膀胱水扩张结合视觉反馈排尿训练在治疗脊髓损伤患者神经源性膀胱中的意义

Significance of byaluronate irrigation combined with visual feedback for neurogenic bladder in the patients with spinal cord injury

目的：观察膀胱水扩张结合视觉反馈排尿训练用于脊髓损伤后神经源性膀胱的疗效。方法2011年1月至2013年1月，我院收治脊髓损伤的神经源性小容量低顺应性膀胱患者15例。其中男10例，女5例，年龄32（18～64）岁。初期采用膀胱水扩张方法，在膀胱安全压力（＜40 cm H2O ）监测下，逐渐将小膀胱扩张到有效膀胱容量后开始视觉反馈排尿训练。膀胱水扩张前后，视觉反馈排尿训练后，均记录膀胱安全容量、基础和最高膀胱内压、自主排尿量、残余尿量、排尿时程等数据，并行泌尿系B 超及简易尿流动力学检查。结果经过2～12周膀胱水扩张训练后，除1例损伤时间较长外，其余患者膀胱均达到有效安全容量≥300 ml。经过2～6周视觉反馈排尿训练，无自主排尿者（12例）均建立反射排尿，且残余尿＜80 ml。平均最大膀胱压力：水扩张前、后变化不明显（ P＞0.05）；视觉反馈训练后有明显改善为（65.24±16.37），与水扩张后（43.12±18.64）（ cm H2O ）相比，差异有统计学意义（ P＜0.05）。所有患者平均日排尿次数治疗后（9.67±4.25）明显小于治疗前（17.5±5.64），且平均单次排尿量治疗后（160.50±25.31） ml明显多于治疗前（70.25±23.18） ml，差异有统计学意义（ P＜0.05）。所有漏尿频繁者的尿失禁次数，治疗后（5.36±3.21）明显小于治疗前（12.73±3.74）次，差异有统计学意义（P＜0.05）。结论膀胱水扩张可以有效将脊髓损伤后该类型膀胱小容量低顺应性膀胱功能改善，达到一定储尿功能；后期视觉反馈排尿训练，可以有效提高膀胱容量，增加顺应性，为膀胱功能的恢复创造良好的条件，为后期患者有效排尿提供基础。

Objective To observe the hyaluronate irrigation combined with visual feed back in the treatment of neurogenic bladder after spinal cord injury （ SCI ）.Methods Fifteen patients who suffered from neurogenic bladder following SCI were involved in this study. Early hyaluronate irrigation was used in the bladder under safety pressure （ 〈 40 cm H2O ）. Under supervision, visual feedback urination training began when the small bladder gradually expanded up to effective capacity. Before and after the hyaluronate irrigation, safe bladder capacity, urine output, urine residue, micturition time history, etc were recorded after the visual feedback training.Results After 2 to 12 week’s hyaluronate irrigation training, except for 1 case of with longer time of damage, all the rest patients’ safe bladder capacity were more than 300 ml. After 2 to 6 weeks’ visual feedback training, urinary relfex was established in patients without automatic micturition relfex （ 12 cases ）. The residual urine was less than 80 ml. The average time of urinating each day was 9.67±4.25 after the treatment, which was obviously lower than 17.5±5.64 before the treatment. The average urination volume each time was （ 160.50±25.31 ） ml after the treatment, which was obviously more than （ 70.25±23.18 ） ml before the treatment, with statistically signiifcant differences between them （P〈0.05 ）. The average time of urinary incontinence was 5.36±3.21 before the treatment in the patients with frequent urine leakage, which was obviously lower than 12.73±3.74 before the treatment, with statistically significant differences between them （P〈0.05 ）.Conclusions Hyaluronate irrigation can effectively improve the bladder functions of small capacity and low compliance, reaching a certain urinary storage function. Combined with later visual feedback bladder training,the bladder after spinal cord injury can effectively increases the capacity and decrease the compliance, creating good conditions for the recovery of bladder functions and providing the basis for patients with late effective micturition.