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頁籤選單縮合
| 題 名 | 神經性因排尿障礙之尿路動力學及處置=Urodynamics and Management of Neurogenic Voiding Dysfunction |
|---|---|
| 作 者 | 郭漢崇; | 書刊名 | 慈濟醫學 |
| 卷 期 | 15:4 2003.08[民92.08] |
| 頁 次 | 頁205-221 |
| 分類號 | 415.8 |
| 關鍵詞 | 神經性因排尿障礙; 腦血管病變; 下尿路功能; 尿路動力學; Neurogenic voiding dysfunction; Cerebral vascular accident; Lower urinary tract function; Urodynamics; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 排尿動作是一個結合神經系統與膀胱、尿道等肌肉等系統的一個動作。當神經系統自中樞神經到周邊神經有損傷時,可能會影響到排尿動作的完整性,而導致病人的下尿路症狀。凡此神經性病變所造成之排尿功能障礙均稱之為神經性因排尿障礙(neurogenic voiding dysfunction)。由於神經性因排尿障礙會導致下尿路症狀,這些下尿路症狀都會使得排尿時產生殘尿或是高壓力性排尿,而導致病人泌尿,而導致病人泌尿系統的併發症,也會影響到腎臟功能,而產生末期之腎病變,病人可能需要提早進行血液透析以挽救其生命。對於神經性因排尿障礙之治療,我們也應該要根據病人潛在之病理生理學變化予以矯正,但也要考慮病人自我處理的能力如何,或是家人支持度,病人就醫的方便性,以及病人本身對於處置方式的意願。例如一個病人四肢全癱,並不能想要讓他使用間歇性自行導尿來排空尿液,當他家庭支持度相當低的時候,我們也不能期待家人給他做膀胱壓迫來排尿。如果病人不想拔除導尿管改用間歇性導尿管,我們也不能強迫病人使用我們提供較好的處置方式。在許多神經性疾病,例如:多發性硬化性、巴金森氏症,甚至是腦炎後遺症等等,病人的下尿路症狀都可能隨著其神經的復原或治療情況的改善,而有明顯的改變。因此對於這些病人我們必須反覆的加以檢查,對於其下尿路功能障礙的改變能夠充份掌握而提供適當的治療。在病人復原的過程當中,應該特別注意預防膀胱過度漲尿以及反覆的膀胱發炎之發生,尤其應該避免不必要的手術或是不正確的用藥。 |
| 英文摘要 | Micturition is an act combining both the nervous system and urethrovesical muscles. Lesions involving the nervous system can lead to voiding dysfunction and result in lower urinary tract symptoms. Neurogenic voiding dysfunction causes incomplete bladder emptying. A large residual urine volume and high voiding pressure; these sequelate further result in urologic complications such as urinary tract infection, genital tract infection, and deterioration of renal function. Urodynamic study is mandatory for determining lower urinary tract dysfunction following neurologic lesions. Changes in lower urinary tract urodynamics may affect the choice of treatment. Management of neurogenic voiding dysfunction should be based on the underlying pathophysiology of the voiding dysfunction, the ability of the patient to handle the situation himself, family support, and the convenience of medical care. Lower urinary tract dysfunction may improve with recovery of neurologic lesions. It is necessary to investigate serial urodynamic changes of the lower urinary tract for patients with neurogenic voiding dysfunction to determine the etiology such as cerebral vascular accidents, parkinson’s disease, transverse myelitis before adequate and proper treatment can be instituted. During the recovery period, it is important to not over-distend the urinary bladder, to prevent urinary tract infection, and to avoid unnecessary surgery for the lower urinary tract. |
本系統中英文摘要資訊取自各篇刊載內容。