Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/23425
標題: 以膀胱壓力變化預測急性尿滯留病患移除尿管之時機
Predicting timepoints for removing urethral catheters using transballoon cystometry in acute urinary retention
作者: 鄭文炫
Cheng, Wen-Hsuan
關鍵字: acute urinary retention
急性尿滯留
transballoon cystometry
urodynamic study
經尿管膀胱壓力圖
尿路動力學
出版社: 生命科學院碩士在職專班
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摘要: 研究目的:現階段國內外醫師對於急性尿滯留病患的移除尿管之時機,仍是依照經驗法則,沒有理論的根據。即便現在可以使用尿路動力學檢查來了解下泌尿道功能,卻欠缺移除尿管前後膀胱功能數據,提供醫師來決定是否可移除尿管,因此有進一步研究的需要。材料與方法: 本研究自97年1月至12月,從台中某區域暨教學醫院之泌尿外科電腦資料庫,共收集81位急性尿滯留患者,患者在放導尿管之後或是拔除導尿管之前,皆接受膀胱壓力圖檢查。結果:移除導尿管後病患分為「自解尿液」、「未自解尿液」兩組比較,在膀胱壓及逼尿肌壓方面,兩組在「第一次有尿液感」(p=0.000)、「感到尿漲」(P=0.009 & 0.002)、「感到尿很漲」(p=0.001)以及「感到尿漲無法忍受時」(p=0.003),統計上皆達到顯著差異;「自解尿液」比起「未自解尿液」族群在膀胱壓及逼尿肌壓方面低逾31%~50%。結論:建議急性尿滯留病患,觀察到膀胱壓及逼尿肌壓低逾31%~50%,可作為移除尿管時機之參考;本研究另導出一個「解尿機率」方程式,只要將這個公式內建在尿路動力檢查儀中,不需改變原有操作習慣,檢查完即可自動顯示移除導尿管後是否自解尿液成功機率,敏感性為83.3%,特異性為91.2%。
OBJECTIVE: To predict the time point for removing urethral catheter is equivocal. Urologists make use of transballoon cystometry to evaluate bladder function. But the classic examples of cystometry diagram which the bladder function is good enough to urinate are difficult to determine. It is necessary to interpret functional characters of bladder by transballoon cystometry in acute urinary retention. MATERIALS AND METHODS: A total of 81 patients with acute urinary retention in a regional teaching hospital completed cystometry analysis which was done after indwelling urinary catheter or before removing urethral catheter. RESULTS: Intravesical pressure differed significantly between these two groups of ability and in-ability to urinate. Intravesical pressure and detrusor pressure at first desire (p=0.000), normal desire (p=0.009&0.002), strong desire (p=0.001), urgency (p=0.003) were significantly higher in the group of in-ability to urinate. The pressure difference between these two groups is 31% ~ 50%. CONCLUSIONS: When the decrease in intravesical pressure and detrusor pressure are around 31% ~ 50%, the urinary catheter could be removed successfully. We also construct a micturition equation from binary logistic regression. The equation is reliable, its sensitivity and specificity are 83.3% and 91.2% respectively. This micturition equation can be installed in urodynamic software and the successful rate of removing urinary catheter can be obtained whenever patient completes a cystometry analysis.
URI: http://hdl.handle.net/11455/23425
其他識別: U0005-1906200922242300
文章連結: http://www.airitilibrary.com/Publication/alDetailedMesh1?DocID=U0005-1906200922242300
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