骶神经调节治疗排尿障碍的护理
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摘要
[目的]探讨骶神经调节治疗慢性排尿障碍的围术期护理措施。[方法]回顾性分析在我院行骶神经刺激电极植入(Ⅰ期)的9例病人,术前行排尿日记以及尿流动力学检查,明确诊断为非梗阻性排尿功能障碍。病人行骶神经刺激电极植入后随访2～4周,如病人症状好转则行永久电极植入(Ⅱ期)。主要护理措施为心理护理,骶神经调节的健康教育以及正确记录排尿日记和残余尿。[结果]参与调控的9例病人中,6例病人排尿症状较前明显好转,并行永久性刺激电极植入。其中1例病人在植入后因切口感染而重新取出电极。其余5例病人植入后随访1～12个月,排尿排便症状较前明显改善。[结论]骶神经调节是一种微创、安全、有效的治疗非梗阻性排尿障碍的方法。充分的术前准备和术前有针对性的心理护理,是保证骶神经调节治疗顺利进行的关键;术后有效的护理措施、正确记录排尿日记是促进病人尽快康复、减少严重并发症的主要措施。
Objective:To probe into the perioperative nursing measures for the treatment of chronic urinary dysfunction with sacral nerve regulation. Methods: A retrospective analysis was conducted for 9 patients with sacral nerve stimulation electrode implantation(stage I) in our hospital. The patients received the preoperative urinary diary and urodynamic examination,with a clear diagnosis of non-obstructive urinary dysfunction. The patient received 2 to 4 weeks follow-up after implantation of the nerve stimulation electrode. If the patient's symptoms improved,permanent electrode implantation(stage II) was performed. The main nursing measures included psychological care,health education for sacral nerve regulation,and proper recording of urination diary and residual urine. Results:In the 9 patients,6 patients had significantly improved urinary symptoms compared with the previous ones,and the permanent stimulating electrodes were implanted. In a patient,the electrode was re-extracted due to wound infection. The remaining 5 patients were followed up for one to 12 months after implantation,and the symptoms of urination and defecation were significantly improved. Conclusions: The sacral nerve regulation was a minimally invasive,safe,and effective method for the treatment of non-obstructive dysuria. Adequate preoperative preparation and preoperative targeted psychological care were the keys to ensure the smooth progress of sacral nerve regulation treatment. Effective postoperative nursing measures and correct urination diary recording were the main measures to promote the recovery of patients as soon as possible and reduce serious complications.
Objective:To probe into the perioperative nursing measures for the treatment of chronic urinary dysfunction with sacral nerve regulation. Methods: A retrospective analysis was conducted for 9 patients with sacral nerve stimulation electrode implantation(stage I) in our hospital. The patients received the preoperative urinary diary and urodynamic examination,with a clear diagnosis of non-obstructive urinary dysfunction. The patient received 2 to 4 weeks follow-up after implantation of the nerve stimulation electrode. If the patient's symptoms improved,permanent electrode implantation(stage II) was performed. The main nursing measures included psychological care,health education for sacral nerve regulation,and proper recording of urination diary and residual urine. Results:In the 9 patients,6 patients had significantly improved urinary symptoms compared with the previous ones,and the permanent stimulating electrodes were implanted. In a patient,the electrode was re-extracted due to wound infection. The remaining 5 patients were followed up for one to 12 months after implantation,and the symptoms of urination and defecation were significantly improved. Conclusions: The sacral nerve regulation was a minimally invasive,safe,and effective method for the treatment of non-obstructive dysuria. Adequate preoperative preparation and preoperative targeted psychological care were the keys to ensure the smooth progress of sacral nerve regulation treatment. Effective postoperative nursing measures and correct urination diary recording were the main measures to promote the recovery of patients as soon as possible and reduce serious complications.
引文
[1] NOBLETTKL,CADISHLA.Sacral nerve stimulation for the treatment of refractory voiding and bowel dysfunction [J].Am Jobstet Gynecol,2014,210(2):99-106.
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[5] AMEND B,KHALILM,KESSLERTM,et al.How does sacral modulation work best?Placement and programming techniques tomaximizeefficacy[J].Curr Urol Rep,2011,12(5):327-335
[6] GORMLEYEA,LIGHTNERDJ,BURGIOKL,et al.Diagnosis and treatment of overactive bladder (non-neurogenic) in adults:AUA/SUFU guideline[J].J Urol,2012,188:2455-2463.
[7] PETTIT P.Current opinion:complications and troubleshooting of sacral neuromodulation[J].Int Urogynecol J,2010,21(Suppl 2):s491-496.
[8] MAEDA Y,MATZEL K,LUNDBY L,et al.Postoperative issues of sacral nerve stimulation for fecal incomtinence and constipation:a systematic literature review and treatment guideline[J].Dis Colon Rectum,2011(54):1443-1460.
[2] PETERS K M,KANDAGATLE P,KA,et al.Clinical outcomes of sacral neuromodulation in patients with neurologic conditions[J].Urology,2013,81(4):738-743.
[3] 陈国庆,宋勇,丁留成,等.骶神经调节术临床应用中国专家共识[J].中华泌尿外科杂志,2014,35:1-5.
[4] KACKERR,DASAK.Selection of ideal candidates for neuromodulation in refractory overactive bladder[J].Curr Urol Rep,2010,11:372-378.
[5] AMEND B,KHALILM,KESSLERTM,et al.How does sacral modulation work best?Placement and programming techniques tomaximizeefficacy[J].Curr Urol Rep,2011,12(5):327-335
[6] GORMLEYEA,LIGHTNERDJ,BURGIOKL,et al.Diagnosis and treatment of overactive bladder (non-neurogenic) in adults:AUA/SUFU guideline[J].J Urol,2012,188:2455-2463.
[7] PETTIT P.Current opinion:complications and troubleshooting of sacral neuromodulation[J].Int Urogynecol J,2010,21(Suppl 2):s491-496.
[8] MAEDA Y,MATZEL K,LUNDBY L,et al.Postoperative issues of sacral nerve stimulation for fecal incomtinence and constipation:a systematic literature review and treatment guideline[J].Dis Colon Rectum,2011(54):1443-1460.