Department of of Spinal Injuries, Midlands Centre for Spinal Injuries, Robert Jones and Agnes Hunt Orthopaedic Hospital, Keele University, Oswestry, UK.
Spinal Cord. 2012 Jan;50(1):14-21. doi: 10.1038/sc.2011.78. Epub 2011 Aug 2.
Retrospective longitudinal study of short- and long-term urinary complications in chronic spinal cord injury (SCI) patients managed at the Midlands Centre for Spinal Injuries (MCSI).
MCSI, Oswestry, UK.
A total of 185 SCI patients were admitted to the MCSI between 1984 and 1989. Only 119 patients who met the following criteria were included: traumatic SCI, Frankel grade A-D, admission within 6 weeks post injury, regular annual follow-up or alternate year at MCSI, follow-up longer than 8 years. Follow-up ranged between 8 and 21 years with a mean of 17.7 (s.d.=1.98). The method of bladder drainage varied from the time of injury. Drainage was by indwelling urethral catheterisation (IndUC) before admission to the MCSI. Within 24 h of admission, assisted clean intermittent catheterisation (ACIC) by the nursing staff was commenced. This was followed by clean intermittent self catheterisation (CISC) once the patient was mobilised in the wheel chair and trained in the procedure. When detrusor reflex activity develops, patients with good hand function were given a choice between CISC and reflex voiding (RV). Patients with poor hand function are given the choice between RV, suprapubic catheters or ACIC during hospitalisation and after discharge. Only a minority of these patients choose ACIC following discharge. RV was supplemented occasionally by sphincterotomy. There were 99 males and 20 females (5:1). The age at the time of injury was 16-63 years with a mean of 29 (s.d.=12). Instead of a single method, a pattern of bladder management was analysed in the context of three continuous phases: Phase1 preadmission to MCSI. Phase2 during first hospitalisation at MCSI. Phase3 post discharge. In each phase, the patients were divided into those with and without complications. The complications were analysed in relation to the management and other relevant factors.
The total complication rate at all stages was 62%. Complications of the upper urinary tract accounted for 22.6%. These results compared favourably with published material.
The sequential system of supervised bladder management commencing with brief IndUC followed by IntC and/or RV remains effective in keeping the complication rate relatively low in SCI patients, who undergo regular surveillance and timely intervention.
The project was supported by SPIRIT, a charitable not for profit trust that supports teaching, training, clinical research and dissemination of knowledge about all aspects of spinal paralysis in the UK.
对在米德兰脊髓损伤中心（MCSI）接受治疗的慢性脊髓损伤（SCI）患者的短期和长期尿路并发症进行回顾性纵向研究。
英国奥斯特里的 MCSI。
1984 年至 1989 年间，共有 185 名 SCI 患者入住 MCSI。仅纳入符合以下标准的 119 名患者：外伤性 SCI，Frankel 分级 A-D，受伤后 6 周内入院，在 MCSI 进行定期年度随访或每两年一次，随访时间超过 8 年。随访时间为 8 至 21 年，平均为 17.7（标准差=1.98）。膀胱引流方式因受伤时间而异。在入住 MCSI 之前，通过留置导尿管（IndUC）进行引流。入院后 24 小时内，由护理人员开始进行辅助清洁间歇性导尿（ACIC）。一旦患者在轮椅上活动并接受了该程序的培训，就开始进行清洁间歇性自我导尿（CISC）。当逼尿肌反射活动发展时，具有良好手部功能的患者可以在 CISC 和反射排空（RV）之间进行选择。手部功能较差的患者在住院期间和出院后可以选择 RV、耻骨上导管或 ACIC。这些患者中只有少数人在出院后选择 ACIC。RV 偶尔通过括约肌切开术补充。男性 99 例，女性 20 例（5:1）。受伤时的年龄为 16-63 岁，平均为 29（标准差=12）。分析了在三个连续阶段中，以膀胱管理模式为背景的膀胱管理模式：阶段 1：在入住 MCSI 之前。阶段 2：在 MCSI 第一次住院期间。阶段 3：出院后。在每个阶段，患者分为有并发症和无并发症两组。分析了并发症与管理和其他相关因素的关系。
所有阶段的总并发症发生率为 62%。上尿路并发症占 22.6%。这些结果与已发表的资料相比表现良好。
从短暂的 IndUC 开始，随后是 IntC 和/或 RV 的序贯系统监督膀胱管理，在接受定期监测和及时干预的 SCI 患者中，使并发症发生率保持相对较低的水平仍然有效。
该项目由 SPIRIT 支持，SPIRIT 是一个慈善非营利信托基金，支持英国脊髓瘫痪各个方面的教学、培训、临床研究和知识传播。
