急性期の尿誘導法の相違よりみた脊損患者の治療成績

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Out of 150 patients with traumatic spinal cord injury admitted to the Chiba Rosai Hospital for the 10 years since its opening in February 1965, 75 cases admitted immediately after the injury were divided into 3 groups according to the drainage method; 48 cases of the group 1 by simple indwelling urethral catheter, 19 cases of the group 2 by closed and aseptic indwelling urethral catheter, and 8 cases of the group 3 by suprapubic cystostomy kept under closed and aseptic state. Statistical evaluations were made on each group concerning the complications in the upper and lower urinary tract, changes of urinary bacteria, and ultimate voiding efficiency. In the group 2 and 3 subjected to aseptic control, the complications of the bladder and upper urinary tract tended to occur far infrequently comparing to the group 1, and the urethral complications due to foreign material in the urethra tended to be least in the group 3. Therefore, suprapubic cystostomy under the closed and aseptic conditions could be regarded as the most suitable method for the control of urinary tract in the acute stage. We particularly found out that it was important to keep the urethra free from urethral injury by the indwelling catheter for the subsequent acquirement of efficient self-urination. We also concluded from 10 years' experiences that careful control such as aseptic drainage method should be made at the acute stage, that renal functions should be carefully checked during the period of bladder training after the removal of catheter, and that, if renal functions tended to be deteriorating, reintroduction of temporal catheter drainage should be considered, while care should be taken not to discourage the patients for training of urination because of the fear of autonomic hyperreflexia. Anti-alpha-adrenergic drugs which became recently available for improving the bladder function and preventing autonomic hyperreflexia, are useful for the management of the patients. At the end, we would like to stress that conservative therapies using these anti-alpha-adrenergic drugs combined with the conventional cholinergic drugs and waitful observations are the best method for the patients with traumatic spinal lesion.
社団法人日本泌尿器科学会の論文

急性期の尿誘導法の相違よりみた脊損患者の治療成績

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