脳卒中患者における尿路管理に関する考察 : 脳病巣と排尿自立との関連性について

Abstract

1)初発の慢性期脳卒中154例の尿路管理について検討した.2)いずれの病巣群においても膀胱利尿筋機能不全タイプの割合に局在性を認めなかった.大脳基底核群を除いた他の脳病巣では高活動型群と正常型群の間で排尿自立の割合に有意差を認めなかった.退院時には154例中113例が排尿自立例であった.3)脳病巣部位にかかわらずADLが排尿自立面での予後に最も関与していた.ADLが高いにもかかわらず, 家族の協力や理解がえられないといった社会的理由からカテーテル抜去が不可能であったり, 高度の痴呆のため排尿自立へ至らなかった

A total of 154 stroke patients, 96 males and 58 females, were analyzed to establish the micturitional modality according to the type of detrusor function and the level of activities of daily living (ADL). All patients had only one episode of stroke attack and were checked at least one month after the onset. Localization of cerebral lesion in each patient was evaluated by neurological findings and cerebral angiography in addition to computed tomography of the brain. In the patient groups classified according to the type of detrusor function, micturitional modality was established in 50% of the patients with the underactive type, 70% of those with the overactive type and in 88% of those with normal function. This suggests that the overactive and normal type of detrusor function may not affect establishment of micturitional modality. On the other hand, when classified according to the level of ADL, none established micturitional modality in patients with poor ADL. By contrast, in the patients on higher levels of ADL who were able to transfer themselves from or to a wheel-chair without any assistance it was established in 75%, and in those who were able to gait with or without a brace upon discharged from the hospital, in 91%. It is concluded that establishment of micturitional modality in stroke patients is closely related to the level of ADL or function of lower extremities, but not to localization of the brain lesion.