脊髓損傷病患於間歇性導尿訓練過程中尿路感染之探討

Urinary Tract Infection is Spinal Cord Injury Patients Undergoing Bladder Training

黃千芬(Chen-Fen Huang) ； 黃美涓(May-Kuen Wong)

《中華民國復健醫學會雜誌》 18期 (1990/12) Pp. 150-156

摘要

本研究分折自民國77年1月至77年12月因脊髓損傷在本院住院並接受間歇性導尿訓練的病患共127例，訓練期間共發生145次尿路感染，其中症狀性尿路感染僅55次，非症狀性尿路感染計90次，究其因，內臟性及體感覺傳入神經功能障礙應是導致這些沒有明顯症狀及徵兆的非症狀性尿路感增加的主要因素。尿液細菌培養的結果，發現引起尿路感染最常見的菌種依次是 Escherichia coli., Klebsiella pneumoniae, Pseudomonas aeruginosa。
發生尿路感染的頻率與病患的年齡大小，脊髓損傷部位高低，損傷程度及神經性膀胱功能障礙的種類均無顯著關係。
在藥物預防方面，結論是單獨用維他命C作預防組，效果不彰，並不能減少尿路感染的發生，而以維他命C加上Macrodantin作預防組，雖然尿路感染比無預防組來得低，但未達統計學上的差異。是否可以使用大量維他命C來有效降低尿液之PH值，或何種藥物適合長期使，且能有效防止尿路感染，則仍有待進一步探討。

關鍵字

尿路感染 ； 脊髓損傷 ； 間歇性導尿訓練法

並列摘要

The difficulty of micturition due to neurogenic bladder in victims of spinal cord injury (SCI) is a common consequence, and also a clinical challenge in the period of rehabilitation for such patients. Intermittent catheterization program (ICP) is a widely employed management for such dysfunction of bladder, however, the occurance of urinary tract infection (UTI) is inevitable. Thus. we carried out this study to investigate the prevention methods of UTI in clinical practice.
A total number of 127 patients, between the age of 16 and 80, were enrolled in this study of UTI while undergoing a period of intermittent catheterization. During the training of ICP, there were a total occurance of 145 UTI with 55 and 90 for symptomatic and asymptomatic UTI respectively. The most common bacteria found in UTI were in the order of Escherichia coli., Klebsiella pneumonia and Pseudomonas aeruginosa. In the present study, The observed higher frequency of asymptomatic UTI was believed to be associated with the visceral and somatic afferent dysfuntion of the patients after injury.
The frequency fo UTI was not found to be related to the age of patient,level of injury, completeness of neurologic deficit, and type of neurogenic bladder. Regarding the effect of prophylactic agents, Vitamin C used alone was not effective, but the group with combination of Vitamin C and macrodantin was found to have lower rate of UTI. However, there was no significant difference when compared with the control.
Therefore, for prevention of UTI during the period of ICP, the most acceptable methods are still: 1). to empty the bladder, 2). to eliminate indwelling catheter, if possible, 3). to prevent bacterial invasion from instrumentation, and 4). to control fluid intake (100cc/hr) and urine output (1500- 2000cc./day). The emphasis of self-catheterization for urine passage in SCI patients with neurogenic bladder is also stressed to avoid UTI.