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題 名 | 男性脊髓損傷患者長期腎功能之追蹤 |
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作 者 | 賴明偉; 藍青; 賴金鑫; 畢柳鶯; 連倚南; | 書刊名 | 復健醫學會雜誌 |
卷 期 | 22:1 1994.06[民83.06] |
頁 次 | 頁9-16 |
分類號 | 415.945 |
關鍵詞 | 脊髓損傷; 膀胱訓練; 二十四小時肌氨酸廓清率; 逼尿肌括約肌共濟失調; Spinal cord injury; SCI; Intermittent catherterization program; ICP; 24 hours creatinine clearance; Ccr; Detrusor-sphincter dyssynergia; DSD; |
語 文 | 中文(Chinese) |
中文摘要 | 本研究目的是要探討外傷性脊髓損傷(Traumatic Spinal Cord Injury)患者腎功能的長期變化。在45例男性脊髓損傷患者中,平均年齡為41.5±18.5歲。四肢麻痺者有17例。下半身麻痺者有28例。這些病例從發病到接受尿路動力學檢查間隔平均為28±21個月。全部患者至少接受兩次尿路動力學檢查,且間隔需大於1年。同時每位患者均接受尿液分析及培養,靜脈腎孟造影(IVP),排尿膀胱尿道造影(VCUG),膀胱壓檢查及括約肌肌電圖,二十四小時肌氨酸廓清率(24 hours creatinine clearance, Ccr),其中有19例做過核醫檢查,有35例做過膀胱鏡檢查。 以Ccr做為腎功能的指標,結果發現患者在追蹤期中是否能維持較佳腎功能與下列三因素有關:(1)膀胱訓練成功者較未接受訓練或訓練失敗者為佳(75±21 vs 56±27,P<0.05),(2)下半身麻痺者較四肢麻痺者為佳(71±27 vs 60±21,p<0.05),(3)下運動元性膀胱功能障礙者較上運動元性肺胱功能障礙者為佳(79±28 vs 60±21,p<0.05)。以膀胱訓練費用而言,接受訓練者平均每人花費約33,000元。如果考慮患者未接受訓練可能發生的併發症,適當的ICP仍其有必要性。而對上運動元性膀胱功能障礙者患者而言,因有相當高比率的(16/28例)逼尿肌括約肌共濟失調(detrusor-sphicter dyssynergia),對於此群患者即使訓練成功,仍需小心追蹤其腎功能的變化。此外,雖然Ccr的敏感性不如核醫等檢查,但如改良Ccr留尿技術後,仍不失為一經濟有效之長期追蹤腎功能的方法。 |
英文摘要 | The purpose of this study is to discuss the long term changes of renal function in traumatic spinal cord injured patients. This study was carried out on 45 male cases who suffered from complete traumatic spinal cord injury. As a result of injury 17 cases were quadriplegic, 28 were paraplegic. The mean age of these cases was 41.5 years (range from 21 to 60 years). The mean period of these cases since onset to receiving urodynamic study was 2 years and 4 months (range from 1 month to 14 years). All of these cases had accepted at least two urodynamic studies with interval longer than 1 year. Meanwhile, every case had been followed by urine analysis and culture, intravenous renography, voiding cystourethrography, cystometry with sphincter EMG and 24 hours creatinine clearance (Ccr). There were also 19 cases followed by renal scan and 35 cases by cystoscopic examination. If Ccr is taken as a parameter of renal function, the results would reveal that the preservation of good renal function depends on the following 3 conditions: (1) successfully ICP trained cases got better result than untrained or failed cases (75±21 vs 56±27,P<0.05). (2)paraplegic cases got better result than quadriplegic cases (71±27 vs 60±21,p<0.05), (3)lower motor neuron type neurogenic bladder got better result than upper type (79±28 vs 60±21,p<0.05). Considering the cost of ICP training, the average cost for each trained case is 33,000 NT dollars. Comparing with the expensive spending for treating complications due to unbalanced neurogenic bladder, it is necessary to accept ICP training. However, as a patient with upper motor neuron type neurogenic bladder, in spite of balanced bladder, he must continue to monitor his renal function carefully because of the relatively high incidence of detrusor-sphincter dyssynergia. Though the Ccr test is not as sensitive as renal scan for detecting renal function, it still can become an economic and effective test for long term follow-up of renal function by modifying its collecting method. |
本系統中英文摘要資訊取自各篇刊載內容。