台灣地區慢性脊髓損傷病患排尿處置之調查報告

Investigation of the Voiding Management of Chronic Spinal Cord Injured Patients in Taiwan

郭漢崇(Hann-Chorng Kuo)

《慈濟醫學雜誌》 11卷1期 (1999/03) Pp. 69-78

https://doi.org/10.6440/TZUCMJ.199903.0069

摘要

脊髓損傷病人是長期照護醫療上的一大課題，除了病人因肢體殘障需要家庭與社會的支持之外，由於神經受傷所導致的泌尿系統後遺症與併發症更會隨著受傷之後的時間增長而有不同的變化。從早期的排尿困難、尿路感染直到晚期引發的尿液逆流、腎臟水腫、甚至發生腎衰竭，都需要泌尿科及復健科醫師作定期及詳細的檢查，才能減少因尿路感染及腎功能衰竭所引發的高死亡率。
本研究係以全國有登錄於脊髓損傷協會之脊髓損傷病人進行排尿品質之問卷調查。研究結果可以提供我們瞭解國內各地區脊髓損傷病人的排尿處置情形，病人就此處置之生活品質，以及併發症之發生率；並且可以藉此篩選出高危險群的病人，發現其存在的泌尿系統併發症，給予適度的教育、處置及治療。
在本調查報告中，704名病人當中有70%病人曾患一次以上尿路感染病史。在併發症方面，則有243名有反覆性尿路感染(34.5%)，90名有尿路結石(12.8%)，62名有腎水腫(8.8%)，55名有膀胱輸尿管尿液逆流(7.8%)，以及25名有慢性或急性腎衰竭的病歷(3.6%)。這些高比率的併發症發生率十分可觀，值得我們注意。
在調查病人家庭與社會支持度方面，26.6%病友在排尿時需要家庭支持，然而有4.3%的人經常，以及18.5%偶爾無法找到家人協助其排尿。共有339名病友(48.2%)從未得到有關排尿的醫療資源，595名病友(84.5%)從未有過公衛護士家訪。至於社會支持度方面，有164名病友(23.3%)認為社會給予脊髓損傷病友的支持不足，而485名病友(68.9%)認為僅有少量來自社會的支持。最後在有關脊髓損傷病人的排尿照護方面，198名病友(28.1%)認為他們所看的醫師無法有效地解決其排尿問題，而337名(47.9%)則認為由其醫師處只得到少量的協助，這些結果值得我們注意及改善。

關鍵字

脊髓損傷 ； 泌尿系統併發症 ； 長期照護

並列摘要

Spinal cord injury (SCI) resulting in paraplegia or quadriplegia is a major issue in ling-term medical care. SCI patients need strong support from their families and society in additional to medical care. Neuropathic urological sequelae change after injury, with dysuria and urinary tract infection (UTI) in the early stage; and vesicoureteral reflux, hydronephrosis, and even renal failure in the late stage. A regular and detailed urological follow-up is mandatory in every SCI patient to reduce the high incidence of urological complications.
In this investigative report of 704 SCI patients in Taiwan, 70% of SCI patients were noted to have a UTI history for more than one per year. Urological complications were reported as follows: 243 patients had recurrent UTI (34.5%), 90 had urolithiasis (12.8%), 62 had hydronephroisi (8.8%), 55 had vesicoureteral reflux (7.8%), and 25 had acute or chronic renal insufficiency (3.6%). This high incidence of complications deserves further investigation to prevent urological damage in SCI patients.
Among SCI patients, 26.6% reported needling family support for urination. However, 30 patients (4.3%) usually. And 130 (18.5%) occasionally could not find anyone to help them urinate. There were 339 patients (48.2%) who clamed that they never had medical resources for voiding management, and the resources they used were from their family (28.8%), clinics or hospitals (36.8%), and friends (11.8%). There were 595 patients (84.5) who were never visited by a public health nurse after their injury. One hundred sixty-four patients (23.3%) did not think they had enough support from society, while 485 (68.9%) believed they had only a little support. One hundred ninety-eight patients (28.1%) believed that the doctors they had visited could not solve their urological problems and 337 (47.9%) believed that doctors helped them only a little.
This study noted a high incidence of UTI and urological complications in SCI patients in Taiwan. Social support and medical care of urological problems need to be improved to provide better quality of life and a lower complication rate for SCI patients in Taiwan.

並列關鍵字

spinal cord injury ； urological complication ； long-term care