时间结合容量型导尿对脑卒中后膀胱排空不全患者的影响

Effect of Catheterization Time combined with Volume on Patients with Incomplete Bladder Emptying after Stroke

目的:观察时间结合容量型导尿对脑卒中后膀胱排空不全(IBE)患者的影响。方法:选择2017年6月—12月在南昌大学第一附属医院住院治疗的脑卒中后IBE患者62例,采用随机数字表法分为对照组和观察组,每组分别30例、32例。对照组给予经皮神经电刺激、针灸、膀胱功能再训练等常规康复治疗,同时给予时间型间歇导尿,每4~8 h导尿1次;观察组在常规康复治疗基础上予以时间结合容量型间歇导尿,根据尿流动力学及膀胱容量压力测定结果进行分型,用膀胱容量测定仪(BladderScar BVI 9400)及排尿日记床边动态监测排尿前的膀胱容量及排尿后的残余尿量,确定尿量达到“膀胱安全容量”时行间歇导尿。在干预前后,观察2组的排尿量、排尿次数、排尿间隔时间等情况;使用膀胱容量测定仪进行膀胱安全容量及残余尿量评定;采用实验室尿培养评估尿路感染发生率;观察2组再次置入留置导尿管的情况。结果:干预前,2组排尿量、排尿次数、排尿时间间隔、膀胱容量、残余尿量、尿路感染、再次置管人次均无明显区别,差异无统计学意义(P>0.05)。与干预前比较,观察组干预3周后排尿量、膀胱容量明显升高,残余尿量明显降低,差异具有统计学意义(P<0.05)。与对照组比较,观察组干预3周后排尿量、膀胱容量均明显更高,排尿次数、残余尿量均明显更低,差异具有统计学意义(P<0.05),2组干预后尿路感染率、再次置管率均无明显区别,差异无统计学意义(P>0.05)。结论:时间结合容量型间歇导尿术依据准确的膀胱安全容量及时排尿,有助于患者重新建立排尿反射弧,提高患者自排尿量、膀胱容量,减少残余尿量、日均排尿次数,促进患者自主排尿功能的恢复,降低尿路感染风险,值得临床推广应用。

Objective:To observe the effect of catheterization time combined with catheterization volume on patients with incomplete bladder emptying(IBE)after stroke.Methods:A total of 62 patients with IBE after stroke were divided into the control group(n=30)and the observation group(n=32)respectively,in the first affiliated hospital of Nanchang University from June to December 2017,according to the random number table method.The control group was given routine rehabilitation treatment such as transcutaneous nerve stimulation,acupuncture,bladder function retraining,and at the same time,the patients were given time-type intermittent catheterization once every 4-8 hours.The observation group was given catheterization time combined with catheterization volume on the basis of routine rehabilitation treatment in the control group.The patients were classified according to the results of urodynamics and bladder volume pressure measurement.Bladder volume before urination and residual urine volume after micturition were dynamically monitored by BladderScar(BVI9400)and micturition diary bedside,and intermittent catheterization was performed when the urine volume reached"bladder safety capacity".Before and after intervention,the patients'micturition volume,times of micturition and interval time of micturition were observed;the bladder safety capacity and residual urine volume were assessed by Bladder capacity tester;the incidence of urinary tract infection was assessed by laboratory urine culture;the reimplantation of indwelling catheter was observed in the two groups.Results:Before intervention,there was no significant difference in micturition volume,micturition times,voiding time interval,bladder volume,residual urine volume,urinary tract infection and repeated indwelling catheter times between the two groups(P>0.05).Compared with those before intervention,the urine volume and bladder volume in the observation group increased significantly and the residual urine volume decreased significantly after intervention for three weeks,and the difference was statistically significant(P<0.05).Compared with the control group,the micturition volume and bladder capacity of the observation group were significantly higher,and the micturition times and residual urine volume were significantly lower after intervention for three weeks in the observation group,and the difference was statistically significant(P<0.05).There was no significant difference in urinary tract infection rate and repeated indwelling catheter rate between the two groups after intervention(P>0.05).Conclusion:Catheterization time combined with volume intermittent catheterization is helpful for patients to re-establish micturition reflex arc,increase self-micturition volume and bladder capacity,reduce residual urine volume and average daily micturition times according to accurate bladder safety capacity.It is worthy of clinical application to promote the recovery of patients'autonomous voiding function and reduce the risk of urinary tract infection.