自我清洁间歇导尿在香港脊髓损伤中心的应用和启示

详细介绍自我清洁间歇导尿在香港新界东联网大埔医院脊髓损伤中心的应用。报告了15例脊髓损伤合并膀胱功能障碍的截瘫患者住院期间进行自我清洁间歇导尿培训的经验,包括准备工作、操作程序、饮水计划、检测指标等,本组病人的泌尿系感染发生率20％明显低于文献记载留置导尿管的感染发生率,提示自我清洁间歇导尿应用于双上肢功能正常,无张力性膀胱或逼尿肌反射低下同时又有足够膀胱容量的脊髓损伤病人是可行的、安全的。     

间歇导尿术在脊髓损伤中的应用

脊髓损伤性患者绝大多数伴有神经性膀胱,其尿路康复对保障全面康复目标的实现、减少死亡率及致残率是极为重要的,我院自1989年3月以来先后,为53名截瘫患者施行无菌性间歇导尿术达一万余次。现将最初26例总结如下: 方法与结果 1适应证和方法 脊髓损伤后脊髓休克期的患者,如不合并有膀胱、尿道损伤,则膀胱容量正常,内压处于低压状态,应在3日内进行间歇导尿术以减少泌尿系感染和促进膀胱功能恢复。我院收治的截瘫患者大多来自全国各地,病史较长,由于初期对膀胱功能训练重视不够,不同程度存有泌尿系的改变,间歇导尿术应在进行泌尿系全面检查做出…     

间歇导尿记录单的设计

间歇导尿是协助脊髓损伤膀胱功能障碍患者恢复膀胱功能的重要手段。以往常规在一般护理记录单上记录导尿的时间、量、颜色等，经常出现记录不完全、不清楚，且记录繁琐，要了解患者膀胱功能时需花较多的时间阅读护理记录。为使护理人员能快速获得患者间歇导尿情况，笔者参考有关文献，结合间歇导尿记录的侧重点自行设计了间歇导尿记录单，介绍如下。     

间歇导尿记录单的设计

间歇导尿是协助脊髓损伤膀胱功能障碍患者恢复膀胱功能的重要手段[1].以往常规在一般护理记录单上记录导尿的时间、量、颜色等,经常出现记录不完全、不清楚,且记录繁琐,要了解患者膀胱功能时需花较多的时间阅读护理记录.为使护理人员能快速获得患者间歇导尿情况,笔者参考有关文献[2-3],结合间歇导尿记录的侧重点自行设计了间歇导尿记录单,介绍如下.     

脊髓损伤患者自我间歇导尿的可行性研究

脊髓损伤可致截瘫或四肢瘫及各种并发症 ,其中排尿障碍较为常见 脊髓损伤造成的排尿障 。碍可终身存在 排尿障碍可导致患者泌尿系统感 ,染 结石 肾积水 严重者可造成肾功能不全甚至 、 、 ,死亡 根 据 国 际 临 床 研 究 结 果 间 歇导 尿术 。 ,interm ittent catheterization IC 可明显减少泌尿( , )系统感染的机会[1] 由于患者不能长期住院治疗 。 ,因 此帮 助 患 者 学 习 自 我 间 歇 导 尿 interm ittent (self-catheterization ISC 或家属导尿术 以便他们 …     

脊髓损伤术后间歇导尿患者家属的健康教育

目的探讨对脊髓损伤术后间歇导尿患者家属实施健康教育的效果。方法将60例脊髓损伤需行间歇导尿的患者随机分成观察组和对照组各30例。两组患者入院后均给予常规护理,依据医院拟定的健康教育手册进行健康教育。观察组在此基础上对家属进行膀胱功能训练及间歇导尿相关知识的健康教育,包括记日记、观看多媒体视频、床旁练习等。结果干预4周后,观察组家属对间歇导尿知识的掌握情况显著好于对照组（均P〈0.01）;观察组患者白细胞尿发生率显著低于对照组（P〈0.01）;两组干预2周、4周时真性菌尿的发生率比较,差异无统计学意义（均P〉0.05）。结论对实施间歇导尿的脊髓损伤患者家属进行健康教育,可以提高家属的护理能力和专业技能,降低患者泌尿系感染的风险。     

脊髓损伤术后间歇导尿患者家属的健康教育

目的 探讨对脊髓损伤术后间歇导尿患者家属实施健康教育的效果.方法 将60例脊髓损伤需行间歇导尿的患者随机分成观察组和对照组各30例.两组患者入院后均给予常规护理,依据医院拟定的健康教育手册进行健康教育.观察组在此基础上对家属进行膀胱功能训练及间歇导尿相关知识的健康教育,包括记日记、观看多媒体视频、床旁练习等.结果 干预4周后,观察组家属对间歇导尿知识的掌握情况显著好于对照组(均P＜0.01);观察组患者白细胞尿发生率显著低于对照组(P＜0.01);两组干预2周、4周时真性菌尿的发生率比较,差异无统计学意义(均P＞0.05).结论 对实施间歇导尿的脊髓损伤患者家属进行健康教育,可以提高家属的护理能力和专业技能,降低患者泌尿系感染的风险.     

自我清洁间歇导尿在脊髓损伤神经源性膀胱患者中的应用

目的探讨自我清洁间歇导尿的应用对脊髓损伤神经源性膀胱患者的影响。方法将符合入选标准的80例患者按随机数字表法分为清洁间歇导尿组(自我清洁间歇导尿)和留置导尿组(长期留置尿管)各40例,比较两组患者4周后尿路感染发生率、出院3个月后残余尿量及日常生活活动能力。结果两组患者尿路感染发生率比较,差异有统计学意义(P0.01);出院3个月两组日常生活活动能力比较,差异有统计学意义(P0.01)。结论自我清洁间歇导尿优于长期留置尿管,有利于提高患者生活质量。     

宫颈癌术后尿潴留患者清洁间歇导尿的居家护理

目的 总结宫颈癌术后尿潴留患者清洁间歇导尿的居家护理措施。方法 对157例宫颈癌术后尿潴留患者,专科护士正确指导患者进行清洁间歇导尿操作,提高患者首次清洁间歇导尿成功率;通过多种健康教育方式,每日微信群规范化随访,适时电话指导,保证患者间歇清洁导尿的规范及导尿日记的正确记录,预防及减少尿路感染的发生;进行有效沟通,采取同伴教育缓解患者焦虑情绪。结果 112例（71.3%）通过规范化的居家护理最终顺利完成清洁间歇导尿,尿潴留治愈;45例（28.7%）患者因多种因素放弃治疗,改为留置尿管。结论 通过完整的、个性化的居家护理可以保证患者清洁间歇导尿的质量和安全,促进患者膀胱功能恢复,提高尿潴留治愈率。     

居家腹膜透析患者操作环境管理的效果评价

目的探讨居家腹膜透析患者操作环境管理对降低腹膜炎发生的效果。方法将361例居家腹膜透析患者按入组时间先后分为对照组164例和改进组197例,对照组给予常规护理和随访,改进组在此基础上采用自制居家腹膜透析环境评估表进行评估,并针对评估结果予以操作环境管理。结果干预1年内,改进组腹膜炎发生率显著低于对照组(P 0. 05),与腹膜炎有关的拔管率和病死率相对低于对照组,但差异无统计学意义(均P 0. 05)。改进组腹膜炎患者各项环境评分显著高于非腹膜炎(均P 0. 01)。结论对居家腹膜透析患者进行操作环境管理,能有效减少腹膜炎的发生。     

Catheter-associated urinary tract infections in patients undergoing transurethral surgery

A study of 75 patients undergoing transurethral surgery with relatively short-term urethral catheterization with a sterile closed gravity drainage system revealed a 72% over-all incidence of negative urine cultures after catheter removal. The combination of prophylactic use of antimicrobials and a standardized catheter care system is valuable for preventing catheter-associated bacteriuria.     

Cost-effective screening for urinary tract infections in urogynaecological patients

This study aims to test the cost-effectiveness of reagent-strip urine nitrite compared with microbiological laboratory testing for screening of urinary tract infections (UTI). The study is a retrospective review of 708 female patients who underwent cystometry during a 1-year period. Urine dipstick nitrite was used as a screening test for UTI while urine cultures were taken as an outcome. Symptoms of UTI were noted. Of 708 patients screened, 70 (9.9%) had a significant UTI. Only 32 (4.5%)of 708 patients were nitrite positive. Urine dipstick nitrite has sensitivity of 40%, specificity of 99%, positive predictive value (PPV) of 88 % and negative predictive value (NPV) of 94%. If the screening test included symptoms for UTI together with urine nitrite, the results are: sensitivity 89%, specificity 31%, PPV 12% and NPV 96%. A combination of screening with urine nitrite and UTI symptoms can increase sensitivity to 89%. A total of 29% of specimens (screen negative=nitrite negative/asymptomatic) can then be excluded from UFEME/culture testing, thus resulting in cost savings.     

Symptomatic urinary tract infections in patients on maintenance hemodialysis

15 episodes of symptomatic urinary tract infection are described in 11 patients on maintenance hemodialysis. The diagnosis was confirmed by clean-catch or simple voided urine samples where possible, urethral catheterization and bladder washout being used only in anuric patients. Treatment with oral antibiotics proved successful in 13 episodes but 2 patients with polycystic kidneys were admitted to hospital for intravenous therapy. Urinary tract infections are common in dialysis patients including those who are anuric, and patients with polycystic kidneys have an increased risk of serious complications.     

Analysis of urinary tract infections in patients undergoing prostatectomy

Analysis is presented of 260 patients on whom in the years 1974–1976 an operation for adenoma removal was performed. 115 patients (44.2%) had a permanently placed catheter or were repeatedly catheterized before operation, and 145 (55.8%) were able to urinate without any need for catheterization.In the group of preoperatively catheterized patients infection of the urinary system was demonstrated in 84 cases, which amounts to 75%. Among patients not catheterized before operation, infection already existed in 29 cases (20%).Operation by Millin's method was carried out in 181 patients; non-infected urine was postoperatively found in 40 cases, which amounts to 22.3%. 79 patients were operated on by the transvesical method; in this group non-infected urine was found in four cases, i. e. 5.1%.Calculated ² indicates a significant connection between the investigated items, consisting in a much more frequent occurrence of urinary system infection in patients operated on by the transvesical method.The duration of catheter reposition in the urinary bladder after prostatectomy considerably influences the number of postoperative infections of the urinary system.