早期清洁间歇导尿在神经源性膀胱患儿中的应用  

Early application of clean intermittent catheterization in children with neurogenic bladder

作　　者：李延伟[1] 文一博[1] 何翔飞[1] 李云龙[1] 吴军卫[1] 冯锦锦[1] 文建国[1] 

机构地区：[1]郑州大学第一附属医院小儿尿动力学中心,450052

出　　处：《中华泌尿外科杂志》2017年第4期295-298,共4页Chinese Journal of Urology

摘　　要：目的探讨早期清洁间歇导尿（clean intermittent catheterization, CIC）对神经源性膀胱（neurogenic bladder，NB）患儿的疗效。方法2007年1月至2010年1月我院尿动力中心确诊为NB的患儿87例，就诊时均〈1岁，并分别在不同年龄行CIC治疗，其中64例患儿获长期随访。根据此64例治疗时年龄分为两组，1岁之前行CIC治疗者为早治疗组，3岁之后治疗者为晚治疗组。其中早治疗组29例，男19例，女10例；年龄4～11个月，平均7．5个月；合并显性脊柱裂术后4例，隐性脊柱裂22例，骶骨发育不良2例，脑膜炎1例。晚治疗组35例，男20例，女15例；年龄5～11个月，平均8．0个月；合并显性脊柱裂术后2例，隐性脊柱裂28例，骶骨发育不良4例，盆腔手术术后1例。两组就诊时膀胱顺应性、最大膀胱压测定容量和膀胱安全容量差异无统计学意义。对成功随访6年的64例患儿进行尿动力学参数和并发症的比较。结果随访3年发现早治疗组CIC后的膀胱顺应性、膀胱安全容量和最大膀胱压测定容量[（8．5±1．9）ml／cmH2O、（140±25）ml、（142±29）m1]显著高于晚治疗组[（7．0±2．2）mlfcmH2O、（110±31）ml、（120±28）ml；均P〈0．05]。随访6年发现早治疗组的膀胱顺应性、膀胱安全容量和最大膀胱压测定容量[（12．0±2．5）ml／cmH2O、（210±26）ml、（230±30）m1]显著高于晚治疗组[（9．3±2．3）ml／cmH2O、（192±31）ml、（205±35）ml；均P〈0．05]；膀胱输尿管反流比例[24．1％（7／29）]显著低于晚治疗组[54．3％（19／35），P〈0．05]，早治疗组中6例（20．7％）血肌酐和尿素氮升高，显著低于晚治疗组的17例（48．6％）（P〈0．05）。结论NB患儿早期进行CIC要比晚期应用效果更好。Objective To investigate the effect of early application of clean intermittent catheterization（CIC） in infants with neurogenic bladder（NB）. Methods Eighty-seven children with NB diagnosed in our urodynamic center were less than 1 year old when they first came to hospital from January 2007 to January 2010, and CIC was carried out at different age. Sixty-four patients were followed up for a long time and divided into early CIC group（ less than 1 year old children） and late CIC group （more than 3 years old children） according to the treatment time. Early CIC group included 29 patients [ 19 boys and 10 girls with the mean age of （7.5±2. 8 ） months ]. And 4 cases were suffering from postoperative spina bifida manifesta; 22 cases with spina bifida oceulta;2 cases with sacral dysplasia;1 case with meningitis. Late CIC group included 35 patients [20 boys and 15 girls with the mean age of （8.0 ±2. 9） months]. 2 cases were suffering from postoperative spina bifida manifesta; 28 cases with spina bifida occuha;4 cases with sacral dysplasia ; 1 case with postoperative pelvic surgery. Before the treatment, there were no significant differences of the bladder compliance （BC） , the maximum cystometric capacity （MCC） and the safety bladder capacity （SBC） between two groups. Urodynamic parameters and complications of 64 patients who were successfully followed up for 6 years were compared. Results After 3 years follow up, BC , SBC and MCC in early CIC group [ （8. 5 s±1.9） ml/cmH2O, （ 140 ±25 ） ml, （ 142 ±29） ml ] were significantly higher than those of late CIC group [ （ 7. 0 ±2. 2 ） ml/cmH2O, （ 110 ±31 ） ml, （ 120 ±28 ） ml; all P 〈 0. 05 ]. After 6 years follow up, BC, SBC and MCC in early CIC group [ （12. 0 ±2. 5） ml/cmH20, （210 ±26） ml, （230 ±30）ml]were significantly higher than those of late CIC group [ （9. 3 ±2. 3） ml/cmH2O, （ 192 ±31 ） ml, （205 ±35 ） ml; all P 〈 0. 05 ], and the vesicoureteral reflux rate[ 24. 1% （7/29）]

关 键 词：神经源性膀胱 清洁间歇导尿 早期 

分 类 号：R726.9[医药卫生—儿科]