延髓外侧梗死致尿潴留1例并文献复习  

Lateral medullary infarction oblongata urinary retention in one case and literature review

作　　者：孟庆芳[1] 张征[2] 李霞[1] 王蕾[1] 张明庆[1] 姬琳[1] 赵婧[3] 王兴臣[1] MENG Qingfang;ZHANG Zheng;LI Xia;WANG Lei;ZHANG Mingqing;JI Lin;ZHAO Jing;WANG Xingchen(Department of Neurology,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Shandong Province,Jinan 250001,China;Department of Emergency,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Shandong Province,Jinan 250001,China;Experimental Center,Shandong University of Traditional Chinese Medicine,Shandong Province,Jinan 250355,China)

机构地区：[1]山东中医药大学第二附属医院神经内科,山东济南250001 [2]山东中医药大学第二附属医院急诊科,山东济南250001 [3]山东中医药大学实验中心,山东济南250355

出　　处：《中国医药导报》2024年第6期189-192,共4页China Medical Herald

基　　金：山东省自然科学基金项目(ZR2020MH156)。

摘　　要：延髓外侧梗死是常见的脑干梗死综合征之一,但在临床上其导致尿潴留的病例并不多见。本文回顾性分析山东中医药大学第二附属医院收治的延髓外侧梗死致尿潴留的患者1例,患者以头晕、行走不稳为主要症状,同时发现存在急性尿潴留的临床表现,完善影像学检查后诊断为延髓外侧梗死;神经源性膀胱(尿潴留)。及时予以患者静脉溶栓、导尿及其他对症治疗,约1个月后其自主排尿功能完全恢复。尽管延髓外侧梗死导致尿潴留的病例不常见,但应充分了解并提高对此类情况的认知,做到全面预判,提前告知患者及其家属尿潴留的可能性及其预后,反之,在颅脑CT显示不佳、MRI完善不及时的情况下,对于眩晕症状明显而其他定位体征较少,同时又合并急性尿潴留的患者,也能给予脑干-延髓外侧部分-可能受损的提示,提高对后循环梗死的警惕和重视,给予及时、适当的处理,避免延治失治。Lateral medullary infarction is one of the most common brain stem infarction syndromes,but it is rarely associated with urinary retention in clinical practice.A case of urinary retention caused by lateral medullary infarction was retrospectively analyzed in the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine.Dizziness and walking instability were the main symptoms of the patient,and the clinical manifestations of acute urinary retention were found.After improving the imaging examination,the diagnosis was lateral medullary infarction;neurogenic bladder(uninary retention).Intravenous thrombolysis,catheterization,and other symptomatic treatments were given to the patient in time,and the spontaneous urination function was completely restored about one month later.Although the incidence of urinary retention caused by lateral medullary infarction is uncommon,it is important to fully understand and improve the awareness of this condition,achieve comprehensive prediction,and inform patients and their families of the possibility and prognosis of urinary retention in advance,on the contrary,in the case of poor brain CT display and incomplete MRI,for patients with obvious vertigo symptoms and few other localized signs combined with acute urinary retention,it can also give us hints of possible damage to the brainstem-lateral medulla bulbar part,improve vigilance and attention to posterior circulation infarction,and give timely and appropriate treatment to avoid delayed treatment and loss of treatment.

关 键 词：延髓外侧梗死 临床表现 尿潴留 脑桥排尿中枢 

分 类 号：R743.3[医药卫生—神经病学与精神病学]