间歇性清洁导尿治疗神经源性膀胱的疗效和随访结果  

Treatment of neuropathic bladder with clean intermittent catheterization

作　　者：毕允力[1] 阮双岁[1] 陆良生[1] 郑继翠[1] 葛琳娟[1] 

机构地区：[1]复旦大学附属儿科医院,上海200032

出　　处：《中华小儿外科杂志》2008年第7期391-393,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的回顾性分析我院神经源性膀胱患儿经间歇性清洁导尿（CIC）治疗和长期随访的临床资料，总结这一方法的治疗效果。方法2001年1月至2006年5月共治疗57例，男38例，女19例，年龄3个月至17岁。反复尿路感染病例35例，尿失禁45例。上尿路扩张积水SFU分级3～4级38侧，0～2级39侧。尿动力检查逼尿肌无收缩或功能低下12例，逼尿肌过度活动10例，括约肌关闭功能不全39例，逼尿肌括约肌不协调或括约肌过度活动20例。结果57例中36例获长期随访。完全采用CIC排尿27例，采用crede动作辅助排尿4例，两者均有5例。导尿2～3次2例，4～6次25例，6次以上5例。每次尿量80-400ml。36例患儿中31例治疗前有反复发热性尿路感染，导尿后21例有菌尿，8例出现发热性尿路感染。治疗前尿失禁Likert评分平均为2．25，治疗后为4．04，t检验差别有统计意义。治疗前SFU分级2级以下为30侧，3级以上为42侧，治疗后2级以下40侧，3级以上32侧，卡方检验差别有统计学意义。结论CIC在神经源性膀胱的治疗中有重要意义，它对控制尿路感染，缓解尿失禁，改善上尿路扩张积水都有明显效果。Objective To retrospectively study the treatment of neuropathic bladder with clean intermittent catheterization （CIC）. Methods From Jan. 2001 to May. 2006, 57 cases were recruited in this research, including 38 males and 19 females, aged from 3mo to 17yr. Thirty-five of the patients had repetitive urinary tract infection（UTI）, and 45 patients had urinary incontinence. Hydronephrosis was evaluated using the Society of Fetal Urology （SFU） grading based on the long-axis sonographic appearance of the renal parenchyma and pelvicalyceal system. Thirty-eight kidneys had SFU grade 3 to 4 hydronephrosis, and 39 had 0 to 2. Urodynamic study revealed hypocontractile bladder in 12 cases, hyper-reflexive bladder in 10 cases, sphincter function failure in 10 cases and dyssynergia in 20 cases. Results Thirty-six of the patients had been followed up for a long term. Out of the 36 patients, 27 patients underwent CIC, 5 patients underwent CIC combined with crede maneuver, the other 4 patients just underwent crede maneuver. CIC was performed 2-3 times daily on 2 patients, 4-6 times daily on 25 patients and more than 6 times daily on 5 patients. The volume of expelled urine was 80-400 ml. Thirty-one patients had repetitive UTI before treatment. After CIC treatment, 25 had bacteriuria, and only 8 had episode of febrile UTI. For urinary incontinence, Likert score was 2.25 before treatment, and was significantly improved comparing with 4. 04 of post-treatment score. For hydronephrosis, 31） kidneys were degraded as SFU stage 2, and 42 kidneys were SFU stage 3 or 4 before treat ment. After CIC treatment, 40 were below stage 2 and 32 were above stage 3. There was significant difference between the two groups. Conclusions CIC is an important modality for neuropathic bladder. It is effective in controlling UTI and improving incontinence.

关 键 词：神经源性膀胱 随访研究 临床分析 疗效 

分 类 号：R686[医药卫生—骨科学]