尿动力学分析结合膀胱再训练对脊髓损伤后神经源性膀胱功能的影响  

The effects of urodynamic analysis and individualized bladder training on bladder function after spinal cord injury

作　　者：时美芳 朱美红 沈雅萍 顾旭东 孙燕 吴华 曾明 傅建明 李岩 Shi Meifang Zhu Meihong Shen Yaping Gu Xuclong Sun Yan Wu Hua Zeng Ming Fu Jianming Li Yan.(Rehabilitation Medical Center, The Second Hospital of Jiaxing City, Jiaxing 314000, China)

机构地区：[1]浙江省嘉兴市第二医院康复医学中心,嘉兴314000

出　　处：《中华物理医学与康复杂志》2017年第10期756-760,共5页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：嘉兴市科技局科研项目（2012AY1071-4）

摘　　要：目的 观察尿流动力学结合膀胱再训练方法对脊髓损伤后神经源性膀胱功能的影响。 方法 两组患者于治疗前和治疗8周后均采用Laborie尿动力学检查仪行尿流动力学检查，记录两组患者达到平衡膀胱的时间和治疗2、4、6、8周后泌尿系感染的发生情况。对照组患者于初次检查结束后即根据尿流动力学结果行常规药物和间歇性导尿干预，实验组患者在上述方案的基础上依据患者尿流动力学检查的结果制定个体化的膀胱再训练方案，并进行干预。 结果 治疗后，2组患者均可达到平衡膀胱，但实验组患者达到平衡膀胱所需的时间更短，与对照组同损伤节段患者比较，差异均有统计学意义（P〈0.05）。治疗2、4、6、8周后，实验组尿路感染发生率均优于对照组同时间点，差异均有统计学意义（P〈0.05）。治疗8周后，2组患者的VH2O、BC、Pves、Pdet均显著优于组内治疗前差异均有统计学意义（P〈0.05），且实验组上述指标分别为（306.79±29.25）ml、（4.29±1.79）ml/cmH2O、（48.79±18.75）cmH2O、（40.23±13.68）cmH2O，均显著优于对照组同时间点，差异均有统计学意义（P〈0.05）。 结论 对神经源性膀胱患者进行尿流动力学分析下实行膀胱再训练方法可有效恢复平衡膀胱并降低泌尿系感染率。Objective To explore any effect of combining urodynamic analysis with individualized bladder training in rehabilitating neurogenic bladder dysfunction after spinal cord injury. Methods Urology patients who had suffered a spinal cord injury were randomly divided into an experimental group and a control group. Both groups were given routine drugs and intermittent catheterization based on a urodynamics analysis using the Laborie urodynamic analyzer. The experimental group also received individualized bladder training for eight weeks. The bladder balance time and urinary infection rate of both groups were recorded 2, 4, 6 and 8 weeks after the intervention. Results After treatment, all of the patients were able to achieve bladder balance, but the average bladder balance time of the experimental group was significantly shorter than that of the patients in the control group with similar injuries. After 2, 4, 6 and 8 weeks the incidence of urinary infection in the experimental group was significantly lower than in the control group. Moreover, after the treatment the average bladder storage volume （VH2O）, bladder compliance （BC）, bladder pressure （Pves） and detrusor pressure （Pdet） of both groups were significantly better than before the treatment, but the results of the experimental group were, on average, significantly better than those in the control group. Conclusion Individualized bladder training can effectively promote bladder balance and reduce the risk of urinary infection after spinal cord injury.

关 键 词：脊髓损伤 神经源性膀胱 尿流动力学检查 膀胱再训练 

分 类 号：R493[医药卫生—康复医学] R651.2[医药卫生—临床医学]