逼尿肌漏尿点压及膀胱安全容量在神经源性膀胱患者间歇性导尿中的应用价值

发布时间：2019-06-12 06:41

【摘要】：目的:评估逼尿肌漏尿点压(detrusor leak point pressure,DLPP)及膀胱安全容量(safety bladder capacity,SBC)在神经源性膀胱患者间歇性导尿中的应用价值。方法:选取2015年7月~2016年7月在我院住院治疗接受间歇导尿的脊髓损伤致神经源性膀胱患者40例。根据随机数字表法分为观察组与对照组,各20例。对照组患者予以常规间歇导尿,根据残余尿量确定间歇导尿次数。观察组患者抽血查肾功能并行泌尿系B超及影像尿动力学检查,明确患者的上尿路情况,同时测量其DLPP及SBC,进行间歇导尿时,依据饮水计划及排尿日记找到排尿规律,在接近SBC的时间测量膀胱内的尿量,严格在SBC内实施间歇导尿。40例患者均有漏尿,均进行床旁盆底肌训练。对患者进行为期1年的干预,两组患者于干预前、干预1年时分别进行尿动力学检查[包括DLPP、SBC、残余尿量(residual urine volume,RUV)]、肾功能检查(包括血尿素氮、肌酐),并采用焦虑自评量表(self-rating anxiety scale,SAS)及抑郁自评量表(self-rating depressive scale,SDS)分别评估患者心理状态,采用SF-36生活质量量表(包括饮食、精神、睡眠及心理4个维度)评分评估患者的生活质量。结果:每组患者干预1年时的DLPP、SBC、RUV、血尿素氮和肌酐、SAS和SDS评分及饮食、精神、睡眠、心理评分与干预前比较均明显改善(P0.05)。干预前,上述各指标两组间比较均无统计学差异(P0.05)。干预1年时,观察组患者的DLPP、RUV均显著低于对照组,SBC显著高于对照组,血尿素氮、肌酐均显著低于对照组,SAS、SDS评分均显著低于对照组,饮食、精神、睡眠、心理评分均显著高于对照组,差异均有统计学意义(P0.05)。结论:对脊髓损伤致神经源性膀胱患者依据DLPP及SBC进行个性化的间歇导尿,可有效改善患者的尿动力学指标,促进其肾功能的恢复,同时消除患者心理不良情绪,且能显著提高生活质量。
[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.
【作者单位】：首都医科大学附属北京康复医院泌尿与代谢康复中心;
【分类号】：R694.5

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