间歇性排尿训练在脊髓损伤排尿障碍患者中的应用

目的 探讨间歇性排尿训练在脊髓损伤排尿障碍患者中的应用.方法 对46例脊髓损伤患者均采用间歇性排尿训练(观察组),并与32例采用常规长期留王导尿治疗的脊髓损伤患者(对照组)比较.结果 观察组通过间歇性排尿训练,42例患者成功建立了反射性膀胱,有效率和尿路感染率与对照组比较,差异有显著性意义(均P＜0.01).结论 间歇性排尿训练对脊髓损伤排尿障碍患者具有重要的康复治疗意义.     

三种排尿训练方法对脊髓损伤患者自主排尿功能恢复的影响

目的 探讨三种排尿训练方式在脊髓损伤患者自主排尿功能恢复中的作用.方法 将符合纳入标准的患者随机分为三组各40例,分别使用留置尿管导尿(留置尿管组)、间歇性清洁导尿(清洁导尿组)和间歇性无菌导尿(无菌导尿组)并辅以排尿训练,比较三组患者膀胱功能恢复以及泌尿系感染的情况.结果 三组患者膀胱功能恢复及泌尿系感染情况比较,差异有统计学意义(均P＜0.01),留置尿管组效果最差;而清洁导尿和无菌导尿组膀胱功能恢复情况和泌尿系感染发生率比较,差异无统计学意义(P＞0.05,P＞0.0125).结论 间歇性清洁导尿和间歇性无菌导尿训练方式帮助脊髓损伤患者自主排尿功能恢复效果较好,但由于间歇性清洁导尿耗材便宜、住院期间或出院后可由患者或其家属实施,更容易在临床实施和在社区推广应用.     

力奥来素对脊髓不全损伤患者排尿障碍的作用

目的观察力奥来素对脊髓不全损伤排尿障碍患者膀胱功能恢复的作用.方法32例腰椎骨折伴脊髓不全损伤排尿功能障碍患者随机分为观察组(18例)和对照组(14例),观察组采用间歇导尿配合力奥来素治疗,对照组单独采用间歇导尿治疗,两组均行手术治疗.观察两组排尿功能恢复时间、泌尿系感染情况和后遗症.结果观察组患者排尿功能恢复时间平均为5.05 d,对照组平均为9.28 d(P＜0.01),对照组有2例后遗症,观察组没有后遗症.结论力奥来素可促进脊髓不全损伤排尿障碍患者膀胱功能的恢复.     

膀胱扫描仪在脊髓损伤患者间歇性导尿中的应用

目的探讨膀胱扫描仪在脊髓损伤患者行间歇性导尿时的应用效果。方法对8例脊髓损伤患者行间歇性导尿前,采用膀胱扫描仪进行膀胱内尿量测定,寻找患者的最佳导尿时间点。结果住院期间患者行间歇性导尿53例次,其中9例次膀胱扫描仪测得患者尿量<300mL,推迟导尿时间点,但与上一次导尿时间不超过6h;有21例次测得患者尿量>500mL,给予患者即时导尿;有23例次测得患者尿量为300～500mL,按计划时间点导尿。结论采用膀胱扫描仪能够有效监测间歇性导尿前膀胱内尿量,指导脊髓损伤患者行间歇性导尿准确的时间点,避免不必要的导尿,减少患者痛苦。     

干细胞移植治疗脊髓损伤后排尿障碍的可行性

一直以来,脊髓损伤因其高致残率而被视为医学界的一大难题。在脊髓损伤的诸多并发症中,泌尿系统并发症是脊髓损伤患者最主要的死因之一。由于损伤的神经细胞无法再生,目前对于脊髓损伤患者排尿障碍的各种治疗效果都十分有限。然而,随着干细胞研究的不断进展,越来越多的实验表明干细胞移植治疗可以改善脊髓损伤后的排尿功能,提示该方法具有一定的可行性。本文就近年来关于干细胞移植治疗脊髓损伤后排尿障碍的研究进展,从常用干细胞种类、干细胞移植治疗的机制、干细胞移植时间、干细胞移植途径几个方面做一综述,并提出通过干细胞体外分化得到能够分泌5-羟色胺的神经细胞来进行移植治疗脊髓损伤后排尿障碍的新思路。     

脊髓损伤病人早期手法排尿训练的临床观察

脊髓损伤病人早期手法排尿训练的临床观察张雪非，陈步俊，邓建龙，唐迎九，刘刚脊髓损伤后病人排尿功能障碍表现为无张力性膀胱，尿液潴留。目前临床采用的方法有持续导尿、间歇导尿、手法排尿、药物治疗等。我院自１９８１年１月至１９９１年１月收治１１４名外伤性截瘫...     

轮椅越障碍训练在脊髓损伤患者康复治疗中的应用

轮椅越障碍训练在脊髓损伤患者康复治疗中的应用金宁，纪树荣轮椅训练是脊髓损伤患者的一项重要康复训练内容，轮椅越障碍比赛（Ｓｌａｌｏｍ）原是国际轮椅联合会又称国际斯托克·曼德维尔运动联盟（ＩＮＴＥＲＮＡＴＩＯＮＡＬ－ＳＴＯＫＥＭＡＮＤＥ－ＶＬＩＥＧＡＭＥ...     

轮椅篮球训练在脊髓损伤患者康复训练中的应用

自1988年中国康复研究中心文体治疗科开始收治病人以来，对172例脊髓损伤（Spinalcordinjury，SCI）截瘫患者开展了适合于患者特点的体育训练项目——轮椅篮球训练。由于患者丧失了下肢运动功能，所以操纵轮椅进行康复体育训练是一种代偿性的治疗。经过近几年来的实践，取得了较好的康复效果。介绍如下。1资料与方法1·1一般资料172例SCI患者中，男性160例，女性12例。年龄16～49岁，平均29岁。轮椅篮球训练时间平均3个月。脊髓损伤情况见表1。表1172例患者脊髓损伤情况1·2训练方法轮椅篮球的篮球规则和技术动作与正常人的基本相同。主…     

脊髓损伤性排尿功能障碍的理疗观察

脊髓损伤性排尿功能障碍的理疗观察詹昭丽，许延谋脊髓损伤致排尿功能障碍，是脊柱创伤后难以治疗的并发症之一，给病人日常生活带来极大痛苦。目前尚无理想疗法，多数患者仍以留置导尿管的方法，等待其自然康复。我们于１９８６年以来用ＤＬ－３型点送治疗机，对３８例脊...     

腰椎骨折脊髓不全损伤病人膀胱功能训练研究

目的 探讨促进腰椎骨折脊髓不全损伤病人排尿障碍恢复的方法。方法 将51例病人随机分为观察组(32例)和对照组(19例)。观察组采用间歇导尿配合药物治疗,对照组仅采用留置导尿,任其自然恢复。观察两组病人尿管保留时间、膀胱排尿功能恢复时间及泌尿系感染情况等。结果 观察组和对照组尿管保留时间,拔除尿管后膀胱自主排尿恢复时间,排尿恢复正常的例数,泌尿系感染、后遗症发生情况比较,差异有显著性意义(P<0.05、P<0.01)。结论 科学的膀胱功能训练可促进病人膀胱功能早日恢复。     

Bladder Cancer Risk in Patients with Spinal Cord Injury

Abstract

Bladder cancer (BC) is the fourth most common cancer in men. It is associated with several risk factors (RF), of which only a few have been evaluated in previous studies. Models incorporating only one or a severely restricted number of RFs did not predict BC well. We employed 19 a priori RFs and 12 interactions in a multivariate logistic regression analysis for the prediction of BC in a sample of subjects with spinal cord injury (SCI), of whom 149 were outpatients (7 with BC) and 4 were inpatients with BC. We also replicated dichotomous predictions for 10 of the 19 RFs that have been most frequently associated with a higher BC risk in the literature. The overall test for 31 predictors was significant (p = 0.0038). A dichotomized predictor correctly identified 9 of 11 BC cases and all 142 but one of the cases without BC. A more parsimonious subset of 21 predictors satisfied a Scheffé-type multiple comparison criterion. Although duration of SCI satisfied a Bonferroni criterion for statistical significance, it did not satisfy a Scheffé criterion. In the replication studies, only dichotomized duration of indwelling catheterization for at least 10 years significantly replicated the previous findings. Results of this study suggest that using multiple risk factors and interactions in a comprehensive statistical model may provide useful screening of patients with SCI for BC risk. Since early identification of BC substantially improves prognosis, such a model may identify patients at highest risk who are most likely to benefit from bladder biopsy.     

Management of Neurogenic Bladder in Female Spinal Cord Injury Patients

Abstract

Twenty-two female spinal cord injury patients were admitted to the Spinal Cord Injury Service at the West Roxbury VAMC during a period of 17 years (1965–1982). Bladder status and means of drainage were evaluated. Twelve patients (55%) required no means of drainage, nine of them were dry all the time, while the other three needed pamper support to counteract occasional wetness. Seven were on constant indwelling catheters, two were on self-catheterization, while one had an intestinal loop diversion. It appears that female spinal cord injury patients depend more on constant indwelling catheters than their male counterparts. In some instances, female paraplegics do well on self-catheterization. Catheter complications in female spinal cord injury patients appear to be less than in males.     

Risk Factors for Bladder Tumors in Spinal Cord Injury Patients

Purpose

We evaluated risk factors for the development of bladder tumors in spinal cord injury patients.

Materials and Methods

A retrospective review was done of all bladder tumors at 1 institution with matched controls for 7 years.

Results

We identified 17 malignant and 2 benign tumors. Indwelling bladder catheters and a history of bladder stones were statistically significant risk factors. Four patients with negative biopsies underwent repeat biopsy due to suspicious cytology and cancer was found.

Conclusions

An indwelling urinary catheter and a history of bladder stones are statistically significant risk factors. Cytology and biopsy are complementary in the evaluation of urothelial malignancy in this population. A high index of suspicion and thorough evaluation are needed in spinal cord injury patients.     

容量感觉训练法用于脊髓损伤患者膀胱功能重建的研究

目的探讨缩短脊髓损伤患者膀胱功能恢复时间的方法。方法按入院顺序将42例脊髓损伤患者分为对照组（22例）与观察组（20例），对照组采用生物反馈训练法进行膀胱功能重建，观察组采用容量感觉训练法进行膀胱功能重建。观察两组患者尿管留置时间、膀胱排尿功能恢复情况及泌尿系感染情况。结果观察组尿管留置时间显著短于对照组（P〈0．01），泌尿系感染发生率显著低于对照组（P〈0．05）；两组自主排尿量及排尿正常恢复率比较，差异无显著性意义（均P〉0．05）。结论采用容量感觉训练法可使膀胱得到合理的容量刺激，缩短尿管留置时间，有效预防泌尿系感染及促进膀胱功能尽早恢复。     

容量感觉训练法用于脊髓损伤患者膀胱功能重建的研究

目的 探讨缩短脊髓损伤患者膀胱功能恢复时间的方法.方法 按入院顺序将42例脊髓损伤患者分为对照组(22例)与观察组(20例),对照组采用生物反馈训练法进行膀胱功能重建,观察组采用容量感觉训练法进行膀胱功能重建.观察两组患者尿管留置时间、膀胱排尿功能恢复情况及泌尿系感染情况.结果 观察组尿管留置时间显著短于对照组(P＜0.01),泌尿系感染发生率显著低于对照组(P＜0.05);两组自主排尿量及排尿正常恢复率比较,差异无显著性意义(均P＞0.05).结论 采用容量感觉训练法可使膀胱得到合理的容量刺激,缩短尿管留置时间,有效预防泌尿系感染及促进膀胱功能尽早恢复.     

Factors Influencing Bladder Stone Formation in Patients With Spinal Cord Injury

Abstract

Objective: Bladder stones that form in patients with spinal cord injury (SCI) can cause significant morbidity. This study sought dto analyze factors associated withbladder stone formation to determine which patients might be at increased risk to developbladder stones.

Methods: A review of 56 SCI patients treated for bladder calculi over a 10-year period at a single institution was performed. These patients were compared with a control population of general SCI patients known tobe stone free. The factors compared were patient age, duration of injury, Ievei of injury, completeness of injury, method of bladder management, and the presence of documentedurinary tract infections with urease -producing organisms.

Results: All patients with stones were male and had a median age of 5 8.5years. The median Ievei of injury was C6, the median time since injury was 21 years, 66% had complete injuries, 68% managed their bladders with in dwelling cathetersor suprapubic tubes,and 83% had a history of infections with urease-producing organisms. When compared with the control group, patients forming bladder stones were older (P = 0 .03), were more likely to have in dwelling catheters (P < 0.0001 ), had a history of infections with urease-producing organisms (P = 0 .04), and had complete injuries(P= 0 .018).

Conclusion: This information can be used to identify patients who have anincreased risk of bladder stones and measures can betaken to reduce their incidence and morbidity.     

Effect Of Controlled-Release Oxybutynin On Neurogenic Bladder Function In Spinal Cord Injury

Abstract

Objective: This study evaluated the effects and tolerability of extended-release oxybutynin chloride on the frequency of voiding and catheterization and urodynamic capacity in spinal cord injury (SCI) patients with defined detrusor hyperreflexia.

Methods: This was a 1 2-week, prospective, dose-titration study of extended-release oxybutynin (oxybutynin XL) . SCI patients with urodynamically defined detrusor hyperreflexia were recruited for this study. Following a 7 -day washout period, patients were evaluated via video-urodynamic study and then treatment was initiated at a dosage of 1 0 mg per day. Dosage was increased in weekly intervals to a maximum of 30 mg per day. Micturation frequency diaries and urodynamics were completed at baseline and repeated at week 1 2. Tolerability information was collected at each follow-up visit.

Results: Ten patients (mean age = 49 years) with complete or incomplete SCI were enrolled. Participants reported clinical improvement (decreased urinary frequency and fewer incontinence episodes) with oxybutynin therapy following titration to 30 mg per day. All patients chose a final effective dosage of greater than 1 0 mg, with 4 patients taking the maximum of 3 0 mg per day. Mean cystometric bladder capacity increased from 2 7 4 mL to 3 80 mL (P = 0.008). No patient experienced serious adverse events during the 12-week study.

Conclusion: Oxybutynin XL is safe and effective in patients with detrusor hyperreflexia secondary to SCI. The onset of clinical efficacy occurs within 1 week, and daily dosages up to 30 mg are well tole rated.