Clinical Study Of Bladder And Bowel Dysfunction In Patients With Acute Spinal Cord Injury

ObjectiveAutonomic dysfunction is common in patients with spinal cord disease.This article aims to observe the incidence of bladder and intestinal dysfunction in patients with acute spinal cord injury such as transverse myelitis(TM),neuromyelitis optica(NMO)and multiple sclerosis(MS),and its impact on the quality of life of patients.To provide reliable clinically evidence for patients’ treatment and prognosis.MethodsA total of 77 patients with TM,NMO,and MS who were hospitalized in the Department of Neurology,Northern Jiangsu People’s Hospital from October 2017 to September 2019 were continuously collected.Clinical baseline data of patients,including age,gender,time of onset(or course of disease),history of precursor infection was collected.Fasting venous blood was collected in the early morning of the patient the day after admission,and the combined measurement of electrical impedance and radio frequency conductance was used to detect indicators such as white blood cell count,neutrophil count,and lymphocyte count(completed by the Laboratory of Northern Jiang Su People’s Hospital).Neutrophil and lymphocyte count to calculate the neutrophil/lymphocyte ratio(NLR).All patients had undergone spinal MRI examinations at admission,longitudinally extensive transverse myelitis(LETM)was defined as involvement of 3 or more segments of cord on MRI.All patients underwent lumbar puncture before hormone therapy,and the patients’ cerebrospinal fluid protein content,glucose content,chloride content,cell count and classification were collected.Bladder Control Scale(BLCS)was used to evaluate bladder function,and Bowel Control Scale(BWCS)was used to evaluate intestinal function.The Short Form36 Health Survey(SF-36)was used to evaluate the patient’s health and quality of life,the RAND algorithm was used to calculate 8 dimensions,and the factor analysis method was used to calculate the total body composition(PCS)and mental component(MCS).The patient’s prognosis was evaluated using the modified Rank score(m RS),and m RS≤2 was defined as good prognosis,and m RS>2 was classified as poor prognosis.The data was statistically processed using SPSS22.0 statistical software.P<0.05 was considered statistically significant.Results1.Of the 77 patients,33 were TM,24 were NMO,and 20 were MS.The average age was 52.05±16.46,36 were male(46.75%),and 41 were female(53.25%).There was a statistically significant difference in the average age between the three groups of TM,NMO,and MS(P<0.05).The average age of the TM group was significantly higher than that of the MS group(P<0.05).There was no statistical differences in the age between the TM and NMO,NMO,and MS groups(P>0.05).NLR level in TM group was significantly higher than NMO group(P<0.05),and there was no statistical difference between TM and MS,MS and NMO groups(P>0.05).The incidence of bowel dysfunction was significantly higher in the TM group than in the NMO and MS groups(P<0.05),and there was no statistical difference between the NMO group and the MS group(P>0.05).The incidence of thoracic spinal cord disease was significantly higher in the TM group than in the NMO and MS groups(P<0.05),and higher in the NMO group than in the MS group(P<0.05).The incidence of LETM in TM group was higher than that in NMO and MS groups(P<0.05),and that in NMO group was higher than that in MS group(P<0.05).The number of spinal cord segments in the TM group was significantly higher than that in the MS group(P<0.05),and there was no statistically significant difference between the TM and NMO,NMO and MS groups(P>0.05).There was a statistically significant difference in the number of white blood cells in the cerebrospinal fluid between the three groups(P<0.05),The NMO group was significantly higher than the MS group(P<0.05),There was no statistical difference between the NMO and TM and MS and TM groups(P>0.05).2.Of the 77 patients,43 patients were in the bladder dysfunction group(55.84%).Univariate analysis showed that the number of poor prognosis and the incidence of intestinal dysfunction in the bladder dysfunction group were significantly higher than those without bladder dysfunction(P<0.05).The PCS score of the bladder dysfunction group was significantly lower than that of the bladder dysfunction group(P<0.05).Spearman correlation analysis showed that BLCS score and PCS in the bladder dysfunction group were significantly negatively correlated(r =-0.667,P<0.001)3.Of the 77 patients,51 patients were in the bowel dysfunction group(66.23%).Univariate analysis showed that the number of poor prognosis,the incidence of bladder dysfunction,the incidence of thoracic spinal cord lesions,the incidence of LETM,and the number of spinal cord affected segments in the bowel dysfunction group were significantly higher than those in the bowel dysfunction group(P<0.05).The PCS score of the bowel dysfunction group was lower than that of the bowel dysfunction group(P<0.05).Spearman correlation analysis showed that the BWCS score and bowel dysfunction group were significantly negatively correlated(r =-0.67,P<0.001).Conclusion1.Bladder dysfunction and bowel dysfunction occured frequently in patients with acute spinal cord injury such as TM,NMO,and MS.Bowel symptoms in TM patients were more common than MS and NMO.Bladder dysfunction and bowel dysfunction often occured simultaneously.The greater the number of lesion segments and thoracic spinal cord involvement,the higher the incidence of bowel dysfunction.2.The bladder and bowel dysfunction were closely related to the poor prognosis of patients with spinal cord injury,suggesting that the occurrence of sphincter dysfunction indicated poor prognosis.The occurrence of bladder and bowel dysfunction reduced the quality of life of patients.The higher the BLCS and BWCS scores,the worse the quality of life of patients.3.The level of NLR in TM patients was higher than that in NMO and MS groups,suggesting that inflammation played a more active role in promoting the occurrence and development of TM.