脊髓损伤患者泌尿系结石形成高危因素分析:128例报道  

Risk Factors of Urinary Calculus Formation for Spinal Cord Injury: 128 Case Report

作　　者：付光 靖华芳[1,2,3] 吴娟 李东[1,2,3] 鞠彦合[1,2,3] 梁文立[1,2,3] 熊宗胜[1,2,3] 廖利民 

机构地区：[1]中国康复科学所,北京市100068 [2]中国康复研究中心北京博爱医院泌尿外科,北京市100068 [3]首都医科大学康复医学院,北京市100068

出　　处：《中国康复理论与实践》2010年第12期1124-1126,共3页Chinese Journal of Rehabilitation Theory and Practice

基　　金：中央公益性科研院所基本科研业务费专项资助:住院脊髓损伤患者泌尿系结石流行病学特征调查及相关高危因素研究(2010CZ-13)

摘　　要：目的探讨影响脊髓损伤患者泌尿系结石形成的高危因素及其防治措施。方法回顾性分析128例脊髓损伤后泌尿系结石患者的临床资料及治疗方法。结果 128例患者中,膀胱造瘘32例,留置尿管定期更换34例,间歇导尿12例,叩击排尿19例,腹压排尿11例,间断尿失禁应用外部集尿器20例。128例患者中120例存在泌尿系感染,11例血钙升高。影像尿动力学提示逼尿肌无反射39例,逼尿肌过度活动63例,逼尿肌-尿道外括约肌协同失调41例,逼尿肌-膀胱颈协同失调11例,尿道外括约肌过度活动27例,尿道括约肌功能不全11例。部分患者同时存在数种上述病理生理状况。结论膀胱管理方式对脊髓损伤后泌尿系结石的形成有重要影响,脊髓损伤后下尿路感染、逼尿肌-尿道外括约肌协同失调等下尿路功能障碍、长期留置尿管和膀胱造瘘是泌尿系结石形成的高危因素。钙代谢异常可能是诱发泌尿系结石形成的高危因素之一。Objective To study risk factors of urinary calculus formation in spinal cord injured patients.Methods The clinical data of 128 patients with spinal cord injury following urinary calculi were retrospectively reviewed.Results Among the 128 cases,there were 32 cases receiving bladder stoma;34 cases,regular replacement of indwelling catheter;12 cases,intermittent catheterization;19 cases,triggered reflex voiding;11 cases,voiding by abdominal straining;20 cases,condom catheters with urine collection devices.120 cases presented with urinary tract infection,and 11 cases presented serum calcium increase.Video urodynamic suggested detrusor areflexia in 39 cases,detrusor overactivity in 63 cases,detrusor external sphincter dyssynergia in 41 cases,detrusor bladder neck dyssynergia in 11 cases,external urethral sphincter overactivity in 27 cases,and urethral sphincter deficiency in 11 cases.The pathology of several physiological conditions coexisted in some patients.Conclusion Bladder management after spinal cord injury have a major impact on urinary stones formation.Low urinary tract infection,detrusor-urethral sphincter dyssynergia and other lower urinary tract dysfunction,long-term indwelling urinary catheter and cystostomy were main risk factors for urinary calculus formation.The abnormal calcium metabolism after spinal cord injury may be a risk factor for calculus formation.

关 键 词：脊髓损伤 结石 泌尿系感染 影像尿动力学 

分 类 号：R694[医药卫生—泌尿科学]