基于尿动力学检查结果的原位回肠新膀胱功能训练模式的构建
Construct bladder function training model of orthotopicilealneobladder according to the results of urodynamic examination
目的 根据尿动力学检查结果,将原位回肠新膀胱的膀胱功能进行分期并构建相应的训练模式.方法 回顾分析2013年8月至2017年8月行根治性膀胱切除术+原位回肠新膀胱并进行随访的38例患者术后3个月、6个月、1年、2年、3年的尿动力学检查结果,根据尿动力学检查结果将原位回肠新膀胱患者术后膀胱功能训练进行分期,并形成不同时期膀胱功能训练模式.结果 随着术后随访时间的延长,患者日/夜间控尿率提高,最大尿流率、平均尿流率升高,排尿时间缩短,功能膀胱容量增加,膀胱基础压降低,膀胱充盈状态内压、膀胱顺应性提高,排尿时最大膀胱内压、最大腹压及最大逼尿肌压升高,且术后1年后各项指标均趋于稳定.将原位回肠新膀胱的膀胱功能训练分为4期:住院期、恢复期(出院后至术后3个月)、康复期(术后3个月至1年)、稳定期(术后1年以后),并形成不同时期原位回肠新膀胱的膀胱功能训练内容.各期的护理重点:住院期为引流管的护理,恢复期为尿失禁的护理,康复期为排尿功能训练,稳定期为并发症的处理.结论 依据尿动力学检查结果,能对原位回肠新膀胱提出针对性、科学性、实用性的膀胱功能训练模式.
更多Objective To stage orthotopicilealneobladder function and construct the corresponding training mode according to the results of urodynamic examination.Methods 38 patients with bladder cancer underwent radical resection+orthotopicilealneobladder surgery between August 2013 and August 2017,and the urodynamic examination results of 3 months,6 months,1 year,2 years,3 years of were retrospectively analyzed.The bladder function of the patients with orthotopicilealneobladder was staged according to urodynamic examination,and the bladder function training mode was formed.Results As the follow-up time increased after surgery,day/night urine control increased,the maximum urine flow rate,the average urine flow rate increased,urination time shortening,bladder capacity increased,bladder basic pressure decreased,bladder filling state pressure,bladder compliance increased,micturition maximal bladder pressure,maximum abdominal pressure and maximum detrusor pressure increased,and all the indexes tended to be stable after 1 year.Bladder function training orthotopicilealneobladder is divided into four periods,respectively are Hospitalization period,recovery period(3 months after surgery),rehabilitation period(3 months to 1 year after surgery),stable period(1 year after surgery),and formed different stages of orthotopicilealneobladder bladder function training content.The focus nursing of each stage is that early period-drainage tube care,recovery period-incontinence care,rehabilitation period-urinary training,stable period-complications handling.Conclusions According to the results of urodynamic examination,it is possible to propose a targeted,scientific and practical bladder function training model for the orthotopicilealneobladder.
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