Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Периодическая катетеризация мочевого пузыря при цервикальной тетраплегии
Периодическая катетеризация мочевого пузыря при цервикальной тетраплегии
Бушков Ф.А., Салюков Р.В., Машанеишвили Ш.Г., Романовская Е.В. Периодическая катетеризация мочевого пузыря при цервикальной тетраплегии. Consilium Medicum. 2019; 21 (2): 64–68. DOI: 10.26442/20751753.2019.2.190219
________________________________________________
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Аннотация
Цель. Определить способы отведения мочи и факторы, влияющие на применение периодической катетеризации (ПК), у пациентов со спинальной тетраплегией.
Материалы и методы. В исследовании принял участие 31 пациент с тетраплегией, все проходили реабилитацию в Реабилитационном центре «Преодоление» в 2017–2018 гг., с неврологическим уровнем, соответствующим С4–D1 сегментам спинного мозга. Всем больным была назначена ПК мочевого пузыря на основании данных уродинамического обследования. Пациенты с сохранным щипковым захватом пальцев кисти занимались с эрготерапевтом освоением навыка самостоятельного выполнения катетеризации мочевого пузыря. Через 6 (12) мес после выписки из стационара пациенты были анкетированы по телефону с помощью шкалы симптомов нейрогенного мочевого пузыря (Neurogenic Bladder Symptom Score – NBSS). Эти данные сопоставлялись с заключением эрготерапевта и результатами ретроспективного неврологического обследования (неврологический стандарт American Spinal Injury Association – ASIA).
Результаты. На момент анкетирования преобладающими способами отведения мочи у пациентов было рефлекторное мочеиспускание – 39% (категория D по шкале NBSS) и ПК (категория С по шкале NBSS) – 32%. Единственным фактором, влияющим на частоту использования ПК, является наличие навыка ее выполнения непосредственно пациентом (коэффициент корреляции R=0,86), который, в свою очередь, зависит только от полноты повреждения спинного мозга (ASIA 1,20 против 1,14; p=0,04); качество жизни пациентов с нейрогенным нарушением мочеиспускания было выше при неполном типе повреждения (С и D типы по ASIA; критерий F=3,1; p=0,04).
Заключение. Среди факторов, влияющих на приверженность пациентов назначенному методу отведения мочи, преобладающее значение имеют навык ее самостоятельного выполнения и социальные причины, связанные со сложностью организации выполнения ПК мочевого пузыря в домашних условиях.
Ключевые слова: нейрогенный мочевой пузырь, нейрогенная дисфункция мочевого пузыря, травма спинного мозга, тетраплегия, эрготерапия, периодическая катетеризация, нарушение функции опорожнения мочевого пузыря.
Материалы и методы. В исследовании принял участие 31 пациент с тетраплегией, все проходили реабилитацию в Реабилитационном центре «Преодоление» в 2017–2018 гг., с неврологическим уровнем, соответствующим С4–D1 сегментам спинного мозга. Всем больным была назначена ПК мочевого пузыря на основании данных уродинамического обследования. Пациенты с сохранным щипковым захватом пальцев кисти занимались с эрготерапевтом освоением навыка самостоятельного выполнения катетеризации мочевого пузыря. Через 6 (12) мес после выписки из стационара пациенты были анкетированы по телефону с помощью шкалы симптомов нейрогенного мочевого пузыря (Neurogenic Bladder Symptom Score – NBSS). Эти данные сопоставлялись с заключением эрготерапевта и результатами ретроспективного неврологического обследования (неврологический стандарт American Spinal Injury Association – ASIA).
Результаты. На момент анкетирования преобладающими способами отведения мочи у пациентов было рефлекторное мочеиспускание – 39% (категория D по шкале NBSS) и ПК (категория С по шкале NBSS) – 32%. Единственным фактором, влияющим на частоту использования ПК, является наличие навыка ее выполнения непосредственно пациентом (коэффициент корреляции R=0,86), который, в свою очередь, зависит только от полноты повреждения спинного мозга (ASIA 1,20 против 1,14; p=0,04); качество жизни пациентов с нейрогенным нарушением мочеиспускания было выше при неполном типе повреждения (С и D типы по ASIA; критерий F=3,1; p=0,04).
Заключение. Среди факторов, влияющих на приверженность пациентов назначенному методу отведения мочи, преобладающее значение имеют навык ее самостоятельного выполнения и социальные причины, связанные со сложностью организации выполнения ПК мочевого пузыря в домашних условиях.
Ключевые слова: нейрогенный мочевой пузырь, нейрогенная дисфункция мочевого пузыря, травма спинного мозга, тетраплегия, эрготерапия, периодическая катетеризация, нарушение функции опорожнения мочевого пузыря.
________________________________________________
Aim. Identify ways of urinary diversion and factors affecting the use of intermittent catheterization in patients with tetraplegia.
Materials and methods. 31 patients participated in the examination with tetraplegia, under rehabilitation in Rehab center "Preodolenie" in 2017–2018, with neurological level corresponding to the C4–D1 segments of the spinal cord. All patients were assigned intermittent bladder catheterization, based on urodynamic examination data. Patients with an intact plucking of the fingers were engaged with the ergotherapist in mastering the skill of performing bladder catheterization on their own. 6 (12) months after discharge from the in-patient facility, patients were questioned by phone using the Neurogenic Bladder Symptom Score (NBSS). These data were compared with the conclusion of the ergotherapist and the results of a retrospective neurological examination (American Spinal Injury Association Neurological Standard – ASIA).
Results. At the time of the survey, patients had urinary reflex urination with the prevailing methods of urine discharge – 39% (category D on the NBSS scale) and periodic catheterization (category C on the NBSS scale) – 32%. The only factor affecting the popularity of intermittent catheterization is the presence of the skill of its implementation directly by the patient (correlation coefficient R=0.86), which in turn depends only on the completeness of damage to the spinal cord (ASIA 1.20 vs 1.14; p=0.04); the quality of life of patients with neurogenic impaired urination was higher with an incomplete type of damage (C and D types according to ASIA; criterion F=3.1; p=0.04).
Conclucion. Among the factors affecting the adherence of patients to the prescribed method of urine discharge, the skill of self-fulfillment and social reasons associated with the complexity of organizing the implementation of intermittent catheterization of the bladder at home is of paramount importance.
Key words: Neurogenic bladder, neurogenic bladder dysfunction, spinal cord injury, tetraplegia, ergotherapist, intermittent catheterization.
Materials and methods. 31 patients participated in the examination with tetraplegia, under rehabilitation in Rehab center "Preodolenie" in 2017–2018, with neurological level corresponding to the C4–D1 segments of the spinal cord. All patients were assigned intermittent bladder catheterization, based on urodynamic examination data. Patients with an intact plucking of the fingers were engaged with the ergotherapist in mastering the skill of performing bladder catheterization on their own. 6 (12) months after discharge from the in-patient facility, patients were questioned by phone using the Neurogenic Bladder Symptom Score (NBSS). These data were compared with the conclusion of the ergotherapist and the results of a retrospective neurological examination (American Spinal Injury Association Neurological Standard – ASIA).
Results. At the time of the survey, patients had urinary reflex urination with the prevailing methods of urine discharge – 39% (category D on the NBSS scale) and periodic catheterization (category C on the NBSS scale) – 32%. The only factor affecting the popularity of intermittent catheterization is the presence of the skill of its implementation directly by the patient (correlation coefficient R=0.86), which in turn depends only on the completeness of damage to the spinal cord (ASIA 1.20 vs 1.14; p=0.04); the quality of life of patients with neurogenic impaired urination was higher with an incomplete type of damage (C and D types according to ASIA; criterion F=3.1; p=0.04).
Conclucion. Among the factors affecting the adherence of patients to the prescribed method of urine discharge, the skill of self-fulfillment and social reasons associated with the complexity of organizing the implementation of intermittent catheterization of the bladder at home is of paramount importance.
Key words: Neurogenic bladder, neurogenic bladder dysfunction, spinal cord injury, tetraplegia, ergotherapist, intermittent catheterization.
Полный текст
Список литературы
1. Cameron AP, Wallner LP, Tate DG et al. Bladder management after spinal cord injury in the United States 1972 to 2005. J Urol 2010; 184: 213–7.
2. Powell CR. Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system. Transl Androl Urol 2016; 5: 12–21.
3. Yilmaz B, Akkoç Y, Alaca R et al. Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction. Spinal Cord 2014; 52 (11): 826–30. DOI: 10.1038/sc.2014.134
4. Кривобородов Н.С., Ефремов Н.С. Методы опорожнения мочевого пузыря. Рук. для врачей. М.: Е-ното, 2016.
[Krivoborodov N.S., Efremov N.S. Metody oporozhneniia mochevogo puzyria. Ruk. dlia vrachei. Moscow: E-noto, 2016 (in Russian).]
5. Harvey LA, Batty J, Jones R, Crosbie J. Hand function of C6 and C7 tetraplegics 1–16 years following injury. Spinal Cord 2001; 39: 37–43.
6. Hashizume C, Fukui J. Improvement of upper limb function with respect to urination techniques in quadriplegia. Paraplegia 1994; 32: 354–7.
7. Welk B, Lenherr S, Elliott S et al. The Neurogenic Bladder Symptom Score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury. Spinal Cord 2018; 56 (3): 259 64. DOI: 10.1038/s41393-017-0028-0
8. Marino RJ, Barros T, Biering-Sorensen F et al, ASIA Neurological Standards Committee 2002. International standards for neurological classification of spinal cord injury. J Spinal Cord Med 2003; 26 (Suppl. 1): S50–56.
9. Bolinger R, Engberg S. Barriers, complications, adherence, and self-reported quality of life for people using clean intermittent catheterization. J Wound Ostomy Continence Nurs 2013; 40: 83–9.
10. Penders J, Huylenbroeck AA, Everaert K et al. Urinary infections in patients with spinal cord injury. Spinal Cord 2003; 41: 549–52.
11. Sutton G, Shah S, Hill V. Clean Intermittent Self-catheterisation for Quadriplegic Patients-A Five Year Follow-up. Paraplegia 1991; 29: 542–9.
12. Yildiz N, Akkoç Y, Erhan B et al. Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up. Spinal Cord 2014; 52 (6): 462–7. DOI: 10.1038/sc.2014.41
13. Snoek GJ, Ijzerman MJ, Hermens HJ et al. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord 2004; 42 (9): 526–32.
14. Салюков Р.В., Колмаков А.С. Нарушения мочеиспускания при шейном уровне позвоночно-спинномозговой травмы. Consilium Medicum. 2016; 18 (2.1): 45–8.
[Salukov R.V., Kolmakov A.S. Urinary dysfunction in patients with cervical spinal cord injury. Consilium Medicum. 2016; 18 (2.1): 45–8 (in Russian).]
15. Abrams P, Agarwal M, Drake M et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int 2008; 101: 989–94.
16. Li L. Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2013; 94: 782. https://www.ncbi.nlm.nih.gov/pubmed/23168400
17. Kiddoo D. Randomized Crossover Trial of Single Use Hydrophilic Coated vs Multiple Use Polyvinylchloride Catheters for Intermittent Catheterization to Determine Incidence of Urinary Infection. J Urol 2015; 194: 174. https://www.ncbi.nlm.nih.gov/pubmed/25584995
2. Powell CR. Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system. Transl Androl Urol 2016; 5: 12–21.
3. Yilmaz B, Akkoç Y, Alaca R et al. Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction. Spinal Cord 2014; 52 (11): 826–30. DOI: 10.1038/sc.2014.134
4. Krivoborodov N.S., Efremov N.S. Metody oporozhneniia mochevogo puzyria. Ruk. dlia vrachei. Moscow: E-noto, 2016 (in Russian).
5. Harvey LA, Batty J, Jones R, Crosbie J. Hand function of C6 and C7 tetraplegics 1–16 years following injury. Spinal Cord 2001; 39: 37–43.
6. Hashizume C, Fukui J. Improvement of upper limb function with respect to urination techniques in quadriplegia. Paraplegia 1994; 32: 354–7.
7. Welk B, Lenherr S, Elliott S et al. The Neurogenic Bladder Symptom Score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury. Spinal Cord 2018; 56 (3): 259 64. DOI: 10.1038/s41393-017-0028-0
8. Marino RJ, Barros T, Biering-Sorensen F et al, ASIA Neurological Standards Committee 2002. International standards for neurological classification of spinal cord injury. J Spinal Cord Med 2003; 26 (Suppl. 1): S50–56.
9. Bolinger R, Engberg S. Barriers, complications, adherence, and self-reported quality of life for people using clean intermittent catheterization. J Wound Ostomy Continence Nurs 2013; 40: 83–9.
10. Penders J, Huylenbroeck AA, Everaert K et al. Urinary infections in patients with spinal cord injury. Spinal Cord 2003; 41: 549–52.
11. Sutton G, Shah S, Hill V. Clean Intermittent Self-catheterisation for Quadriplegic Patients-A Five Year Follow-up. Paraplegia 1991; 29: 542–9.
12. Yildiz N, Akkoç Y, Erhan B et al. Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up. Spinal Cord 2014; 52 (6): 462–7. DOI: 10.1038/sc.2014.41
13. Snoek GJ, Ijzerman MJ, Hermens HJ et al. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord 2004; 42 (9): 526–32.
14.Salukov R.V., Kolmakov A.S. Urinary dysfunction in patients with cervical spinal cord injury. Consilium Medicum. 2016; 18 (2.1): 45–8 (in Russian).
15. Abrams P, Agarwal M, Drake M et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int 2008; 101: 989–94.
16. Li L. Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2013; 94: 782. https://www.ncbi.nlm.nih.gov/pubmed/23168400
17. Kiddoo D. Randomized Crossover Trial of Single Use Hydrophilic Coated vs Multiple Use Polyvinylchloride Catheters for Intermittent Catheterization to Determine Incidence of Urinary Infection. J Urol 2015; 194: 174. https://www.ncbi.nlm.nih.gov/pubmed/25584995
2. Powell CR. Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system. Transl Androl Urol 2016; 5: 12–21.
3. Yilmaz B, Akkoç Y, Alaca R et al. Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction. Spinal Cord 2014; 52 (11): 826–30. DOI: 10.1038/sc.2014.134
4. Кривобородов Н.С., Ефремов Н.С. Методы опорожнения мочевого пузыря. Рук. для врачей. М.: Е-ното, 2016.
[Krivoborodov N.S., Efremov N.S. Metody oporozhneniia mochevogo puzyria. Ruk. dlia vrachei. Moscow: E-noto, 2016 (in Russian).]
5. Harvey LA, Batty J, Jones R, Crosbie J. Hand function of C6 and C7 tetraplegics 1–16 years following injury. Spinal Cord 2001; 39: 37–43.
6. Hashizume C, Fukui J. Improvement of upper limb function with respect to urination techniques in quadriplegia. Paraplegia 1994; 32: 354–7.
7. Welk B, Lenherr S, Elliott S et al. The Neurogenic Bladder Symptom Score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury. Spinal Cord 2018; 56 (3): 259 64. DOI: 10.1038/s41393-017-0028-0
8. Marino RJ, Barros T, Biering-Sorensen F et al, ASIA Neurological Standards Committee 2002. International standards for neurological classification of spinal cord injury. J Spinal Cord Med 2003; 26 (Suppl. 1): S50–56.
9. Bolinger R, Engberg S. Barriers, complications, adherence, and self-reported quality of life for people using clean intermittent catheterization. J Wound Ostomy Continence Nurs 2013; 40: 83–9.
10. Penders J, Huylenbroeck AA, Everaert K et al. Urinary infections in patients with spinal cord injury. Spinal Cord 2003; 41: 549–52.
11. Sutton G, Shah S, Hill V. Clean Intermittent Self-catheterisation for Quadriplegic Patients-A Five Year Follow-up. Paraplegia 1991; 29: 542–9.
12. Yildiz N, Akkoç Y, Erhan B et al. Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up. Spinal Cord 2014; 52 (6): 462–7. DOI: 10.1038/sc.2014.41
13. Snoek GJ, Ijzerman MJ, Hermens HJ et al. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord 2004; 42 (9): 526–32.
14. Салюков Р.В., Колмаков А.С. Нарушения мочеиспускания при шейном уровне позвоночно-спинномозговой травмы. Consilium Medicum. 2016; 18 (2.1): 45–8.
[Salukov R.V., Kolmakov A.S. Urinary dysfunction in patients with cervical spinal cord injury. Consilium Medicum. 2016; 18 (2.1): 45–8 (in Russian).]
15. Abrams P, Agarwal M, Drake M et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int 2008; 101: 989–94.
16. Li L. Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2013; 94: 782. https://www.ncbi.nlm.nih.gov/pubmed/23168400
17. Kiddoo D. Randomized Crossover Trial of Single Use Hydrophilic Coated vs Multiple Use Polyvinylchloride Catheters for Intermittent Catheterization to Determine Incidence of Urinary Infection. J Urol 2015; 194: 174. https://www.ncbi.nlm.nih.gov/pubmed/25584995
________________________________________________
2. Powell CR. Not all neurogenic bladders are the same: a proposal for a new neurogenic bladder classification system. Transl Androl Urol 2016; 5: 12–21.
3. Yilmaz B, Akkoç Y, Alaca R et al. Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction. Spinal Cord 2014; 52 (11): 826–30. DOI: 10.1038/sc.2014.134
4. Krivoborodov N.S., Efremov N.S. Metody oporozhneniia mochevogo puzyria. Ruk. dlia vrachei. Moscow: E-noto, 2016 (in Russian).
5. Harvey LA, Batty J, Jones R, Crosbie J. Hand function of C6 and C7 tetraplegics 1–16 years following injury. Spinal Cord 2001; 39: 37–43.
6. Hashizume C, Fukui J. Improvement of upper limb function with respect to urination techniques in quadriplegia. Paraplegia 1994; 32: 354–7.
7. Welk B, Lenherr S, Elliott S et al. The Neurogenic Bladder Symptom Score (NBSS): a secondary assessment of its validity, reliability among people with a spinal cord injury. Spinal Cord 2018; 56 (3): 259 64. DOI: 10.1038/s41393-017-0028-0
8. Marino RJ, Barros T, Biering-Sorensen F et al, ASIA Neurological Standards Committee 2002. International standards for neurological classification of spinal cord injury. J Spinal Cord Med 2003; 26 (Suppl. 1): S50–56.
9. Bolinger R, Engberg S. Barriers, complications, adherence, and self-reported quality of life for people using clean intermittent catheterization. J Wound Ostomy Continence Nurs 2013; 40: 83–9.
10. Penders J, Huylenbroeck AA, Everaert K et al. Urinary infections in patients with spinal cord injury. Spinal Cord 2003; 41: 549–52.
11. Sutton G, Shah S, Hill V. Clean Intermittent Self-catheterisation for Quadriplegic Patients-A Five Year Follow-up. Paraplegia 1991; 29: 542–9.
12. Yildiz N, Akkoç Y, Erhan B et al. Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up. Spinal Cord 2014; 52 (6): 462–7. DOI: 10.1038/sc.2014.41
13. Snoek GJ, Ijzerman MJ, Hermens HJ et al. Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord 2004; 42 (9): 526–32.
14.Salukov R.V., Kolmakov A.S. Urinary dysfunction in patients with cervical spinal cord injury. Consilium Medicum. 2016; 18 (2.1): 45–8 (in Russian).
15. Abrams P, Agarwal M, Drake M et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int 2008; 101: 989–94.
16. Li L. Impact of hydrophilic catheters on urinary tract infections in people with spinal cord injury: systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2013; 94: 782. https://www.ncbi.nlm.nih.gov/pubmed/23168400
17. Kiddoo D. Randomized Crossover Trial of Single Use Hydrophilic Coated vs Multiple Use Polyvinylchloride Catheters for Intermittent Catheterization to Determine Incidence of Urinary Infection. J Urol 2015; 194: 174. https://www.ncbi.nlm.nih.gov/pubmed/25584995
Авторы
Ф.А.Бушков*1, Р.В.Салюков1,2, Ш.Г.Машанеишвили2, Е.В.Романовская1
1 АО «Реабилитационный центр "Преодоление"», Москва, Россия;
2 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия
*bushkovfedor@mail.ru
1 АО «Реабилитационный центр "Преодоление"», Москва, Россия;
2 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия
*bushkovfedor@mail.ru
________________________________________________
Fedor A. Bushkov*1, Roman V. Salyukov1,2, Shakro G. Mashaneishvili2, Elena V. Romanovskaya1
1 Rehabilitation Center for Persons with Disabilities “Preodolenie”, Moscow, Russia;
1 Rehabilitation Center for Persons with Disabilities “Preodolenie”, Moscow, Russia;
2 People’s Friendship University of Russia, Moscow, Russia
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.