脑卒中尿失禁患者的预后研究

Prognosis of stroke patients with urinary incontinence

目的:探讨影响脑卒中后尿失禁患者预后的相关因素,以及尿失禁的恢复对脑卒中患者3个月预后的影响。方法:以住院的急性脑卒中患者发病两周内有尿失禁者为研究对象,记录其人口特征、脑卒中危险因素、最初脑卒中严重性(眼球运动障碍、失语、吞咽困难、意识状况),并进行神经功能缺损评分(NIHSS)、日常生活活动能力评分(BI)及简易精神状态测定(MMSE);3个月后随访,调查尿失禁恢复情况及功能康复情况(OHS),根据尿失禁的预后把患者分为两组:恢复自主排尿组和持续尿失禁组,并对两组患者以上各方面特征进行比较。结果:多因素Logistic回归分析发现:格拉斯哥昏迷量表评分小于或等于9分的患者比评分10～15分的患者3个月后持续尿失禁的可能性大犤OR=20.93;95%CI(4.32,101.36)犦;有认知功能缺损的患者3个月后恢复自主排尿的可能性小犤OR=14.19;95%CI(3.81,52.80)犦。3个月后生活不能自理者,在恢复自主排尿组18例(21%,18/86),持续尿失禁组24例(80%,24/30),差异有非常显著性意义(χ2=33.60,P<0.001)。结论:脑卒中急性期严重意识障碍、认知功能缺损是尿失禁预后不良的独立预测指标,持续尿失禁的脑卒中患者3个月后生活多不能自理。

AIM:To explore the related factors that influence the prognosis of stroke pati ents with urinary incontinence(UI) after stroke, and to study the effect of reco very from UI on the 3-month prognosis of stroke patients. METHODS:Acute stroke inpatients with UI within two weeks after episode were in volved in this study, their demographic data,risk factors of stroke,everity of s troke at first (ocular movement disorder,aphasia,dysphagia and status of awarene ss) were recorded.The patients were evaluated with national institute of health stroke scale(NIHSS),modified Barthel Index(MBI)and mini mental state examination (MMSE).After 3-month follow-up,the status of UI rehabilitation and functional rehabilitation were investigated by using Oxford handicap scale(OHS).The patient s were divided into two groups according to their prognosis of UI:automatic mict urition group and remaining UI group,and the items above were compared between t he two groups. RESULTS:Multiple Logistic regression analysis showed that the possibility of r emaining UI after 3 months was greater in the patients with the score of Glasgow coma scale ≤ 9 than those with the score of 10-15 [OR=20.93, 95%CI(4.32,101 .36)].It was almost impossible to recovery automatic miction after 3 months for the patients with cognitive impairment [OR= 14.19; 95%CI(3.81, 52.80)].After 3 months, there were 18 cases (21%, 18/86),in the automatic micturition group a nd 24 cases (80%,24/30)in the remaining UI group who could not take care of the mselves,and the difference between the two groups was significant (χ2=33.60, P< 0.001). CONCLUSION:Unconsciousness and cognitive impairment during the acute period of stroke are the independently predictive indexes of persistent UI.Most stroke pa tients with persistent UI cannot take care of themselves after 3 months.