脑卒中后尿失禁的发生与脑卒中1年结局的相关性

Objective To evaluate the relationship between post-stroke urinary incontinence(UI)and 1 year stroke outcomes.Methods One hundred and thirty consecutive cerebral stroke survivors were classified into 2 groups according to their incontinence status at 1 to 10 d after onset.The patients'baseline characteristics,1 year mortality rate,abilities in the activities of daily living(ADL)and Modified Rankin Scale(mRS)scores were compared.Multivariate analysis was applied to highlight UI risk factors and correlations between UI and 1 year outcomes.Results Total anterior circulation syndrome(TACS)numbers and National Institutes of Health stroke assessment (NIHSS)scores in the UI group exceeded significantly those in the non-UI group,and both were significantly associated with initial UI.The 1 year mortality rate,patients'ADL dependence and mRS scores in the UI group exceeded those in the non-UI group significantly.Initial UI was also significantly associated with the 1 year outcome independently,as well as with age＞75 years,Oxfordshire Community Stroke Project(OCSP)classification and initial NIHSS score.Conclusion UI is common in the patients with TACS and higher initial NIHSS scores.Initial UI predicts a poor 1 year outcome,SO treatment should be strengthened.     

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。     

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。     

脑卒中后尿失禁的治疗及护理进展

尿失禁是脑卒中后常见的并发症,严重影响病人的生活质量.本文对脑卒中后尿失禁的发病机制、治疗及护理进行综述.     

护理干预脑卒中后尿失禁

脑卒中后尿失禁直接影响患生活质量，目前通过护理干预可以有效地改善脑卒中患的尿失禁。对52例患进行较系统的康复指导和训练，取得较好效果。     

脑卒中后尿失禁的治疗与护理现状

正尿失禁是脑卒中后严重并发症之一,脑卒中存活者中尿失禁的发生率为44%～69%[1]。根据国际尿控协会(International Continence Society,ICS)的定义,尿失禁(urinary incontinence,UI)是指确定构成社会和卫生问题,且客观上能证实的不自主的尿液流出。卒中后尿失禁的发生严重影响患者预后和生活质量,其疾病管理也引起临床护理人员的关注。现就脑卒中患者尿失禁的治疗及护理综述如下。     

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。     

老年人尿失禁与衰弱的相关性分析

目的 探讨老年人尿失禁与衰弱的相关性.方法 回顾性分析473例住院老年患者的综合评估资料,尿失禁是采用症状诊断,衰弱是应用FRAIL量表筛查并测定躯体功能.应用多因素logistic回归探索尿失禁与衰弱的相关性.结果 身体强壮患者尿失禁的发生率是16.4％,衰弱前期患者尿失禁发生率为26.5％,而衰弱患者尿失禁的发生率...     

Efficacy of urinary guidelines in the management of post-stroke incontinence

Urinary incontinence (UI) is common occurrence among stroke survivors and impacts their recovery. This mixed method study examined the effects of implementation of evidence-based urinary guidelines by the Interdisciplinary (ID) team in the management of post-stroke UI in stroke survivors in an acute rehabilitation hospital in Southern California. Essential elements of the guidelines included assessment of the bladder pattern, the urinary WBC's, the implementation of a scheduled toileting program, pelvic floor exercises, and the administration of Vitamin C 500 mg. by mouth. Functional Independent Measure (FIM) scores and urinary white blood cells (WBC's) were used to evaluate the efficacy the guidelines. Post guideline implementation FIM scores and urinary WBC's demonstrated improvement over the pre-scores. These results indicate that positive stroke outcomes were achieved following implementation. In addition, the ID team, comprised of nurses, physical therapists, speech pathologists, and occupational therapists, was queried as to the member's knowledge and perceptions of their roles in the implementation of the guidelines. Highlighted themes from the ID focus groups were communication and structure, relating that the guidelines were useful in promoting collaborative practice among the ID team members.     

女性真性压力性尿失禁尿动力学参数与经阴道分娩次数的相关性研究

目的探讨女性真性压力性尿失禁尿动力学参数与经阴道分娩次数的相关性。方法对56例经阴道分娩生育的的真性压力性尿失禁患者行尿动力学检查，记录腹压漏尿点压测定（ALPP）和最大尿道关闭压（MUCP）、功能尿道长度（FUL）。分别对经阴道分娩次数与各个尿动力学参数进行直线相关分析。结果经阴道分娩次数与ALPP呈负相关（r=-0．349，P〈0.05），与MucP和FUL没有相关关系（r=-0．219，r=-0.178，均P〉0.05）。结论经阴道分娩在压力性尿失禁发病中有一定意义，分娩次数越多，尿失禁越严重。     

Relationship between health promotion lifestyle profiles and patient outcomes of biofeedback therapy for urinary incontinence

Computerized EMG biofeedback therapy is a conservative treatment option for patients with urge incontinence, frequency, and certain types of stress urinary incontinence. Patient motivation to follow through with treatment and home exercise program is an important factor for successful therapy. The Health Promotion Lifestyle Profile (HPLP) II measures the frequency of health-promoting behaviors. A preliminary study of 45 patients suggested the HPLP II is a valid and reliable predictor of patient motivation. Further research is needed to ascertain if the tool may serve to predict patients' commitment to biofeedback and subsequent success with therapy. Effective screening of patients can also reduce overuse of services and ensure appropriate use of percapitated dollars.     

Experience of the patient's success in facing post-stroke urinary incontinence: the patient's perspective

Objective: Post-stroke urinary incontinence (UI) is one of the sequelae of stroke. This situation affects all aspects of the patient's life – physically, psychologically, socially, and spiritually. This study aimed to investigate the experience of patients' success in facing a post-stroke UI.Methods: A qualitative study using the Rapid Assessment Procedure (RAP) approach was used in this study. Informants were selected using purposive sampling. In-depth interviews with as many as 8 patients who had recovered from post-stroke UI and living in the greater area of Southeast Sulawesi (Indonesia) were conducted. In-depth interviews were also conducted with 8 caregivers and 2 nurses. Data were analyzed using a thematic analysis approach and interpretation of data was based on Humanbecoming theory and Self-care deficit theory of nursing. Results: Five successful things the patients experienced during post-stroke UI were identified. The five successes were as follows: they provided information to get to know and understand post-stroke UI, followed the procedures to overcome post-stroke UI, conducted self-control exercises and stayed motivated, performed daily activities independently according to ability, and made use of family suppor t and peers' attention. Conclusions: These findings indicated that persistence, belief, independence, and social suppor t (family and peer) made patients to successfully face their post-stroke UI and improved their quality of life. These findings also became the basis for developing a post-stroke UI management model based on Humanbecoming theory and Self-care deficit theory of nursing.     

Risk factors for urinary incontinence one year after nursing home admission

Secondary data analysis was conducted from a longitudinal nursing home study to identify nonurologic risk factors for continence outcomes at 1 year after admission. Of 434 nursing home admissions, 196 subjects (45%) remained. At 1 year prevalence of incontinence was 43.8%. Age was not associated with prevalence or incidence. Risk factors identified were male gender, urinary incontinence and poor behavioral adjustment at 2 weeks, presence of dementia and impaired mobility at 2 months. Once established, incontinence tended to persist. The data suggest types of residents who might be targeted for early preventive intervention.     

Acute urinary retention and urinary incontinence

AUR is a commonly seen genitourinary emergency. It has many etiologies, including obstructive, neurogenic, pharmacologic, and extraurinary causes. Treatment is immediate bladder decompression by transurethral catheterization and treatment of the provoking etiology. Urinary incontinence is less commonly seen as a presenting complaint in the ED. For the emergency physician, the key lies in recognizing its underlying cause. Neurologic and pharmacologic causes need to be considered in all patients. Urinary incontinence that is not caused by a neurologic emergency can be referred for further outpatient evaluation.     

Correlation between lipophilicity and triptan outcomes

BACKGROUND: It has been suggested that triptans achieving higher central nervous system (CNS) levels should have an advantage in efficacy, if central actions are important. Objective.-Our aim was to correlate the efficacy and tolerability results of triptans with their lipophilicity. METHODS: Data for response and pain free at 2 hours, recurrence, adverse events (AE), CNS AE, and chest symptoms taken from Ferrari et al's meta-analysis publications for the recommended doses of oral triptans were correlated with their lipophilicity coefficients (logD(pH)7.4 = -2.1 almotriptan < -1.5 sumatriptan < -1.0 zolmitriptan < -0.7 rizatriptan < -0.2 naratriptan < 0.5 eletriptan). RESULTS: We found no significant correlation between lipophilicity coefficients and any of the analyzed parameters. There was, however, some correlation between lipophilicity and CNS AE (P = .09, r = 0.74) and, to a lesser degree, with a reduction in recurrence rate (r = -0.36). The r values for response and pain free with placebo correction ranged from 0.04 to 0.34, suggesting almost no correlation between lipophilicity and efficacy variables. CONCLUSIONS: According to this analysis, a higher lipophilicity does not seem crucial to improve triptan efficacy. This physico-chemical property, however, correlates with higher CNS AE and, possibly, lower recurrence rates.     

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。