摘要
目的探讨儿童和青少年尿动力学检查的最佳准备方法。方法尿动力学检查准备方法优化和改进包括首先结合病史、症状和体格检查全面评估;将个性化的心理护理贯穿始终;改进膀胱尿道、肠道和用品及检查环境的准备方法等。应用上述改进方法评估191例膀胱功能障碍患儿尿动力学检查结果和成功率,以及与改进前150例膀胱功能障碍患儿尿动力学检查结果进行比较。结果通过优化和改革准备方法后,共有48%(91/191)患儿压力流率研究提示为逼尿肌收缩乏力;但依据病史发现16%(15/91)患儿无明显的神经损害依据和病史,结合排尿日记我们又分别进行了3-5次压力流率研究,其中67%(10/15)发现逼尿肌收缩功能正常。个性化护理应用前,评估家长及患儿的合作理解程度后,发现共22%(50/232)患儿主观不愿意接受检查。将个性化的心理护理措施实施后,全部接受并顺利进行了尿动力学检查。改进膀胱准备后,共有150例存在残余尿量,其中7%(10/150)患儿自由尿流率测定后,经测压管抽得的残余尿量大于测定后即时B超测定残余尿量20ml以上,显著低于改进前的发生率(23%,15/80),改进前后两者有统计学意义(P<0.05);改进肠道准备后,无一例出现直肠蠕动波,显著低于改进前的发生率(3%,4/150)改进前后两者有统计学意义(P<0.05)。尿动力学检查结果与临床诊断结果的符合率从改进方法前的(85.3%,128/150)提高到改进后的(93.2%,178/191),改进前后两者有统计学意义(P<0.05)。结论改进的准备方法可以提高儿童和青少年膀胱功能障碍患者进行尿动力学检查检查成功率和准确性,减少不适及并发症的发生。
Objective To evaluate the quality of urodynamic studies on the children with lower urinary tract dysfunction （LUTD） by the improved methods the improved method. Methods Urodynamic studies were completed on 191 children with LUTD by improved methods, which is included the evaluation on the history, symptom and medical examination, mental nursing on individual, improved preparation of bladder, urethral, bowel, goods for use and work environment. The results and successful rates of urodynamic studies were analyzed, and urodynamic artifact was also compared to that of 150 children with LUTD before improved methods. Result The bladders of 48% （91/191） of the children were primitively under active detrusor after improved methods. However, sixteen percentage of them were not found damaging evidences according to history, symptom, medical examination and urinary diary. Therefore, urodynamic studies were repetitiously completed, and sixty seven percentages have normal detrusor. Incipiently, twenty two percentages of all children refused to urodynamic studies, but examinations were successfully completed on every one after mental nursing on individual. The difference of pest void volume more than 20ml between through supersound after uroflowmetry and through urethral catheter insertion was found in 7% （10/150）, significantly lower than that before improved methods（23%, 15/80）. No one of rectal peristaltic wave was found during the urodynamic studies, significantly lower than that before improved methods（3% ,4/150）. Conclusion The quality of urodynamic studies on the children with LUTD may be improved, and artifact may be decreased by improved methods.
出处
《医学信息（手术学分册）》
2006年第1期32-35,共4页
Medical Information Operations Sciences Fascicule
