慢性脊髓損傷患者神經性膀胱併發症發生率之回溯性研究

Retrospective Study of Neurogenic Bladder Complications in Patients with Chronic Spinal Cord Injury

張勝閔(Sheng-Min Chang) ； 曾聖維(Sheng-Wei Zeng)

《台灣復健醫學雜誌》 47卷2期 (2019/12) Pp. 125-132

https://doi.org/10.6315/TJPMR.201912_47(2).0006

摘要

慢性脊髓損傷患者近年來由於醫療方面的進步，剩餘壽命得以延長許多，但是伴隨而來的則是疾病進入慢性期後，除了因為脊髓神經受損後引發肢體無力和感覺異常外，多個系統異常後續所造成的併發症也是不可忽視的問題，其中因為神經性膀胱所導致的泌尿系統異常，諸如膀胱過動症（bladder overactivity）、逼尿肌括約肌共濟失調（detrusor external sphincter dyssynergia）、膀胱輸尿管逆流（vesicoureteral reflux）、尿路結石（urolithiasis）、泌尿道感染（urinary tract infection）甚至慢性腎臟損傷（chronic kidney injury）等問題，都能導致病人的健康和生活品質受到影響。本研究旨在藉由病例回溯分析慢性脊髓損傷患者神經性膀胱併發症之發生率。本文一共收錄了113位有定期在本院回診追蹤的受試者，追蹤時間最長超過20年，根據尿路動力學檢查（Video-Urodynamic Study）、腎臟超音波檢查（Renal echo）、患者解尿方式和泌尿道感染發生率統計結果得到以下四點結論：第一，不完全性脊髓損傷的患者接受逼尿肌肉毒桿菌注射的比率大於完全性脊髓損傷的患者（p value = 0.01）；第二，發病時間超過20年的脊髓損傷患者，曾經接受尿道括約肌切開術的比率高於發病時間小於20年的受試者（p = 0.013）；第三，經尿道長期置放導尿管和經膀胱造口長期置放導尿管皆有較高的尿路結石發生率（p = 0.022; p = 0.011）；第四，經尿道長期置放導尿管有較高的泌尿道感染發生率（p = 0.022）。希望研究結果可供未來第一線專業人員在處理慢性脊髓損傷患者泌尿系統照護上的參考。

關鍵字

脊髓損傷（spinal cord injury） ； 神經性膀胱（neurogenic bladder） ； 泌尿道感染（Urinary tract infection） ； 尿路結石（urolithiasis）

並列摘要

Recent advances in medicine have greatly prolonged the average lifespan of patients with chronic spinal cord injury (SCI). However, many complications arise as the disease enters the chronic phase. SCI is known to cause limb weakness and paresthesia, it also causes multiple system abnormalities that cannot be easily ignored. Particularly troublesome issues develop due to the urinary system complications resulting from the neurogenic bladder. These include overactive bladder, detrusor external sphincter dyssynergia, vesicoureteral reflux, urolithiasis, urinary tract infection (UTI), and even chronic kidney disease. All these issues cause annoying problems that disturb the patient’s health and quality of life. The aim of this study was to retrospectively analyze the incidence of neurogenic bladder complications in patients with chronic SCI. In total, 113 patients with chronic SCI were recruited in this study. The renal function of all patients was regularly followed up at our outpatient department, with the longest follow-up duration extending more than 20 years. Following the analysis of video urodynamic study, renal ultrasonography, patient voiding methods and investigation of the incidence of urinary tract infection, four conclusions were made. First, the rates of detrusor botulinum injection are greater for patients with incomplete SCI than for those with complete SCI (p=0.01). Second, patients with chronic SCI whose onset was more than 20 years ago have a higher rate of accepting urethral sphincterotomy when compared to those whose onset was less than 20 years ago (p=0.013). Third, both long-term indwelling urethral catheters and suprapubic catheters cause a higher incidence of urolithiasis (p=0.022; p=0.011). Fourth, long-term indwelling urethral catheters cause higher rates of UTI (p=0.022). The findings reported in this study should be helpful for future first-line professionals who treat urinary system complications in patients with chronic SCI.

並列關鍵字

spinal cord injury ； neurogenic bladder ； urinary tract infection ； urolithiasis

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