课件：神经源性膀胱的处理演示课件.ppt

泌尿系和生殖系感染的预防 Avoid less frequent catheterization and bladder overfilling. 避免导尿次数不够和膀胱过度充盈 Empty the bladder completely without residual urine. 完全排空膀胱，无残余尿 Educate properly all involved in IC: good patient compliance, the use of a proper material and the application of a good catheterization technique. 对与间歇导尿相关的所有人进行适当的教育：使病 人有良好的依从性，使用合适的材料和正确的导 尿技术 * Prophylaxis 预防 CIC 4-6 per day: 5 x less infection than 3 times a day 每天4-6次间歇性清洁导尿：每天导5次的感染发生率少于每天导3次的。 Prophylactic antibacterial : children, diabetes, reflux, diverticula. 预防性使用抗生素：儿童，糖尿病人，尿 液反流和憩室 Danger for resistance 有产生耐药性的危险 * Hydrophilic catheters 亲水导尿管 Beneficial effect on UTI 对控制尿路感染的积极作用 Eur Urol 2005 Cochrane 2007: J Wound Ostomy Continence Nurs 2007 13 trials 13项试验 Current research is weak 目前缺乏研究 No definite studies illustrating UTI less in sterile single use or coated catheters.没有确切研究证明无菌导尿管或涂层导尿管能降低泌尿系感染率。 * 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