The Clinical Application of Clean Intermittent Self-catheterization

清潔間歇性自我導尿法之臨床運用

陳汶吉(Wen-Gii Chen) ； 呂學甫(Hsueh-Fu Lu) ； 吳錫金(Hsi-Chin Wu)

《Mid-Taiwan Journal of Medicine》 3卷4期 (1998/12) Pp. 218-222

https://doi.org/10.6558/MTJM.1998.3(4).5

摘要

清潔間歇性自我導尿法可以適用於各種急慢性排尿功能的異常，它是一種對於神經源性膀胱或膀胱無張力之排尿功能障礙或失禁的安全及簡單的治療方式。但有些排尿障礙的病人因其醫師對此導尿法並不熟悉而尚未接受此治療。而在高反射的神經源性膀胱常使上泌尿道逐漸變差，他們是否可以藉此種導尿法得到改善仍有待評估。從1995年4月至1997年6月，我們以清潔間歇性自我導尿法共治療了56位排尿障礙的病人，追蹤3個月沒有任何病人在中途不滿意或退出。有4例尿路感染及1例副罩丸炎需服用抗生素治療，多位頸椎受傷的病人在從長期留置導尿管改用此法後得以改善慢性尿路感染的狀況，而在膀胱逼尿肌衰竭的所有病人均可在治療後得到排尿功能的恢復。2位脊膜膨出的病人中有1人由腎衰竭中恢復，但另1人因長期腎功能衰竭而需永久血液透析。本研究結果顯示，清潔間歇性自我導尿法對膀胱排尿功能異常之病人幫助甚大，其併發症很少且僅限於尿路感染，值得在臨床上廣泛運用。

關鍵字

清潔間歇性自我導尿 ； 膀胱功能障礙 ； 糖尿病 ； 逼尿肌衰竭

並列摘要

Clean intermittent self-catheterization (CISC) can be performed to manage acute or chronic bladder dysfunction. It is a safe and simple technique that may improve the quality of life in patients with urinary incontinence or urinative dysfunction because of a neuropathic or atonic bladder. However, some patients who are indicated for CISC may not have the opportunity to try self-catheterization because their doctors are not familiar with the procedure. The upper urinary tract function often gradually worsens in the hyper-reflexia neurogenic bladder. Whether CISC can alleviate urinary dysfunction was the subject of this study. To elucidate the practical value of CISC, we report here our preliminary experience on using this procedure on patients with urinary dysfunction due to various etiologies. From April 1995 through June 1997, 56 consecutive in-patients from our hospital who suffered from bladder dysfunction were enrolled in this study. All the patients who were admitted to the training program satisfactorily passed, with none of them withdrawn due to intolerance of the procedure. Four patients got mild urinary tract infection (UTI) and needed oral antibiotics during the follow-up period. Five patients with cervical spine injury and quadriplegia got rid of their long-term UTI by replacing the catheterization to CISC. All the patients with detrusor muscle failure showed improvement in their urinative function after a period of CISC. One of the two patients with myelomeningocele recovered from renal insufficiency after CISC. The other patient, however, finally required continuous hemodialysis. There was no renal function deterioration in patients with hyperreflexia. In conclusion, CISC is a safe, simple, and useful technique to releive urinary dysfuntion, it should be considered in both hospital-care and home-care programs.

並列關鍵字

clean intermittent self-catheterization ； bladder dysfunction ； diabetes mellitus ； detrusor muscle failure