives even after discharge from the hospital. Therapeutic interventions, such as behavioral training, can help manage UI. Recently, a multimodal application of nursing interventions was recommended ( Wilbert‐Herr, Hürlimann, Imhof & Wilbert, 2006 ). The primary goals of the study discussed in this article were to introduce therapeutic interventions of UI management into clinical rehabilitation practice based on a structured process of interdisciplinary caregiving and test the treatment effect. Forty‐four patients who had suffered a cerebrovascular accident (CVA) were included in the study. Nursing interventions included distinction of stress or urge UI and the assessment of different forms of UI The latter intervention was based on the functional independence measure (FIM Item G—bladder management), the protocol of micturition, urine dipstick, and ultrasound measurement of post‐void residual urine (PVR). Interventions were applied according to the recommendations of the 3rd International Consultation on Incontinence. An algorithm of the interdisciplinary process was implemented, and the nursing staff received specific education regarding the interventions. Twenty‐one (47%) of the patients in the study were diagnosed with UI; 67% of these patients achieved the targeted level of continence by individually tailored interventions, which consisted of a systematic nursing assessment and standards for prompted voiding, timed voiding, and habit training. Planned processes, including screening procedures, assessment, profile of continence, intervention, and education and evaluation, increase the likelihood of positive results of rehabilitation of patients after CVA. Additional intervention studies are suggested to investigate the effectiveness of the algorithm used in this study.     

Female Urinary Incontinence

One hundred and eighty-seven Norwegian women with urinary incontinence (UI) were interviewed after having responded to a marketing campaign for incontinence aids. Nineteen per cent stated that UI was a negligible problem. Urge incontinence was associated with more mental distress, practical inconveniences, and social restrictions than stress incontinence. Young women were more handicapped by stress incontinence than old women. Severe incontinence was associated with more mental distress and practical inconveniences than slight incontinence. A wide variety of control measures was used, the most popular being absorbent products. Only four had not used any control measure. Fifty-seven per cent had mentioned their UI-problem with a doctor. The consultation rate increased with the severity and duration of UI. Only 36% were satisfied with the outcome of the consultation.     

糖尿病并急性脑卒中的相关临床特点分析

目的比较糖尿病患者并发急性脑卒中和非合并糖尿病的急性脑卒中患者临床特征差异,为科学诊断和合理治疗提供科学的依据。方法对我院收治急性脑卒中患者124例病情回顾性分析,其中合并糖尿病者62例,非糖尿病组患者62例,分别对比两组合并急性脑出血和合并急性脑梗死患者的临床特征差异。结果糖尿病组并发急性脑出血患者出血灶多,死亡率高,预后差。糖尿病组并发急性脑梗死梗死灶多且梗死面积较大,复发病灶和腔隙性脑梗塞多见,治疗难度大,预后不佳。结论糖尿病并发急性脑卒中包括急性脑梗死和急性脑出血,病情复杂且凶险,死亡率高,临床上应稳定控制血糖,预防脑卒中的发生。     

中风并发急性肾功能损害58例临床分析

目的:分析中风并发急性肾功能损害的原因及其特点,探讨预防抢救措施。方法:对中风并发急性肾功能损害58例进行回顾性分析。结果:本组58例中风并发急性肾功能损害中,治愈好转42例,放弃治疗而自动出院2例,死亡14例。2例行血液透析治疗者均预后良好。结论:中风并发急性肾功能损害的发生,除与发病年龄、原有基础疾病有关外,还与脑部病变的严重程度、治疗药物的使用等关系密切。其发生可以预防,一旦发生,应及时积极治疗,如有条件,尽早行透析治疗。