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目的了解卒中患者排泄需要知觉受损(impaired awareness,IA)尿失禁(urinary incontinence,UI)的临床特点。方法前瞻性连续观察225例住院急性卒中患者,评估排尿事件和排尿知觉、行脑CT/MRI检查;9例IA-UI患者检测尿动力学;随访患者6个月的存活和尿控制情况。结果发生UI 89例,其中急迫性UI 32例,IA-UI 57例。IA-UI的排尿愿望(P<0.01)、漏尿前膀胱充盈感(P<0.01)、对漏尿的知觉(P<0.05)较急迫性UI差,高龄(P<0.05)、全或部分前循环综合征(P<0.01)和有顶叶新病灶(P<0.05)者比较多,Barthel指数(P<0.01)和认知(P<0.05)评分差;尿动力学显示尿道压力低或逼尿肌活动过度;6个月存活和尿控制均较急迫性UI差(P<0.01)。结论高龄、排尿知觉障碍、前循环脑损害重、尿动力学不同和结局不良是卒中后IA-UI的临床特征。
Objective To investigate the clinical features of urinary incontinence (UI) requiring impaired awareness (IA) in patients with excretory stroke. Methods A total of 225 hospitalized patients with acute stroke were prospectively prospectively evaluated for urinary incontinence and micturition. Brain CT / MRI was performed. Nine patients with IA-UI were tested for urodynamics. Survival and urinary control were followed up for 6 months. The results occurred in 89 cases of UI, including 32 cases of urgency UI, 57 cases of IA-UI. IA-UI voiding desire (P <0.01), bladder leakage before urine leakage (P <0.01), awareness of leakage urine (P <0.05) Barthol index (P <0.01) and cognitive (P <0.05) scores were poor; urodynamics showed that the urethral pressure was low or Detrusor hyperactivity; 6 months survival and urine control were more urgent UI worse (P <0.01). CONCLUSIONS: The clinical features of IA-UI after stroke are senile age, dysuria, impaired circulation of forebrain, different urodynamics and poor outcome.