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題 名 | 脊髓損傷患者泌尿併發症及其危險因子之探討=Urological Complication and Its Risk Factors for the Patients with Spinal Cord Injury |
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作 者 | 張時中; 蔡素如; 董莉貞; 畢柳鶯; | 書刊名 | 復健醫學會雜誌 |
卷 期 | 28:2 2000.06[民89.06] |
頁 次 | 頁71-76 |
分類號 | 415.945 |
關鍵詞 | 泌尿併發症; 危險因子; 泌尿系統追蹤; 脊髓損傷; Urologic complication; Risk factor; Urologic surveillance; Spinal cord injury; |
語 文 | 中文(Chinese) |
中文摘要 | 泌尿系統併發症為脊髓損傷患怕的主要罹病原因之一。本研究目的在探討中部地區脊髓損傷患者罹患泌尿併發症之種類及比例,並探討其相關危險因子。本研究對象為自1993年1月至1996年6月,於本院接受定期泌尿功能檢查之脊髓損傷患者共154名,平均年齡35.3±11.9歲,平均受傷時間47.3±55.9個月。其中男125人(81.2%),女性29(18.8%);屬於上運動神經元病變者有133例(86.4%),下運動神經元比變者有21例(13.4%)。使用留置導尿管者有17例(11%)。 研究對象所托受之泌尿功能檢查項目包括腎臟及膀胱超音波(sonography),同位素腎臟掃瞄(renal scan),排尿膀胱連道造影術(voiding cystourethrogram, VCUG),,靜脈注射泌尿系造影術(intravenous urography, IVU)。氣體膀胱壓力檢查(CO2 gas cystometry, CMG)只針對具有上尿路系統併發症患者施行。 154位受檢病人中,上尿路系統功能異常者有81例(52.6%),包括膀胱輸尿管逆流29例(18.8%),腎孟腎盞擴張71例(41%),其中19例同時有前述兩種併發症。證甸曾有尿路感染者有122例,其中男性98人(98/125),女性12人(12/29),不同性別間發生之例例有顯著差異(p<0.05)。男性與女性患者發生上泌尿系統併發症比例分別為55.2%(69/125)及41.4%(12/29),在統計上無顯著之差異。使用留置導尿管產生嚴重之上泌尿系統併發症者(47%, 8/17)較未使用留置導尿管而產生嚴重上泌尿系統併發症者(17.5%,24/137)之比例為高,達顯著之差異(<0.05)。受傷時間大於12個月而上泌統功能正常者所佔之比例(40.4%, 42/104)較受傷時間小於12個月而上泌尿系統功能仍正常者所佔之比例(62%, 31/50)為低,在統計有上有顯著之差異(p<0.05)。上、下運動神經元病變患者發生上泌尿系統併發症者分別為46.1%(71/154)與47.6%(10/21),無統計上的差異。 妥善處理排尿問題以及定期泌尿系統追蹤是脊髓損傷者預防泌尿併發症的重要原則。本研究顯示國內脊髓損傷患者定期接受泌尿功能檢查的情況不夠積極,泌尿併發症的發生機率仍偏高;使用留置尿管、男性及受傷時間較長之患者發生併發症機率較高。 |
英文摘要 | From January 1993 to June 1996, one hundred had fifty-four spinal cord injury (SCI) patients recived urodynamic studies, including urosonography, radionuclide renography, voiding cystoureth-ragrphy, intravenous urography, and/or cystometry. Among the subjects, 125 patients were male (81.2%) and 29 female (18.8%); there are 133 patients (86.4%) with upper motor neuron lesion and 21 (13.4%) with lower motor neuron lesion. One hundred and eleven patients (72.7%) had the history of symptomatic urinary tract infection, and urolithiasis was noted in 3 patients (1.9%). Upper urinary deterioration was noted in 81 patients (52.6%), including 29 vesicoureteral reflux and 71 pyelocaliectasis (19 patients had both complications). The percentage of males with urinary tract infection were significantly higher than the females (78.4% vs. 48.3%, p<0.05), but there was no significant difference of upper urinary deterioration with respect to gender. Patients using indwelling catheters had significantly higher incidence of urinary complications than those without (47% vs. 17.5%, p<0.05). Higher percent of patients with short duration after injury (<12 months) kept normal urologic function than those with long duration after injury (> 12 months) (62% vs. 40.4%, p<0.05). There was no significant difference in the incidence of urologic complications between patients with upper and lower motor neuron lesions (46.1% vs. 47.6%, p>0.05). Urologic complication is still one of the main causes of morbidity for patients with SCI. Proper bladder management and periodic urologic surveillance are the essential factors for prevention of urologic complication in SCI patients. Much progress should be made to improve the urologic condition for the SCI patients in our country. |
本系統中英文摘要資訊取自各篇刊載內容。