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膀胱,神经源性

膀胱,神经源性的相关文献在2001年到2021年内共计56篇,主要集中在外科学、中国医学、临床医学 等领域,其中期刊论文56篇、专利文献605844篇;相关期刊30种,包括河北中医、上海针灸杂志、护理学杂志等; 膀胱,神经源性的相关文献由218位作者贡献,包括陈维秀、陈雨历、李金良等。

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膀胱,神经源性

-研究学者

  • 陈维秀
  • 陈雨历
  • 李金良
  • 文建国
  • 付光
  • 任川川
  • 双卫兵
  • 史文博
  • 吕宇涛
  • 吴娟
  • 期刊论文
  • 专利文献

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    • 许国梅; 魏娟; 赵勇; 钱景丽
    • 摘要: 目的 观察灸法配合西医常规治疗对急性脑梗死后肾阳虚型神经源性膀胱的临床疗效.方法 将94例急性脑梗死后肾阳虚型神经源性膀胱患者随机分为治疗组和对照组,每组47例.治疗组采用灸法配合西医常规治疗,对照组采用单纯西医常规治疗.观察两组治疗前后各项血清生化指标[白介素6(IL-6)、血小板分子标志物-1(PAC-1)、神经元特异性烯醇化酶(NSE)、D二聚体(D-D)]、每日排尿情况各项指标(日均单次排尿量、日均尿失禁次数、日均排尿次数)、尿动力学指标(最大尿流速率、最大膀胱容量、残余尿量)、美国国立卫生院卒中量表(NIHSS)评分的变化情况,并比较两组临床疗效.结果 两组治疗后各项血清生化指标、每日排尿情况各项指标、尿动力学指标及NIHSS评分与同组治疗前比较,差异均有统计学意义(P<0.05).治疗组治疗后各项血清生化指标、每日排尿情况各项指标、尿动力学指标及NIHSS评分与对照组比较,差异均有统计学意义(P<0.05).治疗组总有效率为91.5%,对照组为72.3%,两组比较差异具有统计学意义(P<0.05).结论 灸法配合西医常规治疗是一种治疗急性脑梗死后肾阳虚型神经源性膀胱的有效方法,能减轻炎症反应,促进神经功能修复,改善尿流动力学指标.
    • 蒋雪飞
    • 摘要: 目的 观察温阳化气方敷脐联合康复训练治疗肾阳虚型脊髓损伤后神经源性膀胱的临床疗效.方法 70例肾阳虚型脊髓损伤后神经源性膀胱患者,按随机数字表法分为观察组和对照组,每组35例.对照组给予常规康复训练,观察组在对照组基础上给予温阳化气方敷脐.观察两组治疗前后排尿日记(日均排尿次数、日均单次排尿量、日均尿失禁次数)、尿动力学(最大膀胱容量、膀胱排尿压力和残余尿量)、核心下尿路症状评分(CLSS)变化,并比较两组临床疗效.结果 两组治疗后日均排尿次数、日均单次排尿量、日均尿失禁次数与同组治疗前比较,差异具有统计学意义(P<0.05);观察组治疗后日均排尿次数、日均单次排尿量、日均尿失禁次数明显优于对照组(P<0.05).两组治疗后最大膀胱容量、膀胱排尿压力、残余尿量及CLSS评分与同组治疗前比较差异具有统计学意义(P<0.05);观察组治疗后最大膀胱容量、膀胱排尿压力、残余尿量及CLSS评分明显优于对照组(P<0.05);观察组总有效率明显优于对照组,差异具有统计学意义(P<0.05).结论 温阳化气方敷脐联合康复训练治疗肾阳虚型脊髓损伤后神经源性膀胱,可明显改善膀胱功能.
    • 蒋晓敏; 纪婕; 钱雪; 杨玲; 张艳; 汤燕; 周莉
    • 摘要: 背景 脊髓损伤(SCI)患者易并发神经源性膀胱,而简易膀胱容量-压力测定技术因操作简便、易行、经济实用及可重复性等优势而广泛用于评估SCI患者膀胱功能.目的 分析经水柱法简易膀胱容量-压力测定技术测定的膀胱安全容量与SCI合并神经源性膀胱患者输尿管反流的关系.方法 选取2018年5月—2019年7月江苏省人民医院康复医学科、常州市德安医院康复中心收治的SCI合并神经源性膀胱患者46例,采用水柱法简易膀胱容量-压力测定技术测定患者膀胱安全容量,并进一步通过膀胱尿道造影术观察患者是否发生输尿管反流.收集患者的性别、年龄、损伤平面、美国脊髓损伤协会(ASIA)分级、最大膀胱压力、灌注方式、膀胱安全容量及漏尿/自排发生情况,并采用单因素及多因素Logistic回归分析探讨SCI合并神经源性膀胱患者发生输尿管反流的影响因素.结果 膀胱尿道造影术检查结果显示,在46例患者中,发生输尿管反流13例(28.3%).多因素Logistic回归分析结果显示,ASIA分级A级(完全性脊髓损伤)〔OR=32.753,95%CI(1.332,805.642)〕、膀胱安全容量<300 ml〔OR=15.943,95%CI(1.707,148.919)〕是SCI合并神经源性膀胱患者发生输尿管反流的独立危险因素(P<0.05).结论 ASIA分级A级(完全性脊髓损伤)、膀胱安全容量<300 ml是SCI合并神经源性膀胱患者发生输尿管反流的独立危险因素.
    • 毛二莉; 索吕; 纪婕; 周停; 丁慧; 李卫卫; 王红星
    • 摘要: 目的 观察敏感“扳机点”刺激结合意念排尿训练对早期卒中后排尿障碍患者的自主排尿功能恢复的作用. 方法前瞻性连续纳入2016年1月至2018年4月期间于南京医科大学第一附属医院康复医学中心住院康复、符合入排标准的52例卒中留置尿管患者,并按随机数字表法完全随机分为对照组和观察组,每组各26例.对照组在膀胱功能评定后拔除尿管行清洁间歇导尿,观察组通过膀胱压力测定确定敏感“扳机点”,进行精准刺激,并结合意念排尿训练,分别在治疗3、7d时观察两组自主排尿恢复及残余尿量情况. 结果治疗3d时,观察组恢复自主排尿且残余尿量≤50 ml、恢复自主排尿但残余尿量>50ml和尿潴留的患者分别为15、10、1例,对照组分别为6、15、5例;治疗7d时,观察组恢复自主排尿且残余尿量<50 ml、自主排尿但残余尿量>50ml、尿潴留例数分别为21、4、1例,对照组分别为13、9、4例;治疗3、7d时,观察组排尿障碍较对照组均明显改善,差异均有统计学意义(x2值分别为6.47、5.44,均P<0.01).治疗3、7d时,观察组恢复自主排尿但残余尿量>50ml的患者平均残余尿量均低于对照组[分别为(88±21) ml比(120±47)ml、(73±29) ml比(107 ±42) ml;t值分别为2.233、2.286,P值分别为0.039、0.033]. 结论“扳机点”刺激诱导结合意念排尿训练可促进早期卒中排尿障碍患者自主排尿恢复,并有效减少残余尿量.
    • 罗娟; 徐加龙; 刘倩; 孙小刚; 马楠; 王春田; 李金良
    • 摘要: 目的 描述并分析神经源性膀胱括约肌功能障碍患儿的下尿路尿动力学表现.方法回顾性分析神经源性膀胱括约肌功能障碍(neuropathic bladder-sphincterdysfunction,NBSD)及原发性遗尿症患儿(primary nocturnal enuresis,PNE)的尿动力学检查结果,比较两种疾病患儿逼尿肌不自主收缩、充盈期逼尿肌压、尿道功能长度(functional urethral length,FUL)及最大尿道闭合压(maximum urethral closure pressure,MUCP)四项指标的差异.应用SPSS13.0统计软件进行分析.结果NBSD和PNE各纳入200例,分别为NBSD组和PNE组.NBSD组患儿中,逼尿肌反射亢进占69.0%,MUCP降低占91.0%,充盈期逼尿肌压升高占65.5%;PNE组中,逼尿肌不稳定、充盈期逼尿肌压升高者分别占45.0%、43.5%,MUCP降低者占37.5%,两组间各项异常率的差异均具有统计学意义(P<0.05).NBSD组患儿充盈期逼尿肌压、FUL及MUCP的均值依次为(35.52±4.38)cmH2O、(1.73±0.13)cm、(42.84±4.54)cmH2 O;PNE组患儿充盈期逼尿肌压、FUL及MUCP的均值依次为(17.32±2.42)cmH2O、(3.16±0.17)cm、(83.10±6.99)cmH2O;两组间各指标差异均具有统计学意义(P<0.05).结论与遗尿症患儿相比,神经源性膀胱括约肌功能障碍患儿下尿路尿动力学表现异常率偏高,这为临床诊治该类疾病提供了一定的指导与方向.
    • 王丽
    • 摘要: 目的 探讨微信视频在神经源性膀胱患者自我清洁间歇导尿健康教育中的应用效果.方法 将50例神经源性膀胱清洁间歇导尿患者按入院时间分为对照组(2015年6月-2016年6月)和试验组(2016年7月-2017年6月)各25例,在两组患者均实施常规健康宣教的基础上,让试验组患者加入间歇导尿微信群,将间歇导尿患者需要掌握的相关知识制作成若干个微视频,上传到微信平台,指导患者进行自我学习并评价学习的效果.比较两组患者导尿4周后的对间歇导尿相关知识掌握情况、导尿的依从性、泌尿系并发症的发生率.结果 试验组患者间歇导尿相关知识掌握情况及导尿依从性优于对照组(P<0.05).两组泌尿系并发症的发生率差异无统计学意义(P>0.05).结论 微信视频让患者更容易理解和接受清洁间歇导尿,提高了患者对间歇导尿的依从性及对相关知识的掌握程度.
    • 娄玲娣; 付金英; 李学军; 黄雄昂; 王元姣
    • 摘要: Objective To investigate the influencing factors of using active imagery therapy in spinal cord injury patients with neurogenic bladder. Methods Ninety-two spinal cord injury patients were arranged for bladder function training by active imagery therapy. According to the training effect, they were divided into two groups, and a total of eleven factors were observed including age, education level, time of rehabilitation intervention, the type of spinal cord injury and etc. The logistic regression was used to analyze the possible influence factors of the two groups. Results The analysis results indicated that there were significant differences in education level, depression state, the type of neurogenic bladder, rehabilitation time and course of treatment which were affect the bladder training (χ2 =5. 851, 6. 903, 6. 901, 30. 597, 4. 211,respectively;P<0. 05). The results showed that below the junior college level, HAMD≥17, time of rehabilitation intervention≥60 d, treatment course <8 weeks, incontinence of urine were the adverse factors. Conclusions Education level, depressive state, time of rehabilitation intervention, treatment course, type of neurogenic bladder were the prognostic factors in spinal cord injury patients who was arranged for bladder function training by active imagery therapy. Aiming at these factors, medical staff should provide necessary guidance to improve the results of treatment.%目的:探求运用运动想象疗法治疗脊髓损伤神经源性膀胱患者的影响因素。方法将入组92例应用运动想象疗法进行膀胱功能训练的脊髓损伤神经源性膀胱患者,根据其训练效果是否明显分为两组,分别观察包括年龄、文化程度、康复介入时机、脊髓损伤类型等在内的11项可能影响训练效果的因素,使用Logistic回归分析影响疗效的因素。结果患者的文化程度、抑郁状态、神经源性膀胱类型、介入时间及坚持疗程不同会影响患者进行膀胱训练,差异有统计学意义(χ2值分别为5.851,6.903,6.901,30.597,4.211;P<0.05)。大专以下文化程度、HAMD≥17分、介入时间≥60 d、坚持疗程<8周及神经源性膀胱类型为尿失禁是应用运动想象疗法对脊髓损伤神经源性膀胱患者进行膀胱训练时的不利影响因素。结论文化程度、抑郁状态、康复介入时机、坚持疗程、神经源性膀胱类型是应用运动想象疗法对脊髓损伤神经源性膀胱患者进行膀胱训练时的影响因素,在进行运动想象疗法训练时应针对这些影响因素加强宣教指导。
    • 陈国庆; 廖利民; 史文博; 鞠彦合; 吴娟; 付光; 熊宗胜; 韩春生; 李东
    • 摘要: Objective To assess the effectiveness and safety of sacral neuromodulation (SNM) for neurogenic bladder and/or bowel dysfunction.Methods Between March 2002 and December 2014,32 patients with neurogenic bladder and/or bowel dysfunction were treated with a preliminary test SNM in China Rehabilitation Research Center.If at least 50% clinical improvement occurred,the patient would undergo a permanent SNM procedure.The patients were evaluated by using a bladder diary,post-void residual volume measurement and the Wexner questionnaire score for constipation before and during the test,and after the permanent SNM.Results In the test phase,the rate of improvement in dysuria (23%,6/26) was significantly lower than urgency,frequency (59%,13/22),urinary incontinence (69%,11/16),and constipation (64%,16/25) (P<0.05).An implant was performed in 17 (53%) cases.Nine patients whose symptoms had not been resolved completely chose to undergo permanent SNM combined with other treatments.No complications were reported in test phase.During the follow-up period (1-152 months),2 patients (12%) failed,and 1 patient had vesicoureteral reflux.Conclusions SNM is effective and safe to treat neurogenic bladder and/or bowel dysfunction.For those patients with multiple bladder and bowel symptoms,SNM can not always resolve all the symptoms,but may be helpful in improving multiple symptoms by combining with other treatments.%目的 评估骶神经调节治疗神经源性膀胱患者大小便功能障碍的有效性和安全性.方法 回顾性分析2002年3月至2014年12月32例接受骶神经调节体验治疗的神经源性膀胱患者的临床资料.体验治疗阶段患者临床症状改善>50%时,可将永久刺激器植入体内.体验治疗前、体验阶段以及永久刺激器植入后,采用排尿日记、残余尿量以及Wexner便秘指数评分对患者临床症状进行评估. 结果 体验治疗阶段,骶神经调节对排尿困难的有效率为23% (6/26),明显低于尿频-尿急(59%,13/22)、尿失禁(69%,11/16)以及便秘(64%,16/25) (P<0.05).17例(53%)患者经过体验治疗选择了永久刺激器植入,其中9例体验治疗阶段仅部分临床症状改善≥50%.永久刺激器植入后随访1~152个月,2例患者(12%)症状复发,1例患者出现膀胱输尿管反流. 结论 骶神经调节治疗神经源性膀胱患者的大小便功能障碍安全有效.对于多种症状并存的患者,骶神经调节有时不能改善每种症状,但是结合其他治疗手段,依然是这些患者可以考虑的治疗选择.
    • 谢克基; 陈晖; 蒋重和; 汤平; 欧汝彪; 曾健文; 邓向荣; 周理林; 黄马平
    • 摘要: 目的 探讨膀胱三角区联合逼尿肌注射A型肉毒毒素治疗神经源性逼尿肌过度活动(neurogenic detrusor overactivity,NDO)伴尿失禁的疗效和安全性. 方法 采用前瞻性、多中心、单盲、随机对照的试验方法,2011年6月至2014年6月按1:1的比例将脊髓损伤NDO伴尿失禁患者分为实验组和对照组.实验组患者行膀胱镜下逼尿肌A型肉毒毒素160 U注射,膀胱三角区40 U注射;对照组行膀胱镜下逼尿肌A型肉毒毒素200 U注射术(不包括膀胱三角区).记录治疗前和治疗后4、12周两组患者尿失禁生命质量评分、平均每日尿失禁次数、尿失禁患者、平均每次排尿量(导尿+自然排尿).记录治疗前及治疗后12周的储尿期膀胱逼尿肌最大压力、首次出现逼尿肌过度活动时膀胱容量和膀胱输尿管反流.记录治疗后不良事件.采用SPSS 13.0软件对计量资料采用t检验,计数资料采用x2检验法. 结果 96例患者入选,91例完成试验,其中实验组47例、对照组44例.两组间各基线数据比较差异均无统计学意义(P>0.05).术后两组内各指标与基线比较差异均有统计学意义(P<0.05).术后12周,两组尿失禁生命质量评分较基线分别增加65.84%、55.81% (P=0.01),平均每日尿失禁次数分别减少71.95%、65.80% (P=0.02),尿失禁患者分别减少29.79%、11.36% (P=0.03),平均每次排尿量分别增加79.47%、69.76%(P=0.02),储尿期膀胱逼尿肌最大压力分别减少48.76%、40.68%(P=0.04),首次出现逼尿肌过度活动时膀胱容量分别增加64.56%、57.23%(P=0.02),组间比较差异均有统计学意义.实验组和对照组患者均未发生膀胱输尿管反流.术后3例出现尿路感染,其中实验组1例、对照组2例. 结论 膀胱三角区联合逼尿肌注射A型肉毒毒素治疗NDO伴尿失禁的疗效优于单独逼尿肌注射,且不会引起膀胱输尿管反流.%Objective To evaluate the effect and safety of trigone-including intradetrusor injection of botulinum toxin A (BTX-A) for patients with neurogenic detrusor overactivity (NDO) and incontinence.Methods A prospective,multicenter,single-blind and randomized controlled trial was conducted between June 2011 and June 2014.Patients with NDO and incontinence who suffered from spinal cord injury were recruited.At a 1:1 ratio patients randomly received 200 U BTX-A intradetrusor injections excluding the trigone (control group) or 160 U intradetrusor plus 40 U intratrigonal injections (experimental group).Patients were evaluated at baseline,4 and 12 weeks after injection.The primary outcomes included incontinence specific quality of life (I-QOL),mean voiding volume,mean incontinence episodes,complete dryness,maximum detrusor pressure (Pdetmax) during filling,volume at first involuntary detrusor contraction (VFIDC).Vesicoureteral reflux (VUR) and other adverse events were recorded.Results Ninety-six patients were recruited and 91 of them completed the trial.Among the 91 patients,47 were randomized to experimental group,44 to control group.There were no significant differences in baseline evaluation items between the 2 groups.All outcomes after treatment improved significantly as compared to the baseline in each group (P< 0.05).Twelve weeks after treatment,the improvement percentage of I-QOL (65.84%),mean incontinence episodes (71.95%),complete dryness (29.79%),mean voiding volume (79.47%),P detmax (48.76%),VFIDC(64.56%) in experimental group had significant difference as compared to those in control group (55.81%,65.80%,11.36%,69.76%,40.68%,57.23%) (P=0.01,0.02,0.03,0.02,0.04,0.02),respectively.In both groups,no patients developed VUR.Three cases (1 in experimental group,2 in control group) developed urinary tract infection.Conclusions Trigone-including intradetrusor injection of BTX-A is more effective than intradetrusor injection excluding the trigone for patients with NDO and incontinence.Intratrigonal injection does not induce VUR.
    • 罗德毅; 杨童欣; 林逸飞; 王坤杰; 沈宏
    • 摘要: Objective To assess the outcome of vesicoureteral reflux after augmentation cystoplasty in patients with neurogenic bladder.Methods Between January 2008 and January 2014,a total of 25 patients,with a hypocompliant bladder associated with vesicoureteral reflux confirmed by video-urodynamics preoperatively,were recruited in this study.They all had undergone bladder augmentation with a generous detubularized segment of bowel at our institution.No effort had been made to correct existing reflux.Preoperatively assessment included urinalysis,kidney function tests,ultrasonography,video-urodynamic evaluation.All patients had various degrees of vesicoureteral reflux.The status of vesicoureteral reflux and bladder function were studied by video-urodynamic.Results Mean follow-up was 2.2 years (range 0.5 to 5.5 years).The video-urodynamics manifested a significant improvement of bladder capacity,diminution of intravesical pressure and resolution of reflux after bladder augmentation.Of the 25 patients,20 (80%) no longer had reflux,3 (12%) had improvement,2 (8%) had no change.Sixteen of 18 with grades Ⅰ to Ⅲ (89%),all refluxing units with grade Ⅳ to grade Ⅴ (100%) showed complete cessation of reflux.Symptomatic urinary infection was not found after surgery.Conclusions Augmentation enterocystoplasty without ureteral reimplantation is effective and adequate for patients with high pressure and hypocompliant neurogenic bladder.Therefore,ureteral reimplantation is not necessary underwent when augmentation enterocystoplasty is recommended to patients with neurogenic bladder and vesicoureteral reflux.%目的 探讨单纯肠道膀胱扩大术治疗神经源性膀胱合并输尿管反流的疗效. 方法 2008年1月至2014年1月25例神经源性膀胱合并输尿管反流患者接受单纯肠道膀胱扩大术,同期未行输尿管再植术.25例术前均接受6个月以上的药物治疗无效.神经源性膀胱的病因均为脊髓损伤.术前评估内容包括尿常规、肾功能、泌尿系超声和影像尿动力学检查.25例术前均有不同程度的输尿管反流.随访时通过影像尿动力学检查再次评估膀胱功能及输尿管反流状态. 结果 25例术后随访0.5~5.5年,平均2.2年.所有患者膀胱容量明显增加,膀胱顺应性明显改善.20例(80%)输尿管反流消失,3例(12%)明显改善,2例(8%)无任何变化.Ⅰ~Ⅲ度输尿管反流患者反流消失或改善率为89%(16/18),而Ⅳ~Ⅴ度患者反流消失或改善率为100% (9/9).未发生症状性尿路感染. 结论 对于高压、低顺应性的神经源性膀胱合并输尿管反流患者,单纯肠道膀胱扩大术治疗有效,可以考虑不常规行输尿管再植.
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