脊髓损伤尿失禁患者留置尿管拔管指征的研究

Research on indications for withdrawal of indwelled catheter in spinal cord injury with urinary incontinence

目的 以尿流动力学检查为依据 ,探索拔管试验的可行性 ,以便及时掌握脊髓损伤 (SCI)患者拔除尿管的时机。方法 采用拔管试验对 2 4例SCI尿失禁患者在入院时和经过膀胱训练后 ,间隔 7～ 10d进行膀胱功能的评估 ,设置膀胱容量 >15 0ml和冰水试验 (+ )为达标组 ,膀胱容量≤ 15 0ml或 >15 0ml、冰水试验 (-)和膀胱容量≤ 15 0ml、冰水试验 (+ )为未达标准。同时对达标组和训练 1个月以上仍未达标组进行尿流动力学检查 ,并取膀胱容量、残余尿量、逼尿肌括约肌肌电检测指标作为比较。结果 尿流动力学检查与拔管试验两种方法评估均显示达标组的膀胱容量和残余尿量、逼尿肌括约肌协调情况明显优于未达标组 (P <0 .0 1) ,两组内各指标两种方法评估结果比较无显著性差异。结论 拔管试验中膀胱容量 >15 0ml和冰水试验 (+ )可作为拔除尿管的参考指标。

ObjectiveTo Probe into feasibility of catheter withdrawing test (CWT)so as to find proper time to withdraw catheter in spinal cord injury (SCI)Methods24 urin ary incontinence received CWT at admission and at interval of 7～10 d after bladder training to estimate thebladder function. Supposed that bladder capacity exceeded 150 ml and aqua astricta test was positive, the cases were categorized into one group reaching the standards, Supposed that the bladder capacity exceeded 150 ml or did not exceed 150 ml while aqua astricta test was negative and that the bladder capacity did not exceed 150 ml while aqua astricta test was positive, the cases were categorized into the other group not reaching the standards. Meanwhile, urodynamic examinations were performed for the cases reaching the standards and the cases not reaching the standards after more than 1 m of exercises. The values of bladder capacity, residual urine and bladder electromyogram were recorded and compared between the groups.ResultsThe results obtained by urodynamic examination and CWT indicated that the cases reaching the standards were significantly superior to those not reaching the standards as far as bladder capacity, residual urine and bladder electromyogram were concerned ( P <0.01). But the comparison among the cases in the same group showed no significance in differences in view of the 3 items.ConclusionIn CWT,the conditions that bladder capacity exceeds 150 ml and meanwhile aqua astricta test is positivecan be considered as referred indication for withdrawal of indwelled catheter.