脊髓损伤后康复期膀胱功能预后的相关因素  

Related factors of prognosis of bladder function during rehabilitation period for patients with spinal cord injury

作　　者：闫鹏 刘金辉 郑伟东 崔京福 马玉斐[1] 杜鹃[1] 母心灵[1] 杨小玉[2] YAN Peng;LIU Jinhui;ZHENG Weidong;CUI Jingfu;MA Yufei;DU Juan;MU Xinling;YANG Xiaoyu(Department of Spinal Surgery,Zhengzhou First People's Hospital,Zhengzhou,Henan 450004,China)

机构地区：[1]郑州市第一人民医院脊柱外科,450004 [2]吉林大学第二医院骨科,长春134001

出　　处：《中国骨科临床与基础研究杂志》2018年第6期338-342,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

基　　金：吉林省科技厅产业技术创新战略联盟项目(20150309002GX);吉林省科技型中小企业技术创新基金(SC201502001)

摘　　要：目的探讨脊髓损伤后康复期膀胱功能预后的相关因素。方法选择2006年4月至2016年6月郑州市第一人民医院收治的209例不完全脊髓损伤康复期患者,均行包括膀胱收缩练习在内的系统康复治疗,记录膀胱管理方式(包括留置导尿、耻骨上膀胱造瘘、清洁间歇性导尿及自主排尿),评估膀胱排尿功能。观察美国脊柱损伤协会(ASIA)分级、排尿感觉、膀胱内压等指标,对影响膀胱功能预后的相关因素进行分析。结果209例患者中单纯留置导尿率由45.0%下降至13.9%,自主排尿率由45.0%上升至53.1%;ASIA分级B、C、D级患者的自主排尿率分别为5.6%、25.7%和77.8%,随着脊髓损伤程度的减轻,自主排尿率逐渐增高(P<0.05)。94例入院时采用留置导尿的患者中,17例出院时恢复自主排尿,77例仍需导尿,前者排尿感觉恢复比例明显高于后者(P<0.05);91例愿意接受膀胱内压检测,其中出院时自主排尿患者其膀胱内压异常比率低于导尿患者,但差异无统计学意义(P>0.05)。结论 ASIA分级和排尿感觉与脊髓损伤后康复期膀胱功能预后密切相关,对于大多数ASIA分级D级或有明确排尿感觉的患者无需进行尿道干预,可自主排尿;膀胱内压检查对于评估排尿功能具有一定的参考价值,但对于膀胱管理方式的选择并无决定性作用。Objective To explore the related factors of prognosis of bladder function during rehabilitation period for patients with spinal cord injury (SCI). Methods A total of 209 patients with incomplete SCI treated by systemic rehabilitation training including bladder contraction exercises at Zhengzhou First People's Hospital from April 2006 to June 2016 were selected. Bladder management methods including indwelling catheterization, suprapubic cystostomy, clean intermittent catheterization and autonomous urination were recorded, bladder urinary function was evaluated, indicators such as American Spinal Injury Association (ASIA) grading, urinary voiding sensations, intravesical pressure were observed, and the related factors affecting the prognosis of bladder function during convalescent period were analyzed. Results The rate of indwelling catheterization alone decreased from 45.0% to 13.9%, and the rate of autonomous urination increased from 45.0% to 53.1%. As for ASIA grade B, C and D, the rate of autonomous urination was 5.6%, 25.7% and 77.8% respectively, which showed that the autonomous urination rate gradually increased with the alleviation of degree of SCI ( P < 0.05). Of 94 patients with indwelling catheterization at admission, 19 restored autonomous urination at discharge, while 77 patients still needed catheterization, the former patients had a significantly higher rate of recovery of urination sensation than the latter ( P < 0.05);Among 91 patients who were willing to accept intravesical pressure test, the abnormal intravesical pressure rate in patients with autonomous urination was lower than that in patients with catheterization at discharge, but there was no significant difference ( P > 0.05). Conclusions ASIA grading and urinary voiding sensation are closely related to the prognosis of bladder function during rehabilitation period for SCI patients;Most patients with ASIA grading D or definite urinary voiding sensation can urinate autonomously without urethral intervention. Intravesical pressure examination

关 键 词：脊髓损伤 康复 预后 膀胱功能 排尿 尿动力学 

分 类 号：R651.21[医药卫生—外科学] R334.4[医药卫生—临床医学]