| Objective:To investigate the optimal nursing protocol of bladder function rehabilitation for patients with different segments of spinal cord injuries.Methods:151 patients with spinal cord injuries and bladder dysfunction,who were treated in the Department of Spine Surgery and Rehabilitation at Chengde Central Hospital from September 2016 to September 2017,were randomly selected for this study,including 74 patients with cervical and thoracic spinal cord injuries,and 77 with lumbar spinal cord injuries.We designed two different bladder function rehabilitation nursing protocols.Protocol A:Clean intermittent catheterization combined with trigger point bladder function training.Protocol B:Clean intermittent catheterization with Crede bladder function training.According to the spinal cord injuries segment,patients with cervical and thoracic spinal cord injuries were randomized with random data tables and divided into treatment group A1 and B1,respectively.36 patients in group A1 were treated with protocol A,and 38patients in group B1 were treated with protocol B.Patients with lumbar injuries were randomly assigned into treatment group A2 and B2.37 and 40patients were treated with protocol A and B,respectively.Measurement data were tested with independent t-tests,and count data were tested with?~2.All patients were followed up for 6 months to observe the differences of residual urine volume,maximum bladder capacity,and maximum urine output before and after treatment with different rehabilitation nursing protocols in patients with different segments of spinal cord injuries.Differences in treatment effects were evaluated to further optimize the bladder function rehabilitation training protocol for patients with spinal cord injuries in different segments.Results:1.74 patients with cervical and thoracic spinal cord injuries were assigned to group A1(36)and B1(38).There was no difference in the composition of general information,such as gender,age,level and site of spinal cord injuries,initial residual urine volume,initial bladder maximum capacity,and initial maximal urine output between two groups(P>0.05).2.In group A1,bladder function rehabilitation training was performed with protocol A.Residual urine volume was lower after treatment(196.80±37.54 vs.69.03±19.24,t=40.053,P<0.001).While maximum bladder capacity and maximum urine output were higher than before(258.90±20.95vs.354.25±51.77,t=-14.733,P<0.001;134.75±40.71 vs.244.14±53.75,t=-9.733 P<0.001).All of these had statistical difference.3.In group B1,bladder function rehabilitation training was performed with protocol B.Residual urine volume was lower after treatment(195.23±44.60 vs.127.10±40.13,t=11.919,P<0.001),while maximum bladder capacity and maximum urine output were higher than before(252.89±24.37vs.283.50±47.81,t=-6.973,P<0.001;142.76±38.82 vs.175.36±50.81,t=-2.657,P<0.001).All of these had statistical difference.4.Residual urine volume in group A1 with protocol A was less in contrast to group B1 after treatment(69.03±19.24 vs.127.10±40.13,t=-7.866,P<0.001),while both the maximum bladder volume and maximum urine volume in group A1 were higher(354.25±51.77 vs.283.50±47.81,t=6.112,P<0.001;244.14±53.75 vs.175.36±50.81,t=5.685,P<0.001).Incidence of urinary tract infection and calculi in group A1 was lower than group B1(2.78%vs.18.42%,?~2=4.692,P=0.033;5.56%vs.23.68%,?~2=4.801,P=0.029).All of these had statistically difference.5.77 patients with lumbar spinal cord injuries were assigned to group A2(37)and B2(40).There was no difference in the composition of general data,such as gender,age,level and site of spinal cord injuries,initial residual urine volume,initial bladder maximum capacity,and initial maximal urine output between two groups(P>0.05).6.In group A2,bladder function rehabilitation training was performed with protocol A.Residual urine volume was lower after treatment(197.78±50.28 vs.115.80±43.79,t=17.41,P<0.001),while maximum bladder capacity and maximum urine output were higher than before(252.97±34.63 vs.268.45±68.30,t=-5.069,P<0.001;146.16±44.26 vs.190.10±54.84,t=-3.793,P<0.001).All of these had statistical difference.7.In group B2,bladder function rehabilitation training was performed with protocol B.Residual urine volume was lower after treatment(189.80±57.79 vs.68.30±14.33,t=42.067,P<0.001).While maximum bladder capacity and maximum urine output were higher than before.All of these had statistical difference(255.00±27.08 vs.351.00±50.47,t=-14.285,P<0.001;154.80±47.75 vs.232.30±49.22,t=-7.010,P<0.001).All of these had statistical difference.8.Residual urine volume in group B2 with protocol B was less in contrast to group A2 after treatment(115.80±43.79 vs.68.30±14.33,t=6.352,P<0.001),while both the maximum bladder volume and maximum urine volume in group B2 were higher(268.45±68.30 vs.351.00±50.47,t=-6.062,P<0.001;190.10±54.84 vs.232.30±49.22,t=3.557,P<0.001).Incidence of urinary tract infection and calculi in group B2 was lower than group A2(21.62%vs.5.26%,?~2=4.699,P=0.032;18.91%vs.2.50%,?~2=5.565,P=0.021).All of these had statistical difference.Conclusion:Clean intermittent catheterization combined with trigger point bladder function training and clean intermittent catheterization with Crede bladder function training can be used for the rehabilitation nursing of patients with spinal cord injuries with bladder dysfunction.Both methods can reduce the residual urine volume,increase the maximum bladder capacity and maximum urine output.However,they have different effects on rehabilitation nursing in patients with different segments of spinal cord injuries.For patients with cervical and thoracic spinal cord injuries,the use of clean intermittent catheterization combined with trigger point bladder function training is more effective with less complication.And the use of clean intermittent catheterization and Crede bladder function training is more effective and less complications for patients with lumbar spinal cord injuries. |
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