痴呆をともなう高齢尿失禁患者に対する時間排尿誘導法の検討

Abstract

尿失禁を伴う高齢脳血管性痴呆患者41人に対して尿流動態検査を行ったうえ, 時間排尿誘導を1週間おこない, これと同時に切迫性尿失禁の17例には塩酸オキシブチニンの併用をおこない排尿の自立を試みた。1)14例がおむつからの離脱ができた。時間排尿誘導は高ADLあるいは正常膀胱機能の患者で特に有効であった。2)膀胱機能障害をみとめるものではおむつの離脱がむずかしく, とくに低ADL患者や残尿の多い低活動性膀胱, 過活動性膀胱ではこれが著明であった。3)過活動性膀胱の17例に対しては, 時間排尿誘導とともに塩酸オキシブチニンを9mg/日投与し, 切迫性尿失禁症状は14例に改善をみとめた。しかしおむつから離脱できたのは3例のみであった

Fourty-one demented elderly patients who had been diapered because of urinary incontinence in Hanwa-Senboku Hospital were treated with the one-week timed voiding schedule. Finally 14 patients (34%) became dry, and free from diapers for more than 1 week after the treatment. With regard to their cystometrogram findings, 10 (67%) of 15 patients having normoactive detrusor function, 3 (14%) of 21 patients having overactive detrusor function and 1 (20%) of 5 patients having underactive detrusor function became free from diapers after the treatment. Therefore a patient with normoactive detrusor function is thought to be a good candidate for the timed voiding schedule. Regardless of their detrusor function, those who showed good responsiveness to the treatment had better activities in daily life (better than D in the Katz index) and small amount of residual urine (less than 80 ml), indicating that not only the detrusor function but also both activities in daily life and the amount of residual urine are the important factors to reestablish voiding behavior in demented elderly patients. The timed voiding schedule is thought to be a useful method to treat incontinence in demented elderly patients, and should be tried first of all, although intermittent catheterization and/or other alternatives would be necessary for those with a large amount of residual urine with poor activities in daily life.