【摘要】：目的:評估逼尿肌漏尿點壓(detrusor leak point pressure,DLPP)及膀胱安全容量(safety bladder capacity,SBC)在神經(jīng)源性膀胱患者間歇性導尿中的應用價值。方法:選取2015年7月~2016年7月在我院住院治療接受間歇導尿的脊髓損傷致神經(jīng)源性膀胱患者40例。根據(jù)隨機數(shù)字表法分為觀察組與對照組,各20例。對照組患者予以常規(guī)間歇導尿,根據(jù)殘余尿量確定間歇導尿次數(shù)。觀察組患者抽血查腎功能并行泌尿系B超及影像尿動力學檢查,明確患者的上尿路情況,同時測量其DLPP及SBC,進行間歇導尿時,依據(jù)飲水計劃及排尿日記找到排尿規(guī)律,在接近SBC的時間測量膀胱內(nèi)的尿量,嚴格在SBC內(nèi)實施間歇導尿。40例患者均有漏尿,均進行床旁盆底肌訓練。對患者進行為期1年的干預,兩組患者于干預前、干預1年時分別進行尿動力學檢查[包括DLPP、SBC、殘余尿量(residual urine volume,RUV)]、腎功能檢查(包括血尿素氮、肌酐),并采用焦慮自評量表(self-rating anxiety scale,SAS)及抑郁自評量表(self-rating depressive scale,SDS)分別評估患者心理狀態(tài),采用SF-36生活質(zhì)量量表(包括飲食、精神、睡眠及心理4個維度)評分評估患者的生活質(zhì)量。結(jié)果:每組患者干預1年時的DLPP、SBC、RUV、血尿素氮和肌酐、SAS和SDS評分及飲食、精神、睡眠、心理評分與干預前比較均明顯改善(P0.05)。干預前,上述各指標兩組間比較均無統(tǒng)計學差異(P0.05)。干預1年時,觀察組患者的DLPP、RUV均顯著低于對照組,SBC顯著高于對照組,血尿素氮、肌酐均顯著低于對照組,SAS、SDS評分均顯著低于對照組,飲食、精神、睡眠、心理評分均顯著高于對照組,差異均有統(tǒng)計學意義(P0.05)。結(jié)論:對脊髓損傷致神經(jīng)源性膀胱患者依據(jù)DLPP及SBC進行個性化的間歇導尿,可有效改善患者的尿動力學指標,促進其腎功能的恢復,同時消除患者心理不良情緒,且能顯著提高生活質(zhì)量。
[Abstract]:Objective: to evaluate the value of detrusor leakage point pressure (detrusor leak point pressure,DLPP) and bladder safety volume (safety bladder capacity,SBC) in intermittent catheterization in neurogenic bladder patients. Methods: from July 2015 to July 2016, 40 patients with neurogenic bladder caused by spinal cord injury were treated in our hospital. According to the random digital table method, the observation group and the control group were divided into observation group (n = 20) and control group (n = 20). The patients in the control group were given routine intermittent catheterization, and the times of intermittent catheterization were determined according to the residual urine volume. In the observation group, the renal function was examined by B-ultrasound and imaging urodynamics, and the upper urinary pathway was determined. at the same time, when DLPP and SBC, were measured for intermittent catheterization, the urination law was found according to the drinking water plan and urination diary, the urine volume in the bladder was measured at the time close to SBC, and intermittent catheterization was strictly carried out in SBC. All 40 patients had urine leakage and were trained in bedside pelvic floor muscle. The patients in the two groups were given urodynamic examination (including DLPP,SBC, residual urine volume (residual urine volume,RUV), renal function test (including blood urea nitrogen, creatinine), and self-rating anxiety scale (self-rating anxiety scale,SAS) and self-rating depression scale (self-rating depressive scale,SDS) to evaluate the psychological state of the patients before and 1 year after intervention. The quality of life (QOL) of patients was evaluated by SF-36 quality of life scale (including diet, spirit, sleep and psychology). Results: the DLPP,SBC,RUV, blood urea nitrogen and creatine, SAS and SDS scores, diet, spirit, sleep and psychological scores of each group were significantly improved compared with those before intervention (P 0.05). Before intervention, there was no significant difference between the two groups (P 0.05). After one year of intervention, the DLPP,RUV of the patients in the observation group was significantly lower than that in the control group, SBC was significantly higher than that in the control group, blood urea nitrogen and creatinine were significantly lower than those in the control group, SAS,SDS scores were significantly lower than those in the control group, and the scores of diet, spirit, sleep and psychology were significantly higher than those in the control group (P 0.05). Conclusion: individualized intermittent catheterization of neurogenic bladder patients caused by spinal cord injury according to DLPP and SBC can effectively improve the urodynamic indexes of patients, promote the recovery of renal function, eliminate the psychological malaise of patients, and significantly improve the quality of life.
【作者單位】： 首都醫(yī)科大學附屬北京康復醫(yī)院泌尿與代謝康復中心;
【分類號】：R694.5

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