脊髓损伤患者间歇导尿过程中自主神经反射障碍的影响因素

doi:10.3969/j.issn.1006-9771.2021.02.005

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (2): 150-155.doi: 10.3969/j.issn.1006-9771.2021.02.005

脊髓损伤患者间歇导尿过程中自主神经反射障碍的影响因素

卫波^1,²,刘根林^1,²,孙薇^1,²,汪林依^1,²,郑樱^1,²,郝春霞^1,²,张缨^1,²,王一吉^1,²,康海琼^1,²,逯晓蕾^1,²,袁媛^1,²,蒙倩茹^1,²,周红俊^1,²()

^1.首都医科大学康复医学院，北京市 100068
^2.中国康复研究中心北京博爱医院脊髓损伤康复科，北京市 100068

收稿日期:2020-05-03 修回日期:2020-06-21 出版日期:2021-02-25 发布日期:2021-02-26
通讯作者: 周红俊 E-mail:zh87569303@qq.com
作者简介:卫波(1975-)，男，汉族，山西晋城市人，博士，副主任医师，主要研究方向：脊髓损伤康复。
基金资助:
中国康复研究中心自主创新课题专项基金项目(2017ZX-08)

Factors Related to Autonomic Dysreflexia during Intermittent Catheterization in Patients with Spinal Cord Injury

Bo WEI^1,²,Gen- lin LIU^1,²,Wei SUN^1,²,Lin-yi WANG^1,²,Ying ZHENG^1,²,Chun-xia HAO^1,²,Ying ZHANG^1,²,Yi-ji WANG^1,²,Hai-qiong KANG^1,²,Xiao-lei LU^1,²,Yuan YUAN^1,²,Qian-ru MENG^1,²,Hong-jun ZHOU^1,²()

^1.Capital Medical University School of Rehabilitation, Beijing 100068, China
^2.Department of Spinal Cord Injury Rehabilitation, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2020-05-03 Revised:2020-06-21 Published:2021-02-25 Online:2021-02-26
Contact: Hong-jun ZHOU E-mail:zh87569303@qq.com
Supported by:
China Rehabilitation Research Center Independent Innovation Project Special Fund Project(2017ZX-08)

摘要/Abstract

摘要： 目的

探讨脊髓损伤患者间歇导尿过程中自主神经反射障碍(AD)的发生情况及影响因素。

方法

采用病例对照研究的方法，对2019年4月至2020年4月住院的脊髓损伤患者44例进行间歇导尿，收集年龄、性别、伤后时间、损伤节段、损伤程度、静息血压、导尿后即刻血压、导尿次数、导尿量、导尿操作持续时间等资料，对AD的发生情况和影响因素分别进行描述性分析及Logistic回归分析。

结果

有26例(59.1%)出现AD。共导尿1738次，发生AD 187次(10.8%)。随着伤后时间和年龄的增加，发生AD的风险增加(P < 0.05)；T₇及以下脊髓损伤发生AD的风险明显低于T₆及以上脊髓损伤(P = 0.002)。导尿次数、性别、损伤程度、导尿量和导尿操作持续时间不是发生AD的影响因素(P > 0.05)。

结论

对SCI患者间歇导尿过程中AD的发生应有充分认识。对于T₆及以上脊髓损伤、伤后时间长及老年患者，间歇导尿时建议常规监测血压，及时发现并处理AD。

关键词: 脊髓损伤, 自主神经反射障碍, 间歇导尿, 影响因素

Abstract: Objective

To investigate the occurrence and related factors of autonomic dysreflexia (AD) during intermittent catheterization in patients with spinal cord injury (SCI).

Methods

Case control study was used in this study. Intermittent catheterization was performed on 44 SCI patients hospitalized from April, 2019 to April, 2020, The data of age, gender, time after injury, segment of injury, degree of injury, resting blood pressure, immediate blood pressure after catheterization, catheterization numbers, catheterization volume and duration of catheterization were collected. Descriptive analysis and binary Logistic regression analysis were used to analyze the occurrence and related factors of AD.

Results

Totally, AD happened in 26 (59.1%) patients. Urethral catheterization was done 1738 times, out of which AD accounted for 187 times (10.8%). The risk of AD increased with the time after injury and age (P < 0.05). The probability of AD was lower in T₇ SCI and below than in T₆ SCI and above (P = 0.002). Catheterization numbers, gender, degree of injury, catheterization volume and duration of catheterization were not influencing factors of AD (P > 0.05).

Conclusion

It is necessary to have a full understanding for the occurrence of AD in patients with SCI during intermittent catheterization. For patients with SCI in T₆ and above, long time after injury and elderly patients, routine monitoring of blood pressure during intermittent catheterization is recommended to detect and deal with AD in time.

Key words: spinal cord injury, autonomic dysreflexia, intermittent urinary catheterization, related factors

中图分类号:

R651.2

卫波,刘根林,孙薇,汪林依,郑樱,郝春霞,张缨,王一吉,康海琼,逯晓蕾,袁媛,蒙倩茹,周红俊. 脊髓损伤患者间歇导尿过程中自主神经反射障碍的影响因素[J]. 《中国康复理论与实践》, 2021, 27(2): 150-155.

Bo WEI,Gen- lin LIU,Wei SUN,Lin-yi WANG,Ying ZHENG,Chun-xia HAO,Ying ZHANG,Yi-ji WANG,Hai-qiong KANG,Xiao-lei LU,Yuan YUAN,Qian-ru MENG,Hong-jun ZHOU. Factors Related to Autonomic Dysreflexia during Intermittent Catheterization in Patients with Spinal Cord Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(2): 150-155.

图/表 4

表1

图1

图2

表2

参考文献 40

1	Vaidyanathan S, Soni B M, Hughes P L, et al. Fatal cerebral hemorrhage in a tetraplegic patient due to autonomic dysreflexia triggered by delay in emptying urinary bladder after unsuccessful intermittent catheterization by carer: lessons learned [J]. Int Med Case Rep J, 2018, 11: 53-58.
2	Beauchemin L, Newman D K, Le Danseur M, et al. Best practices for clean intermittent catheterization [J]. Nursing, 2018, 48(9): 49-54.
3	Association A S I. International Standards for Neurological Classification of Spinal Cord Injury [M]. Richmond, VA: American Spinal Injury Association, 2019.
4	Squair J W, Phillips A A, Harmon M, et al. Emergency management of autonomic dysreflexia with neurologic complications [J]. CMAJ, 2016, 188(15): 1100-1103.
5	Solinsky R, Svircev J N, James J J, et al. A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries [J]. J Spinal Cord Med, 2016, 39(6): 713-719.
6	Morgan S. Recognition and management of autonomic dysreflexia in patients with a spinal cord injury [J]. Emerg Nurse, 2020, 28(1): 22-27.
7	Furlan J C. Autonomic dysreflexia: a clinical emergency [J]. J Trauma Acute Care Surg, 2013, 75(3): 496-500.
8	Krassioukov A V, Furlan J C, Fehlings M G. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity [J]. J Neurotrauma, 2003, 20(8): 707-716.
9	Lee E S, Joo M C. Prevalence of autonomic dysreflexia in patients with spinal cord injury above T₆ [J]. Biomed Res Int, 2017, 2017: 2027594.
10	Gunduz H, Binak D F. Autonomic dysreflexia: an important cardiovascular complication in spinal cord injury patients [J]. Cardiol J, 2012, 19(2): 215-219.
11	Sharif H, Hou S. Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury [J]. Neural Regen Res, 2017, 12(9): 1390-1400.
12	Shouman K, Benarroch E E. Segmental spinal sympathetic machinery: implications for autonomic dysreflexia [J]. Neurology, 2019, 93(8): 339-345.
13	Jarve A, Todiras M, Lian X, et al. Distinct roles of angiotensin receptors in autonomic dysreflexia following high-level spinal cord injury in mice [J]. Exp Neurol, 2019, 311: 173-181.
14	Weaver L C. What causes autonomic dysreflexia after spinal cord injury? [J]. Clin Auton Res, 2002, 12(6): 424-426.
15	Blackmer J. Rehabilitation medicine: 1. Autonomic dysreflexia [J]. CMAJ, 2003, 169(9): 931-935.
16	Fougere R J, Currie K D, Nigro M K, et al. Reduction in bladder-related autonomic dysreflexia after onabotulinumtoxin A treatment in spinal cord injury [J]. J Neurotrauma, 2016, 33(18): 1651-1657.
17	Hubli M, Gee C M, Krassioukov A V. Refined assessment of blood pressure instability after spinal cord injury [J]. Am J Hypertens, 2015, 28(2): 173-181.
18	Popok D W, West C R, Hubli M, et al. Characterizing the severity of autonomic cardiovascular dysfunction after spinal cord injury using a novel 24 hour ambulatory blood pressure analysis software [J]. J Neurotrauma, 2017, 34(3): 559-566.
19	Eldahan K C, Rabchevsky A G. Autonomic dysreflexia after spinal cord injury: systemic pathophysiology and methods of management [J]. Auton Neurosci, 2018, 209: 59-70.
20	Phillips A A, Krassioukov A V. Contemporary cardiovascular concerns after spinal cord injury: mechanisms, maladaptations, and management [J]. J Neurotrauma, 2015, 32(24): 1927-1942.
21	Allen K J, Leslie S W. Autonomic Dysreflexia [M]. Treasure Island, FL: StatPearls, 2020.
22	Vaidyanathan S, Soni B, Oo T, et al. Autonomic dysreflexia in a tetraplegic patient due to a blocked urethral catheter: spinal cord injury patients with lesions above T-6 require prompt treatment of an obstructed urinary catheter to prevent life-threatening complications of autonomic dysreflexia [J]. Int J Emerg Med, 2012, 5: 6.
23	Wan D, Krassioukov A V. Life-threatening outcomes associated with autonomic dysreflexia: a clinical review [J]. J Spinal Cord Med, 2014, 37(1): 2-10.
24	Furlan J C. Headache attributed to autonomic dysreflexia: an underrecognized clinical entity [J]. Neurology, 2011, 77(8): 792-798.
25	Jain A, Ghai B, Jain K, et al. Severe autonomic dysreflexia induced cardiac arrest under isoflurane anesthesia in a patient with lower thoracic spine injury [J]. J Anaesthesiol Clin Pharmacol, 2013, 29(2): 241-243.
26	Sumiya T. Hypertensive intracerebral hemorrhage due to autonomic dysreflexia in a young man with cervical cord injury [J]. J UOEH, 2013, 35(2): 159-164.
27	Delhaas E M, Frankema S P G, Huygen F. Intrathecal baclofen as emergency treatment alleviates severe intractable autonomic dysreflexia in cervical spinal cord injury [J]. [ahead of print]. J Spinal Cord Med, 2019. doi: 10.1080/10790268.2019.1695080. doi: 10.1080/10790268.2019.1695080
28	Solinsky R, Kirshblum S C, Burns S P. Exploring detailed characteristics of autonomic dysreflexia [J]. J Spinal Cord Med, 2018, 41(5): 549-555.
29	Huang Y H, Bih L I, Liao J M, et al. Blood pressure and age associated with silent autonomic dysreflexia during urodynamic examinations in patients with spinal cord injury [J]. Spinal Cord, 2013, 51(5): 401-405.
30	West C R, Popok D, Crawford M A, et al. Characterizing the temporal development of cardiovascular dysfunction in response to spinal cord injury [J]. J Neurotrauma, 2015, 32(12): 922-930.
31	Schottler J, Vogel L, Chafetz R, et al. Patient and caregiver knowledge of autonomic dysreflexia among youth with spinal cord injury [J]. Spinal Cord, 2009, 47(9): 681-686.
32	Furusawa K, Tokuhiro A, Sugiyama H, et al. Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury [J]. Spinal Cord, 2011, 49(1): 49-54.
33	Helkowski W M, Ditunno J F, Boninger M. Autonomic dysreflexia: incidence in persons with neurologically complete and incomplete tetraplegia [J]. J Spinal Cord Med, 2003, 26(3): 244-247.
34	Weld K J, Dmochowski R R. Effect of bladder management on urological complications in spinal cord injured patients [J]. J Urol, 2000, 163(3): 768-772.
35	Lamin E, Newman D K. Clean intermittent catheterization revisited [J]. Int Urol Nephrol, 2016, 48(6): 931-939.
36	Newman D K, Willson M M. Review of intermittent catheterization and current best practices [J]. Urol Nurs, 2011, 31(1): 12-28, 48; quiz 29.
37	Lindan R, Joiner E, Freehafer A A, et al. Incidence and clinical features of autonomic dysreflexia in patients with spinal cord injury [J]. Paraplegia, 1980, 18(5): 285-292.
38	Markić D, Šimičić J, Strčić N, et al. Autonomic dysreflexia [J]. Lijec Vjesn, 2017, 139(1-2): 38-44.
39	Solinsky R, Linsenmeyer T A. Intravesical lidocaine decreases autonomic dysreflexia when administered prior to catheter change [J]. J Spinal Cord Med, 2018, 42(5): 1-5.
40	Krassioukov A, Warburton D E, Teasell R, et al. A systematic review of the management of autonomic dysreflexia after spinal cord injury [J]. Arch Phys Med Rehabil, 2009, 90(4): 682-695.

变量	B	S.E.	Wald	df	P	Exp(B)	Exp(B)的95%置信区间
导尿次数	0.000	0.000	0.052	1	0.820	1.000	1.000~1.000
伤后时间(个月)	0.021	0.005	21.677	1	< 0.001	1.022	1.012~1.031
年龄	0.029	0.008	14.398	1	< 0.001	1.030	1.014~1.046
性别	-0.200	0.242	0.686	1	0.408	0.819	0.510~1.315
损伤节段	-1.051	0.336	9.818	1	0.002	0.349	0.181~0.675
损伤程度	-0.191	0.204	0.879	1	0.349	0.826	0.554~1.232
导尿量(ml)	0.001	0.001	0.348	1	0.555	1.001	0.999~1.002
导尿操作持续时间(min)	0.047	0.074	0.403	1	0.525	1.048	0.907~1.210
常量	-4.207	0.898	21.935	1	< 0.001	0.015

[1]	王子豪, 李昕华, 蒋慧萍, 郭赛男, 梁秋曼, 史婷奇. 全膝关节置换术后短期膝关节功能及其影响因素[J]. 《中国康复理论与实践》, 2024, 30(1): 111-118.
[2]	刘冬, 徐子涵, 李江, 鞠萍. M1区联合背外侧前额叶高频重复经颅磁刺激对脊髓损伤后神经病理性疼痛患者脑电图θ振幅的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 87-94.
[3]	李芳, 霍速, 杜巨豹, 刘秀贞, 李小爽, 宋为群. 经颅直流电刺激联合任务导向性康复训练对脊髓损伤大鼠前肢运动障碍的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 777-781.
[4]	刘宁, 刘雨泉, 祝斌, 于凌佳, 谭海宁, 杨雍, 李想. 脊髓损伤神经学分类国际标准国内应用情况的文献计量学研究[J]. 《中国康复理论与实践》, 2023, 29(7): 808-815.
[5]	王一吉, 周红俊, 何泽佳, 刘根林, 郑樱, 郝春霞, 卫波, 康海琼, 张缨, 逯晓蕾, 袁媛, 蒙倩茹. 不完全性脊髓损伤患者运动功能对称性与步态对称性的关系[J]. 《中国康复理论与实践》, 2023, 29(6): 639-645.
[6]	袁媛, 周红俊, 丛欣莹, 刘根林, 卫波, 郑樱, 郝春霞, 张缨, 王一吉, 康海琼, 逯晓蕾, 蒙倩茹. 创伤性颈脊髓损伤程度与磁共振成像的关系[J]. 《中国康复理论与实践》, 2023, 29(6): 725-730.
[7]	王光程, 段明雪, 郭桐桐, 邢洋, 董志伟, 张琳琳, 郭培武, 井淇, 郑文贵. 康复治疗师职业发展及其转型影响因素分析[J]. 《中国康复理论与实践》, 2023, 29(5): 565-569.
[8]	蒋乐, 杜良杰, 黄富表. 完全性脊髓损伤患者的情绪及认知行为分析[J]. 《中国康复理论与实践》, 2023, 29(5): 576-581.
[9]	郭霜, 谢咏祺, 张良, 张春佳, 彭润, 杨德刚, 杨明亮. 舞蹈致儿童无骨折脱位型脊髓损伤神经学预后的影响因素及预测模型[J]. 《中国康复理论与实践》, 2023, 29(5): 582-589.
[10]	高飞, 刘丽旭, 袁永学. 脑干卒中导致吞咽障碍的临床特征及康复[J]. 《中国康复理论与实践》, 2023, 29(4): 465-471.
[11]	张园, 杨剑. 基于ICD-11和ICF脊髓损伤患者运动康复干预方案及其健康效益：系统综述的系统综述[J]. 《中国康复理论与实践》, 2023, 29(12): 1377-1385.
[12]	石孝宇, 杨剑. 脊髓损伤患者适应性身体活动及其健康效益：基于ICF的Scoping综述[J]. 《中国康复理论与实践》, 2023, 29(12): 1395-1404.
[13]	李经宇, 吕云, 辛雨, 李硕, 彭思静, 密忠祥. 城市医疗集团康复患者向下转诊意愿及影响因素[J]. 《中国康复理论与实践》, 2023, 29(12): 1481-1488.
[14]	刘根林,周红俊,李建军,卫波,郑樱,郝春霞,张缨,王一吉,康海琼,逯晓蕾,袁媛,蒙倩茹. 伴并发症脊髓损伤的神经学分类研究进展[J]. 《中国康复理论与实践》, 2022, 28(8): 934-938.
[15]	康海琼,周红俊,刘根林,卫波,郑樱,张缨,郝春霞,王一吉,逯晓蕾,袁媛,蒙倩茹. 脊髓损伤患者股骨远端和胫骨近端骨密度的变化[J]. 《中国康复理论与实践》, 2022, 28(7): 855-858.

脊髓损伤患者间歇导尿过程中自主神经反射障碍的影响因素

Factors Related to Autonomic Dysreflexia during Intermittent Catheterization in Patients with Spinal Cord Injury

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 4

参考文献 40

相关文章 15

Metrics

本文评价

推荐阅读 0

项目		对照组(n =18)	病例组(n = 26)
性别	男	13	22
	女	5	4
年龄	30岁以下	4	5
	30~50岁	7	11
	50岁以上	7	10
损伤节段	T₆及以上	14	19
	T₇及以下	4	7
损伤程度	完全性脊髓损伤	5	12
	不完全性脊髓损伤	13	14