宫颈癌根治术后居家清洁间歇导尿患者出院准备度及影响因素调查

目的调查宫颈癌根治术后居家清洁间歇导尿患者出院准备度及影响因素,为实施针对性护理干预提供参考。方法采用一般资料调查表、出院准备度量表、出院指导质量量表对132例宫颈癌根治术后需要居家清洁间歇导尿患者进行调查。结果患者出院准备度总分为92.45±12.34;多元线性回归分析显示,居住地、主要照顾者、出院指导质量是宫颈癌根治术后居家清洁间歇导尿患者出院准备度的主要影响因素(P0.05,P0.01)。结论宫颈癌根治术后居家清洁间歇导尿患者出院准备度处于中等水平,临床医护人员应加强出院指导,根据患者情况给予针对性的干预措施,确保患者出院后的安全。     

间歇性自我清洁导尿术在宫颈癌术后尿潴留患者中的应用

目的探讨间歇性自我清洁导尿术在宫颈癌术后尿潴留患者中的应用效果。方法将120例宫颈癌术后尿潴留患者随机分为观察组和对照组各60例,观察组行间歇性自我清洁导尿,对照组予留置导尿。于术后第14天、第21天留取患者中段尿液进行细菌培养,术后第21天评估患者膀胱残余尿量情况。结果术后第14天、第21天两组泌尿系感染发生率比较,差异有统计学意义(均P0.01);术后第21天观察组残余尿量及膀胱功能恢复情况显著优于对照组(均P0.01)。结论间歇性自我清洁导尿术能显著降低宫颈癌术后尿潴留患者泌尿系感染发生率,对促进患者膀胱功能的恢复有积极作用。     

宫颈癌根治术后间歇导尿患者延续护理方案的构建

目的 构建宫颈癌根治术后间歇导尿患者延续护理方案,以规范间歇导尿延续护理实践.方法 结合奥马哈问题分类系统,在检索指南、专家会议基础上,采用Delphi法对20名专家进行2轮函询.结果 2轮函询问卷有效回收率均为100％,专家权威系数分别为0.920、0.926,方案重要性的Kendall's W系数分别为0.140、...     

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。     

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。     

前列腺增生尿潴留留置导尿的护理体会

<正>前列腺增生尿潴留是泌尿外科常见的疾病,留置导尿是最简单直接的处理方法。我院泌尿外科2007-01～2010-01共收治前列腺增生尿潴留患者104例,现将护理介绍总结如下。1资料与方法1.1临床资料本组104例,年龄55～85岁,平均75.6岁。病程10 d～10 a,合并慢性膀胱炎24例,心脑血管病、原发性     

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。     

针灸治疗宫颈癌术后尿潴留的研究

为探讨针灸对子宫颈癌术后神经损伤性膀胱功能障碍恢复的作用,选用健康雌性家兔３６只,随机分成造模组（子宫切除术后尿潴留模型）、针灸组（术后电针加艾灸治疗）和对照组,分别进行膀胱内压、排尿阈值、残余尿量、盆神经放电频率测定。结果：３组家兔随着膀胱内注入量的增加膀胱内压力随之增加,造模组明显低于对照组及针灸组（Ｐ〈０．０１,Ｐ〈０．０５）;膀胱排尿阈植造模组明显高于对照组及针灸组（Ｐ〈０．０１,Ｐ〈０．     

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.     

综合护理措施预防子宫颈癌术后尿潴留的疗效观察

目的研究宫颈癌患者广泛子宫切除术+盆腔淋巴结清扫术术后预防尿潴留的综合护理措施的疗效。方法122例宫颈癌术后病人随机分为对照组和试验组,对照组采用常规护理方法,试验组在常规护理方法上加用综合护理措施。2组尿潴留发生率之间利用检验,检验水准α=0.05。结果对照组和试验组的尿潴留发生率间差异显著(P0.005)。结论子宫颈癌术后尿潴留综合护理措施可以有效的减少尿潴留发生。     

Sacral neuromodulation for multiple sclerosis patients with urinary retention and clean intermittent catheterization

Introduction and hypothesis

Multiple sclerosis is a chronic, debilitating, neurological disease with numerous urological manifestations including urinary detrusor overactivity, detrusor sphincter dyssynergia, and urinary retention. Can sacral neuromodulation be successfully implemented for urinary retention in ambulatory women with multiple sclerosis?

Methods

Between January 2002 and January 2008, we conducted an observational retrospective case–control study where 12 of 14 consecutive, ambulatory women with multiple sclerosis had stage 1/2 sacral neuromodulation performed under general anesthesia for urinary retention.

Results

Twelve of 14 patients (86%) were successfully implanted, with a mean follow-up of 4.32?±?1.32 years and mean postvoid residual of 50.5?±?21.18 ml. The mean maximum uroflow was 17.7?±?7.9 ml/s. Two of the 12 patients (17%) required revisional surgeries for lead migration, and 40% needed battery replacement.

Conclusion

Urinary retention in multiple sclerosis female patients can be successfully and safely managed with sacral neuromodulation with few complications with a mean of 4 years follow-up.     

Female urethral strictures: successful management with long-term clean intermittent catheterization after urethral dilatation

OBJECTIVE: To report our experience in the diagnosis and treatment of urethral stricture in women. PATIENTS AND METHODS: A retrospective review of records and video-urodynamics identified women treated for urethral stricture between 1999 and 2004 at one institution by one surgeon. Urethral stricture was defined as a fixed anatomical narrowing between the bladder neck and distal urethra of <14 F preventing catheterization, and the diagnosis was confirmed by cysto-urethroscopy, and/or video-urodynamics. Women with a history of external beam radiotherapy to the pelvis, or of gynaecological, urethral or bladder malignancy, were excluded, and the women had a urethral biopsy to exclude a malignant cause of the stricture. Initial treatment consisted of urethral dilatation to > or = 30 F. After a period of indwelling catheterization, the women were placed on clean intermittent self-catheterization (CISC) at least once daily, and monitored every 3-6 months. At each follow-up, the urethra was catheterized to exclude recurrence. American Urological Association (AUA) symptom scores were obtained at presentation and at the initial 3 month follow-up. RESULTS: Seven women met the criteria for urethral stricture, and were followed for a mean (range) of 21 (6-34) months. All were initially maintained on daily CISC, and some were gradually reduced to weekly CISC for the duration of follow-up. No patient had a recurrent stricture while on CISC, and none has had a urethral reconstruction to manage their condition. AUA symptom scores improved in all of the women by a mean of 10.7 points. No complications related to catheterization were noted. CONCLUSION: Urethral stricture is rare in women. Long-term CISC in these women is safe and effective, and can avoid the need for major reconstructive surgery.     

基于信息-动机-行为模型的宫颈癌术后尿潴留带管出院患者的护理干预

目的探讨基于信息-动机-行为模型的宫颈癌术后尿潴留带管出院患者的护理干预效果。方法将96例宫颈癌根治术后14d首次拔除尿管时确诊的尿潴留患者,按照随机数字表法分为对照组和观察组各48例,对照组按常规进行尿管护理,指导患者进行盆底肌功能锻炼,面对面讲解并示范尿管的护理操作,并进行常规的出院随访;观察组实施基于信息-动机-行为模型的护理干预。比较干预后两组残余尿量、膀胱功能及尿路感染率。结果干预后观察组残余尿量和尿路感染率显著低于对照组,膀胱功能显著优于对照组,差异有统计学意义(P<0.05,P<0.01)。结论基于信息-动机-行为模型对宫颈癌术后尿潴留患者进行护理干预,可以降低其残余尿量和尿路感染率,促进膀胱功能的恢复。     

Bladder perforation secondary to clean intermittent catheterization

Clean intermittent catheterization has been an effective treatment for the management of patients with a neurogenic bladder during the last 15 years. Reported complication rates have been low and the majority of these problems have been minor. While significant problems are seen only rarely during clean intermittent catheterization, we recently diagnosed 2 potential life-threatening complications: bladder perforation and bladder necrosis. We present our experience with these major problems associated with routine clean intermittent catheterization.     

宫颈癌根治术后尿潴留预防和管理最佳证据的审查及障碍因素分析

目的 审查宫颈癌根治术后尿潴留预防和管理的最佳证据,分析循证护理实践中的障碍因素,为临床护理工作提供参考。方法 计算机检索最佳证据并总结,确定审查指标、审查方法,针对审查结果进行障碍因素分析。结果 依据12条最佳证据制订13条质量审查指标,障碍因素主要为培训不足、物资缺乏、医务人员意识问题、缺乏规范化管理。结论 临床科室需要结合临床环境、医务人员应用证据的促进因素及阻碍因素、患者意愿及偏好等有针对性地选择证据,同时应用者还需持续对证据进行更新。     

Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization

OBJECTIVE: To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. METHODS: A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. RESULTS: Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (<10 mL/cmH2O), detrusor overactivity, bladder trabeculation and the presence of vesico-ureteral reflux (VUR) to be significant factors in the incidence of febrile UTI. The presence of detrusor overactivity and a low bladder compliance, in addition to the presence of VUR, were found to be significant factors for the incidence of febrile UTI using a multivariate analysis. CONCLUSION: These results demonstrate that, in addition to VUR, urodynamics linked to bladder storage function disorder appear to be directly correlated with the cause of febrile UTI in children with myelodysplasia.