Kết quả thông tiểu ngắt quãng sạch điều trị bệnh nhân bàng quang thần kinh do dị tật nứt đốt sống bẩm sinh

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Tác giả: Duy Việt Nguyễn

Ngôn ngữ: Vie

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Thông tin xuất bản: Tạp chí Y học Việt Nam 2023

Mô tả vật lý: 46-51

Bộ sưu tập: Metadata

ID: 409673

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Mô tả kết quả thông tiểu ngắt quãng sạch điều trị bệnh nhân bàng quang thần kinh sau phẫu thuật dị tật nứt đốt sống bẩm sinh. Đối tượng và phương pháp: mô tả tiến cứu đánh giá trước sau thông tiểu ngắt quãng sạch ở bệnh nhân bàng quang thần kinh sau mổ dị tật nứt đốt sống bẩm sinh, tại Bệnh viện Nhi Trung ương giai đoạn từ 01/03/2013 đến 31/03/2019. Siêu âm mô tả tình trạng bể thận - niệu quản, chụp niệu đạo - bàng quang ngược dòng mô tả trào ngược bàng quang - niệu quản và đo áp lực bàng quang mô tả các tham số. Các biến số được đánh giá trước và sau khi hướng dẫn thông tiểu ngắt quãng sạch. Test thống kế mcnemar đánh giá hiệu quả đối với tình trạng giãn bể thận - niệu quản và trào ngược bàng quang - niệu quản với p <
0,05 có ý nghĩa thống kê. Kết quả: có 62 bệnh nhân bàng quang thần kinh sau phẫu thuật dị tật nứt đốt sống bẩm sinh với 27 trường hợp là trẻ nam chiếm 43,5%, 35 trường hợp là trẻ nữ chiếm 56,5%. Trong đó thoát vị tủy - màng tủy chiếm đa số với tỷ lệ 72,6%, thoát vị mỡ - tủy màng tủy 27,4%. Vị vị trí tổn thương tủy lưng thấp dưới tủy 4 là 40,3% và tổn thương tủy cùng cụt là 50,9%. Với triệu chứng rỉ nước tiểu là 100% trường hợp. Sự cải thiện tình trạng giãn bể thận - niệu quản trước và sau thông tiểu ngắt quãng sạch không có ý nghĩa thống kê 32,3% so với 25,8%. Tương tự sự cải thiện tình trạng trào ngược bàng quang - niệu quản trước và sau thông tiểu ngắt quãng sạch không có ý nghĩa thống kê 46,8% so với 35,5%. Với những trường hợp có áp lực bàng quang <
30 cmH2O sau thông tiểu ngắt quãng sạch thì thể tích bàng quang trước và sau thông tiểu ngắt quãng sạch bình thường, ngược lại với những trường hợp có áp lực bàng quang ≥ 30 cmH2O sau CIC thì thể tích bàng quang nhỏ hơn so với tuổi. Tuổi bắt đầu tiến hành thông tiểu ngắt quãng sạch là 3,2 ± 2,8 tuổi (0,3 - 11,5 tuổi), với thời gian theo dõi trung bình là 39,9 ± 15,1 tháng (24 - 65 tháng). Có 51,6% bệnh hết rỉ tiểu sau CIC. Kết luận: Thông tiểu ngắt quãng sạch giúp cải thiện 51,6% bệnh nhân hết rỉ tiểu, duy trì thể tích bàng quang, áp lực bàng quang ở những trường hợp mà trước đó thể tích bàng quang so với tuổi >
80%, áp lực bàng quang <
20 cmH2O. Tuy nhiên thông tiểu ngắt quãng sạch cải thiện tình trạng giãn bể thận - niệu quản và tình trạng trào ngược bàng quang - niệu quản không có ý nghĩa thống kê., Tóm tắt tiếng anh, Describe the results of clean intermittent catheterization in patients with neurogenic bladder after surgery for congenital spina bifida. Subject: Descriptive study evaluates before and after clean intermittent catheterization in neurogenic bladder patients after surgery for spina bifida at the National Children's Hospital from March 1 2013 to March 31, 2019. Ultrasound describes the condition of the renal pelvic-ureteral dilation, voiding cystography describes vesicoureteral reflux and cystometry describes the parameters. Variables were assessed before and after clean intermittent catheterization. Statistical test mcnemar evaluates the effectiveness of pyelonephritis - ureteral dilatation and vesicoureteral reflux with p <
0.05 with statistical significance. Results: There were 62 neurogenic bladder patients after surgery for spina bifida, with 27 males accounting for 43.5%, and 35 females accounting for 56.5%. Myelomeningocele accounted for the majority with a rate of 72.6%, and lipomyelomyelomeningocele was 27.4%. The location of the below 4th spinal cord lesion was 40.3% and the sacral spinal cord lesion was 50.9%. Urinary incontinence is 100% of cases. The improvement of pelvic-ureteral dilation before and after clean intermittent catheterization was not statistically significant in 32.3% compared with 25.8%. Similarly, the improvement of vesicoureteral reflux before and after clean intermittent catheterization was not statistically significant at 46.8% versus 35.5%. For cases with vesical pressure <
30 cmH2O after clean intermittent catheterization, the bladder capacity before and after clean intermittent catheterization is normal (>
80%), in contrast to cases with vesical pressure >
30 cmH2O after CIC, bladder capacity is smaller for age (<
65%). The age at initiation of clean intermittent catheterization was 3.2 ± 2.8 years (0.3 - 11.5 years), with a median follow-up is 39.9 ± 15.1 months (24 - 65 months). There are 51.6% of patients with urinary continence after clean intermittent catheterization. Conclusions: Clean intermittent catheterization helps to improve 50% of patients with urinary incontinence and maintain bladder capacity, and vesical pressure in cases where the bladder capacity for age is >
80% before, vesical pressure <
20 cmH2O. However, clean intermittent catheterization improved renal pelvic-ureteral dilation and vesicoureteral reflux was not statistically significant.

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