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| 題 名 | 慢性脊髓病變患者的膀胱處理及尿路預後=Bladder Management and Urologic Outcome in Patients with Chronic Spinal Cord Lesions |
|---|---|
| 作 者 | 楊哲魁; 蔡素如; 陳怡君; 畢柳鶯; | 書刊名 | 臺灣復健醫學雜誌 |
| 卷 期 | 35:1 2007.03[民96.03] |
| 頁 次 | 頁25-32 |
| 分類號 | 416.27 |
| 關鍵詞 | 神經性排尿障礙; 膀胱處理; 泌尿系統併發症; 脊髓損傷; Neurogenic voiding dysfunction; Bladder management; Urologic complication; Spinal cord injury; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 在2004年2月至9月間,共有73例受傷兩年以上的脊髓病變病人於本院接受定期泌尿追蹤,包括男性55例,平均年齡為29.3±12.1歲,平均受傷期間為9.5 ± 6.9年。女性18例 (24.7%),平均年齡為32.0±13.0歲,受傷期間為7.0 ± 4.5年。研究方法採用病歷回顧方式登錄其目前的膀胱處理方式,受傷以來是否發生尿路併發症,其治療方式以及成效。本研究對象中自發病起就長期留置導尿管者有8人 (11.0%),經過膀胱訓練者有65人。膀胱訓練組男性維持自解者有67.3% (33/49),括約肌切開手術後自解者7.1% (3/49),間歇導尿者19.0% (11/49),改為留置導尿者2.4% (2/49)。膀胱訓練組女性能自解者68.8% (11/16),需間歇導尿者25.0% (4/16),改為留置導尿者6.3% (1/16)。尿路結石的發生率在留置導尿管組和膀胱訓練組分別為62.5% (5/8)和9.2% (6/65)。阻塞性泌尿病變的發生率在兩組分別為62.5% (5/8) 和32.3% (21/65)。留置導尿管組有較高的機率發生泌尿併發症。經過膀胱訓練者,仍可能有三分之一的機率得到阻塞性泌尿病變,但如果能定期追蹤泌尿系統,早期診斷、早期治療,其治療成效良好。經過膀胱訓練者約有三分之二可以自行解尿無需導尿管,且維持良好腎臟功能,對於有上尿路併發症徵候者而言,間歇導尿配合抗膽素激性藥物為較安全的處置方式。 |
| 英文摘要 | Between February and September 2004, 73 patients with spinal cord lesions of greater than 2 years duration were enrolled in this study. A chart review was conducted to record the manner in which the patients' bladder management, previous urologic complications, and any corresponding treatments and effects. Among the patients, 55 were male and 18 were female, with an average age of 29.3±12.1 and 32.0±13.0 years, respectively. The mean duration of the patients' injuries was 9.5±6.9 years in men, and 7.0±4.5 years in women, respectively. Group Ⅰ included 8 patients (11.0%) who had indwelling catheters since the time of their injury and group Ⅱ consisted of 65 patients who underwent bladder training to either void spontaneously or via intermittent catheterization. Of the male subjects in group Ⅱ, 67.3% (33/49) voided spontaneously, 7.1% (3/49) voided post-sphincterotomy, 19.0% (11/49) required intermittent catheterization, and 2.4% (1/49) were converted to an indwelling catheter. Of the female subjects in group Ⅱ, 68.8% (11/16) voided spontaneously, 25.0% (4/16) required intermittent catheterization, and 6.3% (1/16) were converted to an indwelling catheter. The incidence of urolithiasis in groups Ⅰ and Ⅱ was 62.5% (5/8) and 9.2% (6/65), respectively. The incidence of obstructive uropathy in groups Ⅰ and Ⅱ was 62.5% (5/8) and 32.3% (21/65), respectively. As a group, the patients with indwelling catheters had a higher incidence of urologic complications than those patients without an indwelling catheter. Approximately one-third of the patients in the bladder training group suffered from obstructive uropathy. Fortunately, all of the cases of obstructive uropathy were diagnosed early through routine urologic surveillance, and they were graded as mild and responded well to treatment. In conclusion, two-thirds of the patients in the bladder training group did not require an indwelling catheter and they could maintain normal renal function. Bladder training is clearly necessary and helpful for patients with spinal cord lesions. |
本系統中英文摘要資訊取自各篇刊載內容。