脊髓损伤后神经原性膀胱的分类及其治疗原则

脊髓损伤后神经原性膀胱的分类及其与治疗的关系近来有了长足的进展。本简要介绍了各种分类方法及其治疗原则，尤其是新分类法，简明实用。     

骶神经磁刺激对脊髓损伤后逼尿肌无力型膀胱的疗效分析

目的：探讨骶神经磁刺激对脊髓损伤后逼尿肌无力型膀胱的影响。方法：采取随机分组的方法将36例脊髓损伤合并逼尿肌无力型膀胱患者分为试验组与对照组。两组患者均接受常规康复治疗，试验组对S3神经根进行重复功能性磁刺激（repetitive functional magnetic stimulation,r FMS）治疗。于治疗前、治疗4周后分别观察2组患者的简易膀胱容量测定、膀胱超声及焦虑自评量表等指标。结果：2组患者最大自排尿量、平均自排尿量、残余尿量、膀胱初感觉容量及焦虑自评评分与治疗前相比均有所改善，治疗后试验组的最大自排尿量、平均自排尿量均显著优于对照组，具有显著性差异（P<0.05）。结论：重复功能磁刺激作用于骶神经根对治疗脊髓损伤后逼尿肌无力型患者疗效明显优于常规治疗，疗法为临床上治疗逼尿肌无力型神经源性膀胱提供新思路。     

脊髓损伤性神经原性膀胱的一种新分类及其治疗规律

脊髓损伤性神经原性膀胱的一种新分类及其治疗规律中国人民解放军５７００３部队卫生科高兰脊髓损伤（ｓｐｉｎａｌｃｏｒｄｉｎｊｕｒｙ,ＳＣＩ）后出现神经原性膀胱是十分常见的,但对于ＳＣＩ性神经原性膀胱一直缺乏一种与临床紧密结合而又简明实用的分类方法,相应地...     

脊髓损伤后神经性膀胱的功能康复

脊髓损伤（ＳｐｉｎａｌＣｏｒｄＩｎｊｕｒｙ,ＳＣＩ）后,神经性膀胱排尿机能障碍致尿潴留引起膀胱及尿路感染,严重者可导致患者死亡。［１］目前,对神经性膀胱的治疗仍以非手术为主。现就这方面的研究作一综述。１　神经性膀胱的分类［２］脊髓损伤后引起的排尿障碍是神经性膀胱的主要临床表现。根据损伤后的部位和程度不同,神经性膀胱的类型也不一样,以往我国对神经性膀胱,基本上按照Ｎｅｓｂｉｔ的分类方法,即①反射性膀胱;②自律性膀胱;③无抑制性膀胱;④感觉神经麻痹性膀胱;⑤运动神经麻痹性膀胱。这种分类方法实际运用比…     

脊髓损伤后膀胱尿动力学检查及分类

尿动力学检查已成为脊髓损伤后膀胱尿道功能障碍的常规检查技术,列举脊髓完全损伤后膀胱典型的尿动力学表现及不同部位、程度和时期的脊髓损伤所致的非典型的逼尿肌、括约肌功能障碍与其相应的尿动力学表现。目前 ,依据尿动力学检查对膀胱尿道功能障碍的分类方案较多 ,以Krane分类方案 (逼尿肌反射亢进与逼尿肌无反射 )应用为主。通过尿动力学检查可对膀胱尿道功能障碍进行分类外 ,还可为临床的诊断、治疗及疗效评价提供更多的客观指标。     

脊髓损伤患者神经源性膀胱的康复护理进展

对脊髓损伤患者神经源性膀胱的康复与护理进行综述,介绍了神经源性膀胱的分类方法,阐明了实施康复护理和膀胱功能训练的方法和措施,主要包括留置导尿、间歇性导尿、膀胱功能康复训练的护理要点,旨在尽可能地帮助患者恢复和改善膀胱功能,使其生存质量得到提高。     

康复训练对脊髓损伤后痉挛性膀胱功能的影响

目的观察脊髓损伤患者膀胱功能障碍的膀胱功能训练和康复护理疗效。方法53例脊髓损伤后痉挛性膀胱功能障碍患者施以间歇性导尿结合手法训练、局部音频电疗、微波治疗等膀胱功能训练等康复护理。结果53例患者治疗1个月后,膀胱容量及残余尿量治疗前后差异有显著意义（P=0．000）。结论康复护理结合膀胱功能训练,配合局部音频电疗、微波治疗,能使脊髓损伤病人的膀胱训练达到平衡和恢复自主排尿,减少并发症,缩短康复期。     

脊髓损伤病人神经源性膀胱功能评估及分类研究进展

对脊髓损伤病人神经源性膀胱功能评估及分类方法研究现状进行综述,护理人员根据检查结果对脊髓损伤神经源性膀胱功能进行分类,才能对脊髓损伤病人膀胱功能进行针对性个性化的康复护理。     

综合康复治疗5·12汶川地震致脊髓损伤患者神经源膀胱35例临床分析

目的：探讨5·12汶川地震致脊髓损伤患者神经源膀胱的康复治疗方法。方法：通过对35例脊髓损伤患者神经源膀胱康复治疗的总结回顾,观察采用制定饮水计划,间歇性导尿,药物治疗,膀胱功能训练,手术治疗等方法治疗神经源膀胱的疗效。结果：经过综合治疗,35例患者的神经源膀胱都得到了不同程度的改善。结论：地震致脊髓损伤发生率高,而神经源膀胱是其重大并发症之一,危害患者生命,重建脊髓损伤后患者的膀胱功能对于提高截瘫患者的生活质量,降低死亡率具有十分重要的意义。     

膀胱治疗仪在脊髓损伤后神经源性膀胱中的应用观察

目的探讨膀胱治疗仪对脊髓损伤后神经源性膀胱患者残余尿量、膀胱容量、尿路感染率及膀胱平衡时间的影响。方法脊髓损伤后神经源性膀胱患者60例,随机分为实验组和对照组,每组30例。两组均给予常规康复治疗,实验组给予膀胱治疗仪低频电子脉冲治疗,对照组给予膀胱治疗仪假性治疗,观察两组患者残余尿量、膀胱容量、尿路感染率及建立膀胱平衡时间。结果经治疗8周后,实验组残余尿量少于对照组(P<0.05),尿路感染率无显著性差异(P>0.05);膀胱平衡时间实验组早于对照组(P<0.05)。结论膀胱治疗仪低频电子脉冲早期治疗脊髓损伤后神经源性膀胱可减少残余尿量,加快膀胱平衡的建立。     

The neurogenic bladder: an update with management strategies for primary care physicians

Patients with lesions of the central nervous system often have neurogenic bladder dysfunction. Lifelong bladder monitoring and management in these patients is necessary to prevent severe complications, including renal?damage. The urodynamic test, performed by neurourologists or other specially trained providers, is the definitive test for diagnosis and management of neurogenic bladder dysfunction. This article describes the indications and technique of urodynamic testing and the interpretation of the results of such testing. The management of patients with neurogenic bladder dysfunction is also discussed.     

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。     

Inhibition of the external urethral sphincter and sacral reflex by anal stretch in spinal cord injured patients

Relaxation of both detrusor and external sphincter muscles by mechanical stretch instead of cutaneous stimulation of the anal sphincter has been recognized and applied clinically for bladder emptying and for aiding catheterization in patients with spastic urethral sphincter. In a three-year study anal stretch was included as part of urodynamic examination in patients who could potentially use this method for bladder management. Anal stretch was found to inhibit the bulbocavernosus reflex and to be a useful alternative technique for bladder emptying in patients having complete paraplegia with normal hand function and with detrusor-sphincter dyssynergia. It is recommended that anal stretch combined with Credé or Valsalva maneuvers be a part of the urodynamic study of such patients to determine whether or not these techniques can be utilized for bladder management.     

Value of sensory examination in predicting bladder function in patients with T12-L1 fractures and spinal cord injury

OBJECTIVE: To determine whether early sensory examination, voluntary anal sphincter contraction, or bulbocavernosus reflex (BCR) might predict bladder function in patients with a spinal fracture at the thoracolumbar level. DESIGN: Longitudinal study of consecutive patients admitted to a spinal cord injury (SCI) rehabilitation center. SETTING: Primary care center, university facility in Switzerland. PARTICIPANTS: Fifty-five patients with thoracolumbar fractures. INTERVENTIONS: Neurologic (American Spinal Injury Association [ASIA] protocol) and urodynamic examination during the first hospitalization and at follow-up. MAIN OUTCOME MEASURES: Neurologic sensory scores and type of neurogenic bladder. RESULTS: At first examination, there was no correlation between the sensory examination, voluntary anal sphincter contraction, BCR, and neurogenic bladder type. At follow-up (time since first examination: mean, 698+/-47.2d; median, 481d), the sensory examination remained of no value in distinguishing the neurogenic bladder type. However, voluntary anal sphincter contraction distinguished between complete and incomplete neurogenic bladders and BCR differentiated between complete bladder dysfunction of the lower motoneuron and upper motoneuron type. At follow-up, the bladder function (51 patients) remained unchanged in 44 cases and normalized in only 7 cases. Patients who improved their bladder function tended to have higher initial sensory ASIA scores (P<.05, Kruskal-Wallis test). Of the 7 patients who improved their bladder function, all but 1 (85%) had initial perineal pinprick sensation. Nevertheless, preservation of perineal pinprick sensation was of no positive predictive value, because 21 patients (48%) who initially had perineal pinprick sensation did not improve their voiding function, a finding similar to that of the 23 (52%) without initial perineal pinprick sensation whose bladder function also did not improve. CONCLUSIONS: In SCI patients with thoracolumbar fractures, neurogenic voiding dysfunction cannot be predicted by the sensory evaluation. In patients with an SCI at the thoracolumbar level, pinprick sensation in the perineal area is of negative predictive value: absence of pinprick sensation predicts poor bladder recovery. Most patients with a spinal fracture at T12-L1 did not improve in voiding function.     

Traitements chirurgicaux des hyperactivités vésicales neurologiques

Surgical treatment of neurogenic bladder hyperactivity is reserved for cases where conservative medical treatment has failed. The objective of such surgery is to obtain a bladder of adequate capacity, which fills at low pressure. This minimises symptoms, protects the upper urinary tract and reduces the complications of neurogenic bladder. There is a range of therapeutic options: surgical techniques for bladder denervation, detrusor myomectomy, enterocystoplasties with or without continent urinary diversion and, finally, non-continent urinary diversion procedures. We shall not discuss the technique of sacral neuromodulation, which will form the object of a separate article.     

Association of bladder trabeculation and neurogenic bladder with spinal cord injury

ObjectiveTo compare clinical findings and urodynamic parameters according to trabeculation grade and analyze their correlations with trabeculation severity in neurogenic bladder caused by suprasacral spinal cord injury (SCI).MethodsA retrospective chart review was performed of neurogenic bladder caused by SCI. Bladder trabeculation grade was compared with SCI-related clinical parameters and bladder-related urodynamic parameters.ResultsIn SCI patients, factors such as disease duration, bladder capacity, detrusor pressure, peak detrusor pressure values, and compliance were significantly different between different grades of bladder trabeculation, while neurological level of injury, completeness, and detrusor sphincter dyssynergia had no clear relationship with bladder trabeculation grade. In the correlation analysis, vesicoureteral reflux was moderately correlated with trabeculation grade (correlation coefficient 0.433), while the correlation coefficients of disease duration, involuntary detrusor contraction, and bladder filling volume were between 0.3 and 0.4.ConclusionBladder trabeculation with suprasacral-type neurogenic bladder was graded. Although disease duration was positively correlated with bladder trabeculation grade, differences in the neurological level of injury or American Spinal Injury Association Impairment Scale score were not observed. Bladder volume, peak detrusor pressure, compliance, reflex volume, and vesicoureteral reflux also showed significant differences according to trabeculation grade. Vesicoureteral reflux was moderately correlated with trabeculation grade.     

神经源性膀胱功能障碍评估与管理相关指南的整合研究

目的 对现有的神经源性膀胱功能障碍评估与管理相关指南进行整合,从而形成本土化证据资源。方法 以ADAPTE方法为依据,形成神经源性膀胱功能障碍评估与管理的临床护理实践草案,通过神经源性膀胱功能障碍患者与相关专家的相继论证,对推荐意见进行评价并整合,最终修订形成正式版指南。结果 最终纳入5篇循证指南,整合形成的指南内容包括神经源性膀胱功能障碍的分类、病史采集、相关检查、导尿建议及辅助膀胱管理措施共5个主题,共20条推荐意见。结论 本研究整合形成了神经源性膀胱功能障碍评估与管理领域高质量的循证资源,为临床中的循证护理实践提供了参考和依据。     

B超联合尿动力学检查在良性前列腺增生症诊断中的应用价值

目的探讨B超联合尿动力学检查在良性前列腺增生症(BPH)诊断中的应用价值。方法选取在我院进行手术治疗的120例BPH患者,术前均进行B超及尿动力学检查,比较B超、尿动力学检查及术后病理检查结果。结果前列腺体积<30 mL组和体积≥30 mL组的残余尿量、Qmax及Pdet-Qmax有显著差异(P<0.05)。非梗阻组的前列腺体积小于可疑梗阻组及梗阻组,前列腺突入膀胱长度短于可疑梗阻组及梗阻组;可疑梗阻组的前列腺体积小于梗阻组,前列腺突入膀胱长度短于梗阻组;三组的前列腺体积和前列腺突入膀胱长度有显著差异(P<0.05)。前列腺体积与Qmax呈负相关,与Pdet-Qmax呈正相关(P<0.05)。结论 BPH患者术前进行B超及尿动力学检查,对疾病的诊断及治疗方案的制定具有重要的指导意义。     

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。