膀胱药物灌注联合心理护理在间质性膀胱炎/膀胱疼痛综合征治疗中的应用

doi:10.3877/cma.j.issn.1674-3253.2021.05.017

目的

探讨膀胱内药物膀胱灌注联合心理护理在间质性膀胱炎/膀胱疼痛综合征（IC/BPS）患者治疗中的疗效，以指导临床治疗。

方法

2015年11月至2019年5月，泌尿外科共收治IC/BPS患者71例。其中女61例，男10例。年龄21~76岁，平均（43±11）岁。病程6~242个月，平均（63±21）个月。IC/BPS患者症状评估采用O'Leary-Sant调查表和盆腔疼痛和尿频尿急症状评分表（PUF评分表），IC/BPS患者焦虑评估采用焦虑自评量表（SAS），抑郁评估采用贝克抑郁量表（BDI-Ⅱ）。所有患者均行麻醉下膀胱镜检查及水扩张。对水扩张后所有患者均行膀胱内透明质酸钠灌注，根据是否进行心理护理及指导分为两组，比较两组治疗前及治疗后（1个月、3个月、6个月）的疗效情况。

结果

与治疗前相比，两组患者治疗后第1、3、6个月时的各项观察指标均得以改善（P<0.05）。治疗1个月后各项观察指标两组间比较差异无统计学意义（P>0.05）；但治疗后3个月与治疗后6个月，各项观察指标两组间比较差异均具有统计学意义（P<0.05）。

结论

膀胱内透明质酸钠灌注可有效缓解IC/BPS患者的症状，而在长期疗效中膀胱内药物灌注联合心理护理优于单纯进行膀胱内药物灌注。

关键词: 间质性膀胱炎, 膀胱灌注, 心理护理

Objective

To explore the curative effect of intravesical drug intravesical instillation combined with psychological nursing in the treatment of interstitial cystitis / bladder pain symptom (IC/BPS) patients and guide the clinical treatment.

Methods

From November 2015 to may 2019, 71 patients with IC/BPS were admitted. There were 61 women and 10 men. The average age was (43±11) years. The course of disease ranged from 6 to 242 months, with an average of (63±21) months. The symptoms of IC/BPSwere assessed by O'Leary Sant questionnaire, pelvic pain and frequency of urination and urgency of urination symptom scale (PUF scale), the anxiety of IC/BPS patients was assessed by Self-rating Anxiety Scale (SAS), and the depression was assessed by Beck Depression Scale (BDI-Ⅱ). All patients underwent cystoscopy and hydrodilation under anesthesia. After water dilation, all patients were perfused with sodium hyaluronate in bladder. According to whether psychological care and guidance were carried out, they were divided into two groups. The curative effect of the two groups before and after treatment (1 month, 3 months, 6 months) was compared.

Results

Compared with before treatment, all the observation indexes of the two groups were improved at the 1st, 3rd and 6th month after treatment (P<0.05). There was no significant difference between the two groups (P>0.05) 1 month after treatment, and there was significant difference between the two groups 3 months and 6 months after treatment (P<0.05).

Conclusion

Intravesical sodium hyaluronate infusion can effectively relieve the symptoms of IC/BPS patients, and in the long-term effect, intravesical drug infusion combined with psychological nursing is better than intravesical drug infusion alone.

Key words: Interstitial cystitis, Intravesical therapy, Psychosocial nursing

表1 两组治疗后各观察项目情况比较（±s）

项目	治疗前		治疗后1个月		治疗后3个月		治疗后6个月
项目	A组	B组	A组	B组	A组	B组	A组	B组
排尿次数	18.3±2.7	19.2±1.8	14.1±2.1^a	15.3±3.2^a	10.1±2.4^bc	14.2±2.7^a	9.2±1.9^bc	12.5±2.2^a
膀胱容量(ml)	125.4±21.1	133.2±18.9	175.2±24.3^a	167.0±27.1^a	217.0±21.0^bc	172.1±24.0^a	205.8±18.1^bc0	181.3±21.4^a
ICSI	16.7±2.2	17.2±1.9	12.7±2.8^a	11.5±2.5^a	07.8±1.9^bc	10.9±1.9^a	8.6±2.3^bc	10.3±2.7^a
ICPI	14.5±2.7	14.7±2.3	08.9±2.2^a	09.6±2.7^a	06.2±2.2^bc	08.9±3.3^a	5.8±2.7^bc	07.7±1.8^a
PUF	30.1±1.9	28.9±2.7	15.7±3.2^a	14.4±2.8^a	11.7±3.6^bc	14.2±3.5^a	10.3±3.4^bc0	13.9±2.7^a
SAS	65.4±2.2	64.9±1.8	49.8±4.5^a	51.6±3.9^a	39.8±3.3^bc	48.7±3.6^a	38.3±2.8^bc0	49.5±3.1^a
BDI-Ⅱ	18.5±1.9	17.8±1.7	14.0±1.9^a	14.7±1.5^a	09.5±1.8^bc	14.6±1.7^a	8.7±1.0^bc	14.7±1.4^a

表1 两组治疗后各观察项目情况比较（±s）

项目	治疗前		治疗后1个月		治疗后3个月		治疗后6个月
项目	A组	B组	A组	B组	A组	B组	A组	B组
排尿次数	18.3±2.7	19.2±1.8	14.1±2.1^a	15.3±3.2^a	10.1±2.4^bc	14.2±2.7^a	9.2±1.9^bc	12.5±2.2^a
膀胱容量(ml)	125.4±21.1	133.2±18.9	175.2±24.3^a	167.0±27.1^a	217.0±21.0^bc	172.1±24.0^a	205.8±18.1^bc0	181.3±21.4^a
ICSI	16.7±2.2	17.2±1.9	12.7±2.8^a	11.5±2.5^a	07.8±1.9^bc	10.9±1.9^a	8.6±2.3^bc	10.3±2.7^a
ICPI	14.5±2.7	14.7±2.3	08.9±2.2^a	09.6±2.7^a	06.2±2.2^bc	08.9±3.3^a	5.8±2.7^bc	07.7±1.8^a
PUF	30.1±1.9	28.9±2.7	15.7±3.2^a	14.4±2.8^a	11.7±3.6^bc	14.2±3.5^a	10.3±3.4^bc0	13.9±2.7^a
SAS	65.4±2.2	64.9±1.8	49.8±4.5^a	51.6±3.9^a	39.8±3.3^bc	48.7±3.6^a	38.3±2.8^bc0	49.5±3.1^a
BDI-Ⅱ	18.5±1.9	17.8±1.7	14.0±1.9^a	14.7±1.5^a	09.5±1.8^bc	14.6±1.7^a	8.7±1.0^bc	14.7±1.4^a

[1]	李文标, 谢俊聪, 杨飞, 等. 尿流动力学检查在间质性膀胱炎/膀胱疼痛综合征诊断与症状评估中的应用[J/CD]. 中华腔镜泌尿外科杂志（电子版）, 2017, 11(4): 49-52.
[2]	杨飞, 湛海伦, 卢扬柏, 等. 心理评估在间质性膀胱炎/膀胱疼痛综合征患者诊治中的应用. 中华泌尿外科杂志, 2013, 34(9): 670-673.
[3]	Gillenwater JY, Wein AJ. Summary of the national institute of arthritis, diabetes, digestive and kidney diseases workshop on interstitial cystitis, national institutes of health, Bethesda, Maryland, August 28-29, 1987[J]. J Urol, 1988, 140(1): 203-206.
[4]	严秋哲, 杨勇, 朱绪辉，等. 麻醉下水扩张诊断间质性膀胱炎[J]. 中华泌尿外科杂志, 2007, 28(11): 756-758.
[5]	Nordling J, Anjum FH, Bade JJ, et al. Primary evaluation of patients suspected of having interstitial cystitis (IC) [J]. Eur Urol, 2004, 45(5): 662-669.
[6]	李芳家, 曹薇. 间质性膀胱炎的护理[J]. 临床护理杂志, 2010, 9(6): 34-35.
[7]	Chai TC, Zhang CO, Shoenfelt JL, et al. Bladder stretch alters urinary heparin-binding epidermal growth factor and antiproliferative factor in patients with interstitial cystitis[J]. J Urol, 2000, 163(5):1440-1444.
[8]	Glemain P, Riviere C, Lenormand L, et al. Prolonged hydrodistention of the bladder for symptomatic treatment of interstitial cystitis: efficacy at 6 months and 1 year[J]. Eur Urol, 2002, 41(1): 79-84.
[9]	Hsieh CH, Chang WC, Huang MC, et al. Hydrodistention plus bladder training versus hydrodistention for the treatment of interstitial cystitis[J]. Taiwan J Obstet Gynecol, 2012, 51(4): 591-595.
[11]	Riedl CR, Engelhardt PF, Daha KL, et al. Hyaluronan treatment of interstitial cystitis/painful bladder syndrome[J]. Int Urogynecol J Pelvic Floor Dysfunct, 2008, 19(5): 717-721.
[12]	Slade D, Ratner V, Chalker R. A collaborative approach to managing interstitial cystitis[J]. Urology, 1997, 49 (5A Suppl): 10-13.
[13]	Koziol JA, Clark DC, Gittes RF, et al. The natural history of interstitial cystitis: a survey of 374 patients[J]. J Urol, 1993, 149(3): 465-469.
[14]	支杭娟, 顾利慧. 心理干预在治疗间质性膀胱炎中的应用[J]. 浙江医学, 2011, 33(2): 21-22.

[1]	王婷, 刘婧妮, 程金梅. 心理护理干预对二氧化碳点阵激光联合富血小板血浆美容效果的影响[J]. 中华损伤与修复杂志(电子版), 2020, 15(05): 415-418.
[2]	汪洋, 李志鹏, 王可兵. 上尿路尿路上皮癌术后预防性膀胱灌注化疗的研究进展[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 649-652.
[3]	张世昌, 郑江. ERCC1和RRM1基因与膀胱肿瘤临床特征及非肌层浸润性膀胱肿瘤吉西他滨膀胱灌注疗效的关系[J]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(03): 176-180.
[4]	陈雪莲, 苏敏芝, 周祥福, 吴珍, 饶丹灵, 刘柏隆. 微波热疗联合三联药物膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎的临床研究[J]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(04): 230-233.
[5]	倪永梁, 王海新, 焦守镔, 杨义, 周强, 刘希高, 史本康. 膀胱灌注透明质酸钠联合膀胱区极超短波照射在非细菌性膀胱炎中的疗效研究[J]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(05): 318-323.
[6]	乔海园, 王红梅, 高莹莹. 围手术期优质护理配合心理护理对子宫脱垂合并肠疝患者的效果观察[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(02): 241-246.
[7]	孙文娟, 冯波, 姚丹, 孙荣, 张倩, 施伟栋. 综合护理与心理护理干预对小儿腹股沟疝行腹腔镜疝囊高位结扎术效果观察[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(02): 232-235.
[8]	孙晓容, 李长桂. 心理护理在慢性阻塞性肺疾病及哮喘和肺癌中的应用[J]. 中华肺部疾病杂志(电子版), 2019, 12(04): 534-535.
[9]	陈华萍, 吴红梅, 刘禹, 陈琰, 胥洪燕. 心理护理对慢性阻塞性肺疾病合并焦虑抑郁患者CAT评分的影响[J]. 中华肺部疾病杂志(电子版), 2019, 12(04): 478-480.
[10]	李娜, 刘俊成, 解秀玲. 个体化心理护理对晚期肺癌患者的影响[J]. 中华肺部疾病杂志(电子版), 2019, 12(03): 345-347.
[11]	蒋尊丽, 魏媛, 纪元, 闵欠. 177例胃肠道恶性肿瘤患者心理护理体会[J]. 中华结直肠疾病电子杂志, 2019, 08(01): 94-96.
[12]	徐向迎, 宗晶, 梁艳. 流程化护理干预在聚乙二醇肠道准备患者中的应用[J]. 中华消化病与影像杂志(电子版), 2019, 09(05): 220-221.
[13]	王红, 李娜, 杨翠萍. 心理护理对胃癌化疗患者的干预[J]. 中华消化病与影像杂志(电子版), 2018, 08(06): 277-279.
[14]	杨洋, 张中元, 吴士良. 表现为男性间质性膀胱炎的膀胱癌4例诊治分析并文献回顾[J]. 中华临床医师杂志(电子版), 2019, 13(11): 860-863.
[15]	霍桂莲. 心理护理干预对胃镜检查患者焦虑情绪、检查配合度的影响分析[J]. 中华胃肠内镜电子杂志, 2018, 05(04): 155-157.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

The application of bladder drug perfusion combined with psychological nursing in the treatment of interstitial cystitis / bladder pain symptom

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

The application of bladder drug perfusion combined with psychological nursing in the treatment of interstitial cystitis / bladder pain symptom