神经源性膀胱的处理重点分析.ppt

尿道并发症（尿道出血，假道和尿道/尿道口狭窄） * Urethral bleeding frequent new patients and 30 % long-term basis. 新患者及30%长期治疗的病人尿道出血频繁 Trauma of the urethra especially in men can cause false passage 30% - 40 % in long run with ordinary catheters 尿道创伤可引起假道，对于男性来说尤为明显，约30% - 40%的患者 在长期治疗中使用普通导尿管 The incidence of urethral stricture increase 尿道狭窄发病率的增加 longer follow-up, 20 % in 10 years with ordinary catheter 长期随访，20%的患者在10年内使用普通导尿管 higher catheterization rate 高导尿频率 ID had been used before introducing IC. 在开始间歇性导尿前使用留置导尿 The surface of the catheter important factor with less stricture development when hydrophilic catheters are used. 导尿管的表面材料是重要的决定因素，使用亲水性导管可减少尿道狭窄的发生率。 预防尿道并发症 * To prevent urethral bleeding and urethral stricture 预防尿道出血和尿道狭窄 - gentle introduction of the catheter, 轻柔插入导尿管 - lubrication of the catheter, 润滑导尿管 - probably the use of hydrophilic catheters can play a role. 可能亲水性导尿管能发挥一定的作用 Other complications 其他并发症 Bladder stones caused by the introduction of pubic hair, or loss of the catheter in the bladder. 由阴毛或导尿管引起的膀胱结石 Bladder perforation and necrosis : rare 膀胱穿孔及坏死：极少见 * 间歇导尿和间歇自我导尿并发症的处理 * Treatment of UTI only when the infection is symptomatic. 仅当尿路感染有症状时才给予治疗 NO long-term prophylactic antibiotics to avoid resistant organisms. 为避免产生耐药微生物，应避免长期预防性应用抗生素 In neurogenic patients on CIC, urethral trauma and false passage successfully managed by 6-weeks indwelling catheter and 5 days antibiotics. 对于应用间歇清洁导尿的神经源性膀胱病人，尿道损伤和假道可通过留置导尿6周和使用5天抗生素来治愈。 Urethral stricture treated by urethral dilation or internal urethrotomy. 通过尿道扩张和尿道内切开术治疗尿道狭窄。 导尿的长期应用 * Of patients on CIC at discharge 52% discontinue the method and revert to indwelling catheter during follow-up. 间歇清洁导尿的病人在出院时有52%放弃了这种导尿方式，长期治疗又回到留置导尿。 影响患者坚持导尿的因素 * Continence 尿控 Autonomy for practising IC/dependence on care givers 实施间歇性导尿的自主性/对照顾者的依赖性 Surgery on sphincter and prostate 括约肌或前列腺手术 Start spontaneous voiding 出现无意识