脊髓損傷患者上尿路併發症之處理及預後

中山醫學大學機構典藏 CSMUIR > 行政單位 > 教務處 > 期刊論文 > Item 310902500/1915

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/1915

Title:	脊髓損傷患者上尿路併發症之處理及預後 Management and Prognosis of Patients with Spinal Cord Injuries and Upper Urinary Tract Complications
Authors:	吳耀庭;畢柳鶯;林文鮮;蔡素如;戴天慈;丁化 Yao-Ting Wu;Liu-Ing Bih;Wen-Hsien Lin;Su-Ju Tsai;Tien-Tzu Tai;Hwa Ding
Contributors:	中山醫學大學
Keywords:	上尿路併發症;泌尿問題處理;泌尿系統追蹤;脊髓損傷 upper urinary tract complication;urologic management;urologic surveillance;spinal cord injury
Date:	2003-05-01
Issue Date:	2010-07-28T09:04:15Z (UTC)
Publisher:	教務處出版組
Abstract:	研究目的：分析探討脊髓損傷患者罹患上尿路併發症的處理方式及其預後。並調查脊髓損傷者接受定期泌尿系統功能追蹤的順從度。研究對象：1993年1月至1997年6月間於本院檢查出有上尿路系統併發症之脊髓損傷患者共105名，平均年齡34.2 ± 12.5歲，第一次檢查時平均受傷期間為4.2 ± 5.4年。其中男性83人(78.7%)，女性22人；屬於上運動神經原病變者有85例(81.5%)，下運動神經原病變者有20例。研究結果：罹患膀胱輸尿管逆流者有41例，水腎者97例，兩者合併出現者33例。其中69例接受保守治療，治療內容包括教導正確飲水與排尿方式、服用藥物、自我間歇導尿等；36例接受侵入性治療，包括括約肌切開術16例、會陰神經阻斷術3例、人工括約肌手術1例、膀胱擴大整形術2例、反逆流手術1例、放置尿道留置導尿管6例及膀胱造廔7例。降低殘尿量、降低膀胱內壓、降低尿道阻力是治療上尿路併發症的主要原則。至1999年6月為止，44例病情改善，13例情況沒有改變，14例病情惡化；34例未接受後續追蹤，治療效果不明。最後一次追蹤檢查時，泌尿功能完全正常者18例，輕度逆流或尿路阻塞者38例，尿路明顯擴張者6例，一側腎功能下降者23例，一側腎臟無功能者6例，兩側腎功能低下者10例，已經定期洗腎者4例。結論：脊髓損傷患者由於神經因性排尿障礙，造成尿動力學的改變，有很高的機率發生上尿路併發症。早期發現的輕度上尿路併發症，非侵入性的保守治療就可以改善病情。已經產生嚴重腎臟功能損傷時，治療後也無法挽回腎臟功能，最終可能必須洗腎。台灣中部地區的脊髓損傷患者定期接受泌尿功能追蹤的順從度不佳，需要醫療單位加強宣導，以達到早期診斷、早期治療的目標。 From January 1993 to June 1997, 105 spinal cord injured (SCI) patients with upper urinary tract complications were studied. Eighty-three were male (78.7%), and 22 were female. Eighty-five patients (81.5%) had upper motor neuron lesions, and 20 had lower motor neuron lesions. Vesicoureteral reflux was demonstrated in 41 patients, and hydronephrosis in 97. Thirty-three suffered from both of these of upper urinary tract complications. Of 105 patients, 69 patients were treated conservatively, including proper fluid intake and bladder emptying, oral medication to lower intravesical or urethral pressure and self intermittent catheterization to evacuate the bladder. Invasive procedures were performed on 36 patients: sphincterotomy on 16, pudendal nerve block on 3, artificial sphincter on 1, augmentation cystoplasty on 2, anti-reflux surgery on 1 and in-dwelling catheterization on 13. In June 1999, the disorders had resolved in 18 patients, had improved in 24, were unchanged in 13, had worsened in 16 and were unknown in 34 due to loss of follow-up. The onset duration from when patients received their first urologic surveillance was 4.2 years. Thirty-four patients did not follow-up regularly, even after being diagnosed with upper urinary tract complications. Efforts should be made to improve compliance among SCI patients for regular urologic surveillance, which is critical for early diagnosis and effective treatment of urologic complication.
URI:	https://ir.csmu.edu.tw:8080/handle/310902500/1915
Relation:	中山醫學雜誌, v14 n.2 p297-305
Appears in Collections:	[教務處] 期刊論文

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