143例产妇低钳产术后排尿情况观察及影响因素分析

目的 通过对钳产术后产妇排尿情况的观察与影响因素分析,探讨预防产钳术后尿潴留的观察要点及护理措施,以期降低其发生率.方法 采用回顾性分析法对某三级甲等医院2012年1月至2014年8月经阴道分娩并钳产术产后排尿情况进行分析,按照有无留置导尿管分为尿潴留组和非尿潴留组,其中非尿潴留组包括自行排尿及经处理排尿组,比较产妇年龄、产次、会阴完整性、新生儿出生体重、第一产程时间、第二产程时间、总产程时间、产后2h出血量、产后24 h出血量,产后血红蛋白(Hb)减少量、处理方式及结果等.结果 经阴道分娩并产钳助产的143例产妇中,27例发生了尿潴留,发生率为18.88％.尿潴留组较非尿潴留组产后2h、24h出血量、产后Hb减少量及产前导尿次数的差异有统计学意义(P＜0.05).产后2h出血量(383.33±179.91)ml、24h出血量(449.96±187.35)ml、产后血红蛋白(Hb)减少量(34.56±13.44)g/L及产前导尿次数≥2次是钳产术后尿潴留的高风险因素.结论 在第一产程中指导并监督产妇及时排空膀胱,减少胎头对膀胱的压迫,减少产前导尿次数,准确观察产后2h、24 h出血量及Hb变化,促进膀胱功能恢复的锻炼,对钳产术后尿潴留的发生具有重要意义.     

自制新型便器在自发性蛛网膜下隙出血患者排尿中的应用

目的 探讨自制便器在自发性蛛网膜下隙出血(SAH)患者中应用时对促进床上排尿的临床效果.方法 将新入院符合条件的80例Hunt-Hess分级0～2级的自发性SAH患者随机分为观察组和对照组各40例.对照组采取普通便器和常规督导排尿方法,观察组采取自制便器和常规督导排尿方法,比较2组患者自行排尿成功率、诱导排尿时间、诱导排尿过程中患者血压的变化、膀胱残余尿量.结果 观察组患者自行排尿成功率显著高于对照组,诱导排尿时间和膀胱残余尿量及诱导排尿过程中患者血压的变化均显著小于对照组.结论 自制便器可有效促进自发性SAH患者床上排尿,缩短诱导排尿时间,减少因排尿困难引起的血压波动和膀胱残余尿量.     

丹参注射液配合中药治疗皮层性尿频93例

目的:观察丹参注射液配合中药治疗皮层性尿频的疗效。方法:对93例皮层性尿频患者采用静脉注射丹参注射液的同时,肾气不固型加服右归丸,肺脾气虚型加服补中益气汤加味,均治疗3个疗程。结果:肾气不固型52例:治愈35例,好转12例,无效5例,总有效率90.38%。肺脾气虚型41例:治愈26例,好转12例,无效3例,总有效率92.68%。结论:丹参注射液配合中药治疗皮层性尿频有显著疗效。     

Nocturia Frequency,Bother, and Quality of Life: How Often Is Too Often? A Population-Based Study in Finland

Background

Nocturia (ie, waking at night to void) is common and disrupts sleep. Traditionally, one nightly episode has been regarded as clinically meaningless, yet the justification for this belief remains weak.

Objective

To evaluate the association among frequency of nocturia and bother and health-related quality of life (HRQoL).

Design, setting, and participants

In 2003–2004, a survey was mailed to a random sample of 6000 subjects aged 18–79 yr who were identified from the Finnish Population Register Centre (response proportion was 62.4%; 53.7% were females).

Measurements

HRQoL and bother from nocturia were examined in relation to self-reported nocturia frequency (using the American Urological Association Symptom Index and the Danish Prostatic Symptom Score). Bother from nocturia was assessed on a four-point scale (none, small, moderate, major). HRQoL was measured with the generic 15D instrument on a 0–1 scale with a minimum clinically important difference of 0.03.

Results and limitations

Degree of bother increased with nocturia frequency (p < 0.01). The most commonly cited degree of bother for those with one, two, and three nightly voids was no bother, small bother, and moderate bother, respectively. The mean age-adjusted 15D score for men (and women) without nocturia was 0.953 (0.950) and 0.925 (0.927) with one void per night, 0.898 (0.890) with two voids per night, and 0.833 (0.840) with three or more voids per night. Statistically significant decreases were found in 15D score and in all 15D dimensions except eating. Although the response rate was high, approximately one third of those contacted did not participate in the study.

Conclusions

At least two voids per night is associated with impaired HRQoL. The majority of people report having bother when the number of nocturia episodes is two and moderate or major bother when the number is three or more. One void per night does not identify subjects with interference from nocturia and, thus, is not a suitable criterion for clinically relevant nocturia.     

剖宫产术后康复治疗临床分析

目的：探讨产后康复治疗对剖宫产术后促进产妇泌乳、子宫复旧、排气、排尿方面的临床效果。方法：应用康复综合治疗仪进行治疗,并选择同期未用辅助治疗的100例剖宫产患者作为对照组,观察两组产妇泌乳、子宫复旧、排气、排尿方面的临床效果。结果：使用康复综合治疗仪治疗的剖宫产患者,泌乳率、泌乳量和术后子宫复旧程度明显优于对照组,术后肛门排气时间及拔除尿管后排尿时间与对照组比较显著缩短。结论：剖宫产后应用康复综合治疗仪能有效解除产妇痛苦,促进产妇产后康复,是一种安全、有效的康复辅助治疗,值得临床推广应用。     

Nocturia and complementary indices: determination and quantification of the cause of nocturia by frequency-volume charts in women with lower urinary tract symptoms

We evaluated differences between women with lower urinary tract symptoms (LUTS) with and without nocturia in terms of voiding habits, urine production and voided volumes in order to determine and quantify the cause of nocturia by using frequency-volume (FV) charts. At the initial visit, all patients underwent a detailed clinical evaluation including an International Prostate Symptom Score assessment, received a thorough explanation from the study coordinators, and were requested to complete a 3-day FV chart. Of the 123 women enrolled, 106 (86.2%) 20–83 years old (median age 55.0) completed the study. Nocturnal urine volume was higher in nocturics than in non-nocturics, but this was not statistically significant. Total daytime voided volume was lower in nocturics than in non-nocturics (P=0.030) but with no detectable difference in total voided volume. To identify possible risk factors, we examined age and night time parameters including the nocturnal bladder capacity index (NBCI), nocturnal polyuria index (NPI) and nocturia index (NI) by univariate logistic analysis. When nocturia was defined as voiding at least twice per night, age and NI were found to be associated with it by univariate analysis. These two variables were further analyzed using a multivariate logistic model to determine their association with nocturia. In the multivariate analysis, a positive association was observed between age and nocturia. Patients 50 years or older had a 3.9-fold higher risk [odds ratio (OR) 3.86; 95% confidence interval (CI) 1.60–9.31; P=0.003] of voiding at least twice per night than those younger than 50 years. In the same model, patients with NI greater than 1.5 had a 4.5-fold higher risk of voiding at least twice per night (OR 4.59; 95% CI 1.80–11.17; P=0.001). FV charts are valuable for determining the cause of nocturia in women with LUTS. Our findings suggest that age and the NI may be important variables in the evaluation of nocturia in women with LUTS.     

留置尿管早期定时开放对拔除尿管后排尿效果观察

目的:预防术后留置尿管拔管后排尿困难和尿潴留,减少拔管后再次导尿。方法:随机选择腹部手术留置尿管患者60例,分观察组30例,患者采用术后第1天尿管定时开放。对照组30例,采用直接开放尿管引流,拔管前夹闭尿管。两组均在膀胱充盈有尿意时拔管。结果:观察组拔管后第1次排尿平均时间为13.93min,第1次排尿成功率为96.7%(29/30);对照组拔管后第1次排尿平均时间为43.90min,第1次排尿成功率为66.7%(20/30)。结论:应用早期尿管定时开放的观察组拔管后排尿效果优于对照组。     

心-肾反射在调节兔肾水钠排出功能中的作用

目的： 研究不同浓度盐溶液所致的心房及血容量扩张通过心-肾反射对肾排钠利尿功能的影响，探讨心-肾反射在肾脏功能调节中的作用。方法： 取健康家兔分为生理盐水和高渗盐溶液组。去窦弓神经，左肾神经在近肾门处切断。导管经右颈外静脉插至右心房，以10 mL/min输入15%血容量的生理盐水和1.8%氯化钠溶液前后，观察中心静脉压（CVP）、左肾交感神经传出活动（ERSNA）、左、右肾尿量和排钠系数的变化。结果： 输液后高渗盐和生理盐水组 CVP分别升高75.00%±27.40%和64.00%±15.56%；ERSNA频率分别减慢63.00%±12.49%和44.00%±13.64%，平均群集时间分别缩短37.00%±16.49%和31.00%±10.69%，平均群集间期分别延长68.00%±27.04%和60.00%±18.38%；左肾尿量分别增加640.00%±155.39%和158.00%±28.10%，排钠系数分别增加376.00%±121.72%和132.00%±35.23%；右肾尿量分别增加 1 343.00%±429.95%和192.00%±32.26%，排钠系数分别增加856.00%±261.48%和300.00%±76.99%。结论： 在去窦弓神经家兔，不同浓度溶液所致的心房及血容量扩张可刺激心肺感受器，通过心-肾反射活动抑制ERSNA，使肾的排钠和排水增多，进而调整和维持机体血容量的相对稳定。     

陈竹教授基于伏痰理论治疗小儿排尿性晕厥临证经验

由于小儿排尿性晕厥现代病因不清,在临床中主要以急救及对症支持治疗为主,未能针对疾病病因治疗,且本病反复发作,增加患儿及家长心理负担。中医关于“晕厥”的论述可追溯到《黄帝内经》的记载,并由历代医家不断完善,形成独特的理论体系,具有明显优势。文章总结了陈竹教授治疗小儿排尿性晕厥的临证经验,其认为小儿排尿性晕厥病机主要为“痰浊久伏,待时而发”,病位主要在肝,而与心脾密切相关。针对久伏之痰,治疗主要以化痰、行痰、消痰为主,在此基础上结合小儿不同体质特点,辨证论治;取得良好疗效。附医案一则,以资验证。     

腹膜外保留骶前神经对低龄前列腺癌根治术患者勃起功能、精子质量、性生活质量及排尿功能的影响

目的:探讨腹膜外保留骶前神经对低龄前列腺癌根治术患者勃起功能、精子质量、性生活质量及排尿功能的影响。方法:选择2012年1月至2015年12月本院收治的前列腺癌患者80例,按照随机数字法分为两组,各40例,对照组实施常规手术治疗,观察组注重术中行腹膜外保留骶前神经保护,比较手术前后IIEF-5评分、两组术后精液常规及DFI指数、两组术后3月性功能相关指标及两组术后尿动力学检查结果。结果:术后观察组IIEF-5评分优于对照组(P0.05),观察组精子密度、精子活动率及活力均优于对照组(P0.05),且DFI指数小于对照组(P0.05);术后随访3月时,观察组出现性欲增强及勃起功能增强比例大于对照组(P0.05),出现勃起功能障碍比例低于对照组(P0.05);观察组最大尿流量显著大于对照组(P0.05),膀胱顺应性显著优于对照组(P0.05),最大逼尿肌压力及最大尿道压力均显著高于对照组(P0.05)。结论:低龄前列腺癌根治术术中注重行腹膜外保留骶前神经处理,能有效减少手术对患者术后性功能及排尿功能影响,提高术后精子质量及性生活质量。