设为首页
加入收藏
联系我们
Email-Alert
 

    首页 | 杂志介绍 | 编委成员 | 审稿专家名录 | 投稿指南 | 订阅指南 | 过刊浏览 | 论著模板 | 综述模板 | 帮助

 
敖丽娟,左毅刚,李咏梅,钱菁华,王文丽,唐 梅,张丽芬,汤 逊,杨 阳.BTXA治疗脊髓损伤后神经原性膀胱的临床研究[J].中国康复医学杂志,2008,23(5):391~394
BTXA治疗脊髓损伤后神经原性膀胱的临床研究    点此下载全文
敖丽娟  左毅刚  李咏梅  钱菁华  王文丽  唐 梅  张丽芬  汤 逊  杨 阳
昆明医学院第二附属医院康复医学科,云南昆明,650031
基金项目:云南省教育厅基金资助课题(03Y453C)
DOI:
摘要点击次数: 1492
全文下载次数: 1394
摘要:
      目的:观察尿道括约肌内注射A型肉毒毒素BTXA对脊髓损伤后神经原性膀胱逼尿肌-尿道括约肌不协同的疗效,比较两种注射途径的优劣。方法:选择存在逼尿肌-括约肌不协同的17例脊髓损伤患者进行尿道外括约肌BTXA注射,分为经尿道(TU)注射组和经会阴(TP)注射组,TU组采用膀胱镜定位4点注射法,TP组采用肛门指检定位1点尿道周围注射法,每病例注射100U。结果:两组治疗前后排尿障碍情况均有显著性改善,注射后3天—2周开始出现漏尿次数及间断导尿次数减少,残余尿量减少,每次排尿量增加;治疗后1个月的统计结果显示,间断导尿次数、残余尿量减少,每次排尿量增加(P<0.05),注射后1个月尿动力学检查提示第一次无抑制性收缩时膀胱容量及最大膀胱容量增加(P<0.05),最大尿道压降低(P<0.05);注射后3个月上述指标虽有所回升,但并未回到注射前;两种注射途径在排尿日记及尿动力学参数的变化上差异无显著性意义。结论:尿道外括约肌的BTXA注射治疗可明显改善脊髓损伤后神经原性膀胱的逼尿肌-括约肌不协同,改善排尿功能,降低残余尿量及漏尿的发生,减少尿路感染及自主神经反射的发生;经会阴注射和经膀胱镜注射对神经原性膀胱的疗效无明显差异。
关键词:脊髓损伤  逼尿肌-尿道括约肌不协同  A型肉毒毒素
A clinical study on Botulinum A Toxin in the treatment of neurogenic bladder in patients with spinal cord injury    Download Fulltext
Department of Rehabilitation Medicine,The second Affiliated Hospital of Kunming Medical College, 650101
Fund Project:
Abstract:
      Objective:To evaluate the effects of Botulinum A Toxin(BTXA) injected into the external urethral sphincter in patients with detrusor-external sphincter dyssynergia caused by spinal cord injury. The effects of transurethral versus transperineal botulinum A Toxin injection were compared. Method: Seventeen male patients with detrusor-sphincter dyssynergia were divided into 2 groups: transurethral(TU) group and transperineal(TP) group. Four points injection method was employed with allocation by cistoscope in TU group. 1 point injection method percutaneous around the urethral was employed with allocation by digital rectal examination. 100IU BTXA was injected into the external urethral sphincter of each patient. Result:After BTXA injection, the voiding function was distinctly improved both in TU group and TP group. Three days to 2 weeks after injection, times of incontinence and intermittent catheterization, post-void residual urine volume started to decrease, the volume for intermittent catheterization started increased. One month after BTXA injection, the times of incontinence obviously decreased from 4.86 to 2.64(P<0.05). Times of intermittent catheterization decreased from 4.28 to 2.26(P<0.05), post-void residual urine volume obviously decreased from 220.46ml to 89.13ml(P<0.05). Intermittent catheterization volume increased from 109.2ml to 272.25ml(P<0.05). Urodynamic examination suggested the mean FDV statistically increased from 139.85ml to 209.26ml(P<0.05), maximal bladder capacity increased from 295.6 ml to 408.57ml (P<0.05), the maximal detrusor pressure decreased from 144.86mmH2O to 94.5mmH2O(P<0.05). Three months after BTXA injection, the parameters, above-mentioned, rebounded but didn′t reach the level before BTXA injection. Conclusion: BTXA injected into the external urethral sphincter was a promising therapy for neurogenic bladder with detrusor-sphincter dyssynergia(DSD). It can improve DSD and voiding function, decrease residual volume and incidence rate of incontinence, urinary system infection, autonomic hyperreflexia. There was no obvious difference between transurethral and transperineal BTXA injection in the therapeutic effects.
Keywords:spinal cord injury  detrusor-sphincter dyssynergia  Botulinum A toxin
查看全文  查看/发表评论  下载PDF阅读器

您是本站第 20212179 位访问者

版权所有:中国康复医学会
主管单位:国家卫生健康委员会 主办单位:中国康复医学会
地址:北京市朝阳区樱花园东街,中日友好医院内   邮政编码:100029   电话:010-64218095   

本系统由北京勤云科技发展有限公司设计 京ICP备18060696号-2