脊髓損傷者之排尿照護(hù)課件

1、脊髓損傷者之排尿照護(hù)郭漢崇 醫(yī)師慈濟(jì)醫(yī)院 排尿障礙治療中心脊髓損傷者之排尿照護(hù)郭漢崇 醫(yī)師脊髓損傷者常見的泌尿系統(tǒng)問題尿失禁排尿困難反覆尿路感染脊髓損傷者常見的泌尿系統(tǒng)問題尿失禁常見的泌尿系統(tǒng)併發(fā)癥尿路感染腎盂發(fā)炎或膀胱發(fā)炎尿路結(jié)石腎結(jié)石及膀胱結(jié)石腎水腫膀胱漲尿或尿液逆流腎功能衰竭常見的泌尿系統(tǒng)併發(fā)癥尿路感染腎盂發(fā)炎或膀胱發(fā)炎Late complications in 704 SCI頸髓脊髓損傷胸髓脊髓損傷腰髓脊髓損傷薦髓及以下脊髓損傷總計(jì)完全不完全完全不完全完全不完全完全不完全完全沒有44604316184433231(32.8%)反覆尿路感染51377824272204243(34.5%)

2、尿路結(jié)石111038151050190(12.8%)腎臟水腫166215280462(8.8%)輸尿管逆流147196800155(7.8%)腎衰竭6582211025(3.6%)Late complications in 704 SCI頸脊髓損傷者之排尿處置自行反射性排尿下腹敲尿或誘尿使用腹壓或以手壓迫排尿留置導(dǎo)尿管尿完全失禁以尿套或尿布處置脊髓損傷者之排尿處置自行反射性排尿脊髓損傷者之排尿照護(hù)課件留置導(dǎo)尿管的後遺癥尿路感染膀胱結(jié)石膀胱萎縮尿道廔管輸尿管尿液逆流留置導(dǎo)尿管的後遺癥尿路感染我是不是高危險(xiǎn)群 SCI病友?高位脊髓損傷具有高壓性排尿者大量殘尿反覆性尿路感染具有輸尿管尿液逆流我是不是

3、高危險(xiǎn)群 SCI病友?高位脊髓損傷如何避免尿路感染?儘量排空膀胱壓尿、敲尿、導(dǎo)尿定期更換導(dǎo)尿管多喝水及吃酸性食物定期檢查排尿情形及排尿壓力如何避免尿路感染?儘量排空膀胱壓尿、敲尿、導(dǎo)尿如何保護(hù)腎臟?多喝水、多吃酸性食物常常將尿液排空適當(dāng)休息及運(yùn)動(dòng)定期更換導(dǎo)尿管如何保護(hù)腎臟?多喝水、多吃酸性食物尿失禁能不能改善?口服抗膽鹼藥物膀胱內(nèi)灌注紅辣椒素或RTX逼尿肌注射肉毒桿菌毒素膀胱擴(kuò)大整形術(shù)尿失禁能不能改善?口服抗膽鹼藥物Initial CMG Tracing after RTXInitial CMG Tracing after RTXUrodynamic tracings before, duri

4、ng and after resiniferatoxinUrodynamic tracings before, duBotulinum Toxin Detrusor Injection for Detrusor HyperreflexiaBotulinum Toxin Detrusor InjecBotulinum A toxin Detrusor Injection for Detrusor HyperreflexiaBotulinum A toxin Detrusor InjTechnique of augmentation cystoplastyTechnique of augmenta

5、tion cysSurgical results after augmentation cystoplastySurgical results after augment能不能拔除導(dǎo)尿管?低位脊髓損傷膀胱擴(kuò)大整形術(shù)高位脊髓損傷肉毒桿菌毒素注射尿液逆流腸道整型及抗逆流裝置尿道外括約肌切開術(shù)可禁尿式膀胱造廔能不能拔除導(dǎo)尿管?低位脊髓損傷膀胱擴(kuò)大整形術(shù)肉毒桿菌素注射尿道外括約肌肉毒桿菌素注射尿道外括約肌Botulinum A Toxin Injection in WomanBotulinum A Toxin Injection inCystoscopic Urethral Injection in

6、Men*Cystoscopic Urethral InjectionReduction of voiding pressure after Botulinum A Toxin Reduction of voiding pressure Reduced abdominal voiding pressure after botulinum toxinReduced abdominal voiding presReduction of MUCP after Botulinum A ToxinReduction of MUCP after BotuliBladder autoaugmenttionBl

7、adder autoaugmenttionAnti-reflux afferent nipple valveAnti-reflux afferent nipple vaSonography of Kock pouchSonography of Kock pouchDegeneration of intestinal wall in Urinary reservoirDegeneration of intestinal wal脊髓損傷者之排尿照護(hù)課件Reduced Intravesical pressure after external sphincterotomyReduced Intravesical pressure Reduction in MUCP afterExternal sphincterotomyReduction in MUCP afterExternImplantation of a urethral stentImplantation of a urethral