脊髓损伤患者膀胱管理的影响因素

Influencing factors of bladder management practices in patients with spinal cord injury

摘要

目的 探讨影响脊髓损伤患者膀胱管理方式选择及效果的关键因素，为优化个体化膀胱管理策略提供参考。方法 回顾性分析2013年1月1日-2022年12月31日空军军医大学唐都医院诊治的78例脊髓损伤继发神经源性膀胱患者的临床资料及随访资料。分析不同损伤分级间膀胱管理方式分布情况，采用Bowker对称性检验评估患者出院时膀胱管理方式与随访终点膀胱管理方式间的差异，采用多元线性回归分析膀胱管理效果的影响因素，绘制Kaplan-Meier生存曲线计算膀胱管理方式改变中位时间。结果 78例患者出院时膀胱管理方式自行排尿9例、间歇导尿19例、反射性排尿22例、长期置管26例、使用集尿器2例；随访终点的膀胱管理方式转变为自行排尿15例、间歇导尿8例、反射性排尿34例、长期置管14例、使用集尿器7例。患者出院时和随访终点选择的膀胱管理方式存在显著差异（χ²=21.43，P=0.018）。多元线性回归分析结果显示，与损伤分级A相比，损伤分级D的神经源性膀胱症状评分（NBSS）显著下降8.60分（P=0.026）。膀胱管理方式改变的中位时间为7.93（95%CI：5.44～9.44）个月，约50%患者在出院后8个月内发生膀胱管理方式变化。结论 脊髓损伤继发神经源性膀胱患者的膀胱管理方式在出院后发生显著变化，损伤分级是影响膀胱管理效果的关键因素，损伤分级越高，膀胱管理效果越差。

Abstract

Objective To explore the key factors affecting the selection and effectiveness of bladder management modalities in patients with spinal cord injury, so as to provide reference for the optimization of individualized bladder management strategies. Methods The clinical and follow-up data of 78 patients with spinal cord injury treated in our hospital during Jan. 1, 2013 and Dec. 31, 2022 were retrospectively analyzed. The distribution of bladder management modalities among different grades of injuries was analyzed. Bowker symmetry test was used to evaluate the difference between bladder management modalities at discharge and at the end of follow-up. Multiple linear regression was used to explore the influencing factors of bladder management effects. Plotting Kaplan-Meier survival curves were adopted to calculate the median time of changes in bladder management. Results At discharge, there were 9 cases of self-catheterization, 19 cases of intermittent catheterization, 22 cases of reflexive voiding, 26 cases of long-term catheterization, and 2 cases using urinary collector. At the end of follow-up, there were 15 cases of self-catheterization, 8 cases of intermittent catheterization, 34 cases of reflexive voiding, 14 cases of long-term catheterization, and 7 cases using urinary collector. There was a significant difference between the modalities of bladder management at discharge and at the end of follow-up (χ²=21.43, P=0.018). Multiple linear regression showed a significant decrease of 8.60 in the total neurogenic bladder symptom score (NBSS) for grade D injuries compared with grade A injuries (P=0.026). The median time to bladder management change was 7.93 months (95% CI: 5.44-9.44), with approximately 50% of patients experiencing a change in bladder management within 8 months after discharge. Conclusion The modalities of bladder management changed significantly after discharge. The grade of injury was a key factor affecting the effectiveness of bladder management. Higher grade was associated with worse effectiveness of bladder management.

关键词

脊髓损伤 / 神经源性膀胱 / 膀胱管理方式 / 清洁间歇导尿

Key words

spinal cord injury / neurogenic bladder / bladder management / clean intermittent catheterization

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基金资助

国家自然科学基金项目(81872077)