视频联合行动导向教学法对泌尿结石留置输尿管支架患者自我管理能力和并发症的影响

目的探讨视频联合行动导向教学法对泌尿结石留置双J管患者健康教育中的应用效果, 为提升临床护理健康教育水平提供参考。方法选择2018年3月至2019年10月在郑州大学第一附属医院泌尿外科行钬激光碎石术后留置双J管的100例患者为研究对象。按照随机数字表法分为试验组和对照组, 每组50例。对照组采用常规护理和口述式健康教育, 试验组在常规护理基础上实施视频联合行动导向教学法健康教育。比较2组患者健康自我管理能力和并发症发生率。结果拔管时, 试验组健康自我管理能力测评量表中自我管理行为、自我管理认知、自我管理环境等分量表得分和总分分别为(54.26 ± 4.39)、(57.22 ± 6.93)、(39.91 ± 7.91)、(151.39 ± 13.37)分, 高于对照组的(47.92 ± 6.96)、(52.69 ± 6.45)、(34.63 ± 8.53)、(135.24 ± 12.71)分, 差异有统计学意义(t值为2.64 ～ 6.04, 均P<0.05)。试验组并发症总发生率为39.1%(18/46), 明显低于对照组的61.2%(30/49);其中试验组腰痛、膀胱刺激征、血...     

电刺激盆底肌治疗女性真性压力性尿失禁效果及尿动力学变化

目的:观察电刺激盆底肌治疗女性真性压力性尿失禁(GSI)效果及尿动力学变化.方法:35例GSI女性患者,使用神经肌肉电刺激治疗仪行盆底肌电刺激治疗.每周3次,疗程12周.治疗前、后分别记录排尿日记,填写国际尿失禁咨询委员会问卷简表(ICI-Q-SF),并进行尿动力学测定.结果:18例(51%)白天尿失禁症状消失,12例(35%)明显改善,5例(14%)无改善.治疗后总排尿次数、总漏尿事件次数和ICI-Q-SF评分显著低于治疗前,功能性膀胱容量显著高于治疗前(P＜0.05);尿动力学检查显示治疗后valsalva漏尿点压、最大尿道压和最大尿道闭合压显著高于治疗前(P＜0.05).结论:神经肌肉电刺激治疗仪可用于治疗女性真性压力性尿失禁,尿动力学检查是评估其疗效的重要方法.     

成年女性膀胱尿道功能障碍患者B超影像尿动力学检查

目的:探讨B超影像尿动力学检查在评估成年女性膀胱尿道功能障碍中的应用价值.方法:用B超影像尿动力学检查方法对39例成年女性膀胱尿道功能障碍患者进行评估.结果:39例膀胱尿道功能障碍患者中压力性尿失禁14例(38.9%),膀胱过度活动症8例(20.5%),逼尿肌无收缩12例(30.8%),原发膀胱颈口梗阻5例(12.8%).尿动力学检查显示压力性尿失禁患者最大尿道闭合压(6.7±3.1)kPa,逼尿肌无收缩患者残余尿量(424.4±241.1)ml,膀胱顺应性(196.9±149.0)ml/kPa.耻骨上B超显示逼尿肌无收缩和膀胱颈口梗阻患者膀胱壁增厚9例,会阴部B超和阴道B超显示压力性尿失禁患者膀胱颈口表现漏斗状12例,尿道增宽7例.结论:B超影像尿动力学检查可以提供更多的膀胱尿道形态和功能信息,提高了膀胱尿道功能障碍诊断的准确性.     

甘露醇致急性肾衰竭

本文概述了甘露醇致急性肾功能衰竭的发病机理、诱发因素及预防、治疗措施。     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.     

＂一字＂法内眦赘皮矫正术联合睑袋整复术的效果评价

目的 探讨＂一字＂法内眦赘皮矫正术联合睑袋整复术的临床应用效果及评价.方法 由设计的新内眦点处＂一字＂ 法横切开内眦赘皮,切口延至下睑缘5mm左右,分离内眦部的皮下粘连,剪除部分错构组织,形成新的内眦,再将下睑缘切口延至外眦部,切开皮肤、皮下组织,行睑袋整复术,术中将眶隔脂肪释放、重置,紧缩眶隔,去除部分肥厚的眼轮匝肌和松弛的皮肤.结果 本组18例患者,术后均取得较好的治疗效果.随访1~14个月,内眦赘皮消失,基本无瘢痕遗留,双眼间距适当,双睑外形美观,睑袋改善明显,无并发症发生,达到眼周年轻化的良好效果.结论 ＂一字＂法内眦开大术联合睑袋整复术,较好地矫正了内眦赘皮和下睑松弛,达到了眼周年轻化的美容效果.     

电刺激联合盆底肌训练治疗女性压力性尿失禁合并特发性逼尿肌过度活动的疗效观察

Objective To investigate the short-term efficacy of pelvic floor electrical stimulation (PFES) and pelvic floor training (PFT) for female with idiopathic detrusor overactivity (IDO) and stress urinary incontinence (SUI). Methods PFES and PFT were performed on 70 women (average age 40±7 years old) with IDO and SUI for twelve weeks. Urinary diary, International Continence In-quiring Committee's Questionnaire (ICI-Q-SF) scores were recorded and urodynamic study was per-formed before and after the treatment. Results Fifty women (71%) finally completed treatment for twelve weeks. Urinary incontinence disappeared in 8 (16%), detrusor overactivity disappeared in 10 (20 %). The leakage was not found in 6 (12 %) in leakage point pressure measurement. Moreover, the frequency of voiding (28±5 times/72 h), frequency of leakage (10±5 times/72 h), total scores of ICI-Q-SF(10±3), max detrusor uninhibited contraction pressure (18±8 cmH20) and detrusor unin-hibited contraction duration (8±3 s) were significantly lower than those before treatment (43±8 times/72 h, 20±6 times/72 h, 17±3, 27±9 cm H2O and 13±6s,P<0.01). Maximal voided vol-ume(225±48 ml), normal desired cystometric capacity (210±48 ml), maximal cystometric capacity (247±48 ml), Valsalva leak point pressure (94±11 cm H2O) and maximal urethral closure pressure (59±8 cm H2O) were significantly higher than those before treatment (159±37 ml, 141±39ml, 178±36ml, 81±15 cm H2O and 55±8 cm H2O, P<0.01). The effective rate during three months follow up was 60%, similar to time after treatment (P>0.05). Conclusions Pelvic floor electrical stimulation and pelvic floor training could be a useful therapy to treat women with IDO and SUI. It is both convenient and economical.     

老年患者尿动力检查前后影响因素评估的临床研究

目的研究672例老年患者尿动力检查前后影响因素,探讨影响检查结果的相关因素,并提出处理对策。方法研究郑州大学第一附属医院2010年6月-2012年6月对672例60岁以上老年患者尿动力学检查的临床资料,根据老年患者自身生理特点、合并症、文化程度、理解力制定并实施相关的检查事项。结果在672例老年患者中检查成功670例,平均检查时间35.4min,其中2例因患者过于紧张而坚决放弃检查。检查成功率99.7%。结论应从多方面对老年患者尿动力检查前后的影响因素进行评估,可增加患者检查的依从性,又能确保尿动力学检查结果的准确性。     

遗尿伴急迫性和排尿延缓性尿失禁患儿膀胱功能的尿动力学评估

目的 探讨夜间遗尿伴白天急迫性尿失禁(UI)和夜间遗尿伴白天排尿延缓性尿失禁(VPI)患儿的尿流动力学表现,为临床治疗提供依据.方法 本研究选取2008年6月至2009年10月间因夜间遗尿伴白天尿失禁诊断的患儿64例,进行详细的体格检查、腰椎X线、泌尿系超声并测定膀胱壁厚度、尿常规,尿动力学检查.将患儿分为UI和VPI两组.结果 UI组与VPI组比较:膀胱壁厚度较正常增厚比例(5%比20%,P＜0.05),两组中伴随尿痛、便秘等显著临床症状(13%比36%,P＜0.05).最大尿流率VPI组与UI组分别为(20.2±9.0)ml/s、(14.1±11.6)ml/s(P＜0.05),最大尿道压VPI组与UI组分别为(152.3±47.5)cmH2O、(107.7±40.3)cmH2O(P＜0.05).结论 VPI患儿更易出现躯体不适及明显临床症状,VPI的尿动力改变和临床症状明显较UI严重,这些儿童有必要常规行尿动力学检查了解膀胱功能,为规范治疗提供依据.

Abstract：

Objective To evaluate the urodynamic parameters of the children with enuresis nocturna accompanied by daytime urgency incontinence(UI) or daytime voiding postponement incontinence(VPI).Methods From June 2007 to October 2009,a total of 64 children who had enuresis nocturna accompanied by daytime UI or daytime VPI were recruited in this studv.The urodynamics parameters including uroflowmetry,bladder pressure-volume,and static urethral pressure were examined and recorded.The physical examination,X-ray radiography,ultrasonography and urinalysis were of UI patients had thicker bladder wall(P＜0.05).Pain with urinating and constipation occurred in 13% UI patients,and 36%VPI patients(P＜0.05).The maximum flow rate in VPI patients was higher than that in UI patients(20.20±9.02 vs.14.09±11.56 ml/s,P＜0.05).Maximum urethral pressure in VPI patients was higher than that in UI patients(1 52.3±47.5 vs 107.7±40.3 cmH2O,P=0.003).Conclusions The symptoms and urodynamic dysfunction of the children with enuresis nocturna accompanied by VPI are more severe than those of the UI patients.The therapeutic plan should be made according to the urodynamic evaluations of these patients.