自我改良膀胱冲洗改善脊髓损伤致神经源性膀胱疗效的观察

[目的]探讨自我改良膀胱冲洗改善脊髓损伤致神经源性膀胱的疗效。[方法]选取符合标准的脊髓损伤致神经源性膀胱病人70例,按随机数字表法分为观察组(n=35)和对照组(n=35)。对照组由护理人员常规应用生理盐水500 mL为病人进行改良膀胱冲洗,2次/周;观察组由病人或照顾者应用生理盐水500 mL进行自我改良膀胱冲洗,2次/周。连续治疗12周后比较两组泌尿系结石率、尿培养阳性率和泌尿系感染发生率。[结果]两组治疗期间均未发生泌尿系结石,两组治疗期间尿培养阳性率和泌尿系感染发生率比较,差异无统计学意义(P0. 05)。[结论]脊髓损伤病人掌握自我改良膀胱冲洗技术,可以获得良好的神经源性膀胱疗效,改善脊髓损伤致神经源性膀胱病人生存质量。     

脊柱脊髓损伤并发泌尿系感染的防治

脊髓损伤患者由于留置的尿管长期在体内刺激,导致膀胱防御机制减退,其感染率相当高。因此,做好泌尿系护理就显得非常重要。现将扬州大学临床医学院骨科68例脊髓损伤患者泌尿系护理体会介绍如下。     

脊髓损伤患者泌尿系结石形成高危因素分析:128例报道

目的探讨影响脊髓损伤患者泌尿系结石形成的高危因素及其防治措施。方法回顾性分析128例脊髓损伤后泌尿系结石患者的临床资料及治疗方法。结果 128例患者中,膀胱造瘘32例,留置尿管定期更换34例,间歇导尿12例,叩击排尿19例,腹压排尿11例,间断尿失禁应用外部集尿器20例。128例患者中120例存在泌尿系感染,11例血钙升高。影像尿动力学提示逼尿肌无反射39例,逼尿肌过度活动63例,逼尿肌-尿道外括约肌协同失调41例,逼尿肌-膀胱颈协同失调11例,尿道外括约肌过度活动27例,尿道括约肌功能不全11例。部分患者同时存在数种上述病理生理状况。结论膀胱管理方式对脊髓损伤后泌尿系结石的形成有重要影响,脊髓损伤后下尿路感染、逼尿肌-尿道外括约肌协同失调等下尿路功能障碍、长期留置尿管和膀胱造瘘是泌尿系结石形成的高危因素。钙代谢异常可能是诱发泌尿系结石形成的高危因素之一。     

脊髓损伤病人留置尿管易感因素分析与护理对策

在临床护理中，脊柱骨折伴脊髓损伤病人往往不能自行排尿，需要留置尿管，有些还需要长期留置尿管，这就增加了泌尿系感染的机会。因此，做好留置尿管的护理，促使膀胱功能的修复或排尿功能，以尽早拔除尿管，是减少泌尿系感染的关键。我科2004年1月-2008年4月共收治脊柱骨折伴脊髓损伤病人197例，全部留置尿管。现介绍如下：     

脊髓损伤患者夜间尿量增多与膀胱功能训练的探讨

目的 根据脊髓损伤患者夜间尿量增多的情况对膀胱功能训练的方法进行探讨.方法 将68例脊髓损伤患者随机分为实验组与对照组,对照组采用传统膀胱功能训练方法,实验组根据脊髓损伤后患者夜间尿量增多的情况,分三期进行膀胱功能训练.结果 实验组尿管留置时间为(38.38±7.00)d与对照组(66.65±8.00)d比较有显著性差异,P<0.01,泌尿系感染发生率实验组(17.65%)与对照组(47.06%)比较有显著性差异,P<0.05.结论 根据脊髓损伤后患者夜间尿量增多情况,选择夜间间断放尿时间为2～3 h/次,进行膀胱功能训练,有利于膀胱功能恢复,缩短尿管留置时间,降低泌尿系感染.     

不同护理方法对截瘫患者泌尿系管理的临床观察

作者对６５例外伤致截瘫患者受伤早期实施两种不同的泌尿系管理方法。发现乙组采用改进的方法即插入尿管后留置３周，不更换尿管，不行膀胱冲洗，结果尿路感染率明显低于传统护理方法的甲组，Ｐ＜０．０１。对于脊髓性膀胱最后形成的结果，两组无明显差异，Ｐ＞０．０５。因此作者认为脊髓损伤致截瘫患者不管损伤平面和类型怎样，将来会形成何种脊髓性膀胱，早期留置尿管时应注意尽量地控制最少的导尿次数或最短的留置时间，尽可能限制引起感染的任何因素。乙组采用改进的方法，明显降低了泌尿系感染，且顺应了脊髓性膀胱形成发展规律，是脊髓损伤致截瘫患者早期泌尿系统管理简便、有效、可行的护理方法。     

无菌间歇导尿对脊髓损伤尿潴留患者恢复自主排尿功能的影响

目的 探讨无菌间歇导尿与常规留置尿管行膀胱训练对脊髓损伤尿潴留患者排尿功能的影响.方法 将67例脊髓损伤尿潴留患者分为对照组和观察组,对照组33例采用传统的留置尿管下膀胱训练方法,观察组34例采用拔除尿管间歇导尿方法,2个月后分析两组患者恢复自主排尿时间、残余尿量、每日自排尿量及泌尿系感染发生率.结果 观察组患者较对照组恢复自主排尿时间早,残余尿量少,每日自排尿量多,泌尿系感染发生率低,差异均有统计学意义.结论 对于脊髓损伤尿潴留患者损伤4周后即使未出现拔管指征,也可以将尿管拔除采用间歇导尿的方法继续训练膀胱功能,间歇导尿可使患者较快地恢复自主排尿功能,减少残余尿量,增加每日自主排尿量,降低泌尿系感染发生率.     

间歇导尿在降低脊髓损伤神经源性膀胱患者泌尿系感染中的应用

目的基于神经源膀胱护理指南,探讨间歇导尿在预防脊髓损伤神经源性膀胱患者泌尿系感染的作用。方法将符合纳入标准的100例脊髓患者随机分为留置导尿(对症组)和间歇导尿(观察组),2组分别在护理第7d和14d的留取晨尿进行尿沉渣镜检和尿培养,并观察其对生活质量的影响。结果间歇导尿患者泌尿系感染率明显少于留置导尿患者,患者生存质量明显改善,差异具有统计学意义(P0.05)。结论采用间歇导尿的方法,对脊髓损伤神经源性膀胱患者实施干预,能更好的预防脊髓损伤后泌尿系的感染。     

脊髓损伤病人留置尿管易感因素分析与护理对策

在临床护理中,脊柱骨折伴脊髓损伤病人往往不能自行排尿,需要留置尿管,有些还需要长期留置尿管,这就增加了泌尿系感染的机会.因此,做好留置尿管的护理,促使膀胱功能的修复或排尿功能,以尽早拔除尿管,是减少泌尿系感染的关键.我科2004年1月-2008年4月共收治脊柱骨折伴脊髓损伤病人197例,全部留置尿管.     

脊髓损伤后非手术病人泌尿系管理的现状

综述了国内脊髓损伤后非手术病人泌尿系管理的重要性和现状,包括膀胱的排尿生理以及外部集尿器、留置导尿、间歇清洁导尿、手法排尿、反射性排尿和中医针灸等膀胱功能恢复的方法。     

脊髓损伤后神经源性膀胱的个体化康复护理

目的 探讨脊髓损伤后神经源性膀胱的最佳护理方法。方法 60例脊髓损伤后排尿障碍患者随机分为2组，分别采用传统护理法和个体化护理法，比较两组患者自主排尿时问和泌尿系统并发症发生率的差别，从而找到适宜的护理方法。结果 个体化护理组患者自主排尿早，并发症少。结论 针对脊髓损伤后神经源性膀胱的不同特点，实施个体化护理措施，更有利于膀胱功能恢复。     

Bladder trabeculation in spinal cord injury

Bladder trabeculation may occur as an early manifestation of neurogenic bladder following spinal cord injury. The prevalence of bladder trabeculation in relation to other urologic morbidity was assessed in this clinical study using a urologic flow sheet. Data were extracted from a retrospective chart review of 90 patients with spinal cord injury (71% men) regularly followed at a tertiary care center. The study population had a mean age of 33.4 +/- 3.4 years and a mean injury duration of 5.5 +/- 3.7 years. Bladder trabeculation was found in 57% overall and in 31% of patients within 12 months of injury and was significantly associated with male sex, vesicoureteral reflux (p = 0.05), bladder diverticulum, and upper motor neuron type of neurogenic bladder (p = 0.01). Comparing systems of drainage, trabeculation was significantly associated with intermittent catheterization and an external collecting device or an external collecting device alone (p = 0.01). Elevated intracystic pressure in trabeculation development in the neurogenic bladder is related to any combination of bladder overdistention, outflow obstruction, and uninhibited detrusor contractions.     

Neurogenic bladder in spinal cord injury

In the past, renal failure was the leading cause of death after spinal cord injury (SCI). Today mortality from SCI has declined dramatically partly owing to the improved management of urologic dysfunction associated with SCI. The goals of bladder management in spinal cord injury patients are intended to (1) ensure social continence for reintegration into community, (2) allow low-pressure storage and efficient bladder emptying at low detrusor pressures, (3) avoid stretch injury from repeated overdistension, (4) prevent upper and lower urinary tracts complications from high intravesical pressures, and (5) prevent recurrent urinary tract infections. This article provides an overview of neurogenic bladder dysfunction associated with SCI and current management options.     

个体化护理对脊髓损伤患者神经源性膀胱康复的影响

目的探讨脊髓损伤患者神经源性膀胱最佳康复训练方法,针对脊髓损伤后神经源性膀胱的不同特点,实施个体化护理。方法采取随机对照法将143例脊髓损伤患者随机分为两组,对照组65例脊髓损伤患者进行常规护理;实验组78例患者依照脊髓损伤平面不同进行个体化膀胱功能训练并予以间歇导尿。观察并记录两组患者自主排尿时间、残余尿量、泌尿系统感染等情况。结果实验组与对照组相比较残余尿量减少、自主排尿时间缩短、泌尿系感染发生率降低,差异均有显著意义。结论个体化护理能有效恢复膀胱生理功能,降低脊髓损伤患者泌尿系统并发症的发生。     

Rehabilitation care of patients with neurogenic bladder after spinal cord injury: A literature review

This article reviews the research progress of rehabilitation treatment and nursing care of patients with neurogenic bladder after spinal cord injury, in order to provide reference for the rehabilitation treatment and nursing care of patients. We reviewed recent medical literature on patients with neurogenic bladder, focusing on neurogenic bladder caused by spinal cord injury. We analyzed 30 recent of publications in patients with neurogenic bladder after spinal cord injury, in addition to reviewing and evaluating the commonly used rehabilitation nursing methods for neurogenic bladder. Psychological counseling is a vital aspect which cannot be neglected in the process of neurogenic bladder rehabilitation. Hitherto, the commonly used drug and surgical treatments may have negatively impacted the mental health of patients in varying degrees. However, in clinical practice, applying intermittent catheterization in patients who have neurogenic bladder with spinal cord injury may help improve patients’ life quality, mitigate psychological burden, and reduce negative emotions.     

Sonographic diagnosis of hydronephrosis in patients with spinal cord injury: influence of bladder fullness

Objective: To investigate and compare the diagnostic accuracy of prevoid and postvoid renal sonography in detecting hydronephrosis in patients with spinal cord injury.Study Design: A prospective, blind comparison of renal sonography and excretory urography in 67 spinal cord injury patients who underwent periodic urologic examinations. Renal sonography was performed twice, once when the patient's bladder was physiologically full (prevoid) and again when it was just emptied (postvoid).Results: Of 140 kidneys, 24 from 16 patients were found to have hydronephrosis by excretory urography; 116 kidneys had normal urogram findings. Prevoid sonography missed the diagnosis of hydronephrosis in one kidney and showed hydronephrosis in 18 kidneys that had normal results on excretory urography (sensitivity, 95.8%; specificity, 84.5%; negative predictive value, 99.0%). The postvoid sonograms did not detect hydronephrosis in four kidneys and showed hydronephrosis in six kidneys that had normal results on excretory urography (sensitivity, 83.3%; specificity, 94.8%; negative predictive value, 96.5%). Compared to excretory urography, renal sonography detected eight more upper urinary tract abnormalities, which were confirmed by cystograms or radioisotopic renograms.Conclusion: Performing renal sonography while the bladder is full can increase the sensitivity in detecting hydronephrosis in asymptomatic spinal cord injured patients.     

Antibiotic therapy for patients with spinal cord injury undergoing urologic procedures

This prospective study was performed to determine whether gentamicin can be prescribed routinely to patients with spinal cord injury undergoing urologic procedures, or whether antibiotic therapy must be selected on the basis of recent urine microbiologic test results. Between January 2004 and June 2005, procedures were performed on 38 patients, all of whom were prescribed antibiotics on the basis of a microbiology report. Sixteen patients who underwent urologic surgery during 2003 and received gentamicin empirically served as a control group. The patients clinical course was monitored for postprocedure sepsis. Only 12 patients received gentamicin as the sole antibiotic; 10 patients required an additional antimicrobial for urine samples that grew more than 1 organism and contained bacteria resistant to gentamicin; 26 patients needed antibiotics other than gentamicin for gentamicin-resistant uropathogens. Three patients with organisms sensitive to gentamicin as well as another antibiotic received an agent considered less nephrotoxic than gentamicin. After the procedure, sepsis occurred in only 1 patient, a man with chronic lymphocytic leukemia and small cell carcinoma of the urinary bladder. Three control group patients developed a fever in excess of 39°C. One of these patients did not require a change of antibiotic, another patient recovered after 3 changes of antibiotic, and the third patient recovered from septicemia after receiving ventilatory support. Antibiotics should be prescribed on the basis of recent urine microbiologic test results, and empiric therapy with gentamicin should be avoided in patients with spinal cord injury who are scheduled to undergo urologic procedures.     

阴部神经电刺激干预脊髓损伤后神经源性膀胱：功能重建的文献研究

背景：研究证实,以阴部神经为作用靶点,通过对频率、强度、脉宽的调整,调节膀胱逼尿肌和尿道括约肌的协同作用,可改善脊髓损伤后神经源性膀胱功能障碍。目的：了解阴部神经电刺激干预脊髓损伤后神经源性膀胱功能障碍的研究现状。方法：计算机检索PubMed、Cochrane Central Register of Controled Trials（CENTRAL）、中国知网、万方和维普数据库中关于阴部神经电刺激干预脊髓损伤后神经源性膀胱功能障碍的研究报道,并追溯已纳入文献的参考文献。检索时间从建库至2014年7月。由2名研究人员独立进行文献筛选及资料提取。结果与结论：共纳入14篇文献。分析发现：阴部神经电刺激疗法对于脊髓损伤后神经源性膀胱功能障碍有一定疗效。该疗法通过调控阴部神经-膀胱反射及脊髓膀胱反射,从而调节逼尿肌及尿道括约肌的协同运动,改善膀胱壁的顺应性,促进膀胱功能恢复。针对脊髓损伤后神经源性膀胱功能障碍,阴部神经电刺激是一种可行的方法。但因目前临床研究较少,频率双向调节机制背后的神经生理学基础不明,干预强度的选择不明确,故仍需开展更多高质量的研究,以便更好地明确阴部神经电刺激疗法对脊髓损伤后神经源性膀胱功能障碍的干预效果及作用机制。     

Preliminary study of a genetically engineered spinal cord implant on urinary bladder after experimental spinal cord injury in rats

The objective of this study was to determine the effect of neurotrophin-secreting Schwann cell implants on the urinary bladder after spinal cord contusion. One hour after severe spinal cord contusion at the T8 to T11 level, carbon filaments containing nonsecreting Schwann cells, brain-derived neurotrophic factor (BDNF)-secreting Schwann cells, neurotrophin-3 (NT-3)-secreting Schwann cells, or Schwann cells secreting both BDNF and NT-3 were implanted into the spinal cord. Untreated spinal cord injured (SCI) rats and noncontused rats (C) were also studied. Two months after spinal cord injury, cystometry was performed and the bladders were studied using light microscopy. SCI rats had significantly increased bladder mass, thickness, and smooth muscle mass compared to C rats. Bladder capacity of SCI rats and rats with spinal cord implants were both significantly greater than that of C rats. This preliminary study suggests that neurotrophin-secreting Schwann cell implants may lead to improved bladder structure after spinal cord injury.     

76例脊髓损伤患者排尿方式接受度和满意度调查

目的比较脊髓损伤患者对各种排尿方式的接受度与满意度。方法对76例脊髓损伤住院康复患者进行排尿方式的问卷调查。结果61例患者能按照医生建议的方式进行排尿;15例不能。按使用频度顺序排列,脊髓损伤患者实际采用的排尿方式依次为间歇导尿（间导）43.4%、扣击或挤压排尿34.2%、留置尿管2.6%、外部集尿器（自动排尿）3.9%及其他综合方式15.8%。女性多趋向用间导。使用这些方式的总满意度为77.63%。结论医务人员不仅应根据患者的医学情况,而且还应根据患者的社会心理情况综合考虑,对脊髓损伤患者的排尿方式提出合理的指导和建议。