卒中患者排泄需要知觉受损尿失禁的临床特征研究  

Clinical features of post-stroke urinary incontinence with impaired awareness of the need to void

作　　者：李振东[1] 甄君 孙华宾 徐晓华[1] 罗世坚[1] 寇丽[1] 

机构地区：[1]中山大学附属第五医院神经内科,广东珠海519000 [2]康复医学科 [3]泌尿外科

出　　处：《第三军医大学学报》2012年第15期1580-1583,共4页Journal of Third Military Medical University

摘　　要：目的了解卒中患者排泄需要知觉受损(impaired awareness,IA)尿失禁(urinary incontinence,UI)的临床特点。方法前瞻性连续观察225例住院急性卒中患者,评估排尿事件和排尿知觉、行脑CT/MRI检查;9例IA-UI患者检测尿动力学;随访患者6个月的存活和尿控制情况。结果发生UI 89例,其中急迫性UI 32例,IA-UI 57例。IA-UI的排尿愿望(P<0.01)、漏尿前膀胱充盈感(P<0.01)、对漏尿的知觉(P<0.05)较急迫性UI差,高龄(P<0.05)、全或部分前循环综合征(P<0.01)和有顶叶新病灶(P<0.05)者比较多,Barthel指数(P<0.01)和认知(P<0.05)评分差;尿动力学显示尿道压力低或逼尿肌活动过度;6个月存活和尿控制均较急迫性UI差(P<0.01)。结论高龄、排尿知觉障碍、前循环脑损害重、尿动力学不同和结局不良是卒中后IA-UI的临床特征。Objective To understand clinical features of urinary incontinence（UI） with impaired awareness（IA） of the need to void in patients after stroke.Methods Prospective study was carried out in 225 consecutive patients with acute stroke hospitalized in our department during August 2007 to December 2008.Their micturition events and micturition awareness were assessed,and brain CT/MRI scanning was performed.Urodynamic determination was finished in 9 patients with UI.Survival and micturition status of the patients with UI were traced during the 6-month follow-up.Results There were 32 urge UI and 57 IA-UI in the 89 identified UI.The patients with IA-UI had lower micturition desire（P〈0.01）,lower sensation of bladder filling before leakage（P〈0.01） and lower awareness of leakage（P〈0.05）,more advanced age（P〈0.05）,more parietal lobe involvement（P〈0.05）,more total or partial anterior circulation syndrome（P〈0.01）,less scores of BI（P〈0.01） and less scores of recognition（P〈0.01）than those with urge UI.The urodynamic determination showed low urethral pressure during the entire procedure or detrusor over-activity.Bladder sensation was reduced or absent at the same time.The numbers of survival patients with IA-UI and patients with urinary continence were lesser than those with urge UI after 6 months（P〈0.01）.Conclusion The IA-UI after stroke might characterize as advanced age,disorder of micturition awareness,greater brain damage in anterior circulation,various urodynamic patterns and poor outcome.

关 键 词：卒中 尿失禁 知觉 尿动力学 

分 类 号：R448[医药卫生—诊断学] R743.3[医药卫生—临床医学]