中国老年脑卒中患者相关泌尿功能障碍管理指南（2025版）

doi:10.3877/cma.j.issn.1674-3253.2025.06.001

泌尿功能障碍是老年脑卒中患者的常见并发症，主要表现为尿失禁、排尿困难及尿潴留，可引发尿路感染、肾功能损害、膀胱结石等并发症，导致焦虑、抑郁等心理问题并加重经济负担。目前我国针对该人群的泌尿功能障碍管理指南仍属空白，制定符合国际标准的循证指南对规范诊疗、改善预后具有重要意义。本指南由多学科专家联合制定，遵循国际公认的临床实践指南流程，基于GRADE系统和RIGHT规范，结合我国临床实践，系统涵盖分类、评估、治疗、并发症及随访五大核心内容，旨在为各级医疗机构提供标准化诊疗框架，优化老年脑卒中患者泌尿功能障碍的全周期管理，提升其生活质量并降低并发症风险。

关键词: 脑卒中, 泌尿功能障碍, 神经源性膀胱, 尿失禁, 老年康复, 慢病管理, 循证指南, GRADE系统

Urinary dysfunction is a common complication in elderly stroke patients, primarily manifesting as urinary incontinence, dysuria, and urinary retention. It can lead to complications such as urinary tract infections, renal impairment, and bladder stones, induce psychological problems including anxiety and depression, and increase economic burden. Currently, there remains a gap in management guidelines for urinary dysfunction in this population in China. Developing evidence-based guidelines that meet international standards is of great significance for standardizing clinical practice and improving prognosis.Formulated collaboratively by multidisciplinary experts, this guideline adheres to internationally recognized clinical practice guideline development processes, based on the GRADE system and RIGHT reporting standards, while integrating clinical realities. It systematically covers five core domains: classification, assessment, treatment, complications, and follow-up of our country. The guideline aims to provide a standardized diagnostic and therapeutic framework for medical institutions at all levels, optimize the full-cycle management of urinary dysfunction in elderly stroke patients, enhance their quality of life, and reduce the risk of complications.

Key words: Stroke, Uinary dysfunction, Neurogenic bladder, Urinary incontinence, Geriatric rehabilitation, Chronic disease management, Evidence-based guideline, GRADE system

表1 证据质量与推荐强度分级（GRADE）

GRADE分级	具体描述
证据质量分级
高（A）	非常有把握：观察值接近真实值
中（B）	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低（C）	对观察值的把握有限：观察值可能与真实值有很大差别
极低（D）	对观察值几乎没有把握：观察值与真实值可能有极大差别
推荐强度
强（1）	明确显示干预措施利大于弊或弊大于利
弱（2）	利弊不确定或无论证据质量高低均显示利弊相当

表1 证据质量与推荐强度分级（GRADE）

GRADE分级	具体描述
证据质量分级
高（A）	非常有把握：观察值接近真实值
中（B）	对观察值有中等把握：观察值有可能接近真实值，但也有可能差别很大
低（C）	对观察值的把握有限：观察值可能与真实值有很大差别
极低（D）	对观察值几乎没有把握：观察值与真实值可能有极大差别
推荐强度
强（1）	明确显示干预措施利大于弊或弊大于利
弱（2）	利弊不确定或无论证据质量高低均显示利弊相当

表2 中国老年脑卒中患者泌尿功能障碍管理指南（2025）临床问题与推荐意见汇总表

临床问题	推荐意见
1.老年脑卒中患者泌尿功能障碍分类	1.1神经源性膀胱（1A）
1.老年脑卒中患者泌尿功能障碍分类	1.2非神经源性膀胱：膀胱过度活动症、夜尿症、尿潴留（1B）
2.老年脑卒中患者泌尿功能障碍评估诊断方法	2.1病史采集及重点体格检查（GPS）
	2.2问卷调查及排尿日记（GPS）
	2.3专科检查：实验室检查、泌尿系超声、尿流率、膀胱残余尿量测定、尿垫试验、影像学检查、尿动力学检查等（GPS）
3.老年脑卒中患者泌尿功能障碍治疗方法	3.1保守治疗：行为训练、健康教育、盆底肌肉训练、间歇导尿、心理康复等（GPS）
	3.2药物治疗：抗毒蕈碱药、β-3肾上腺素能受体激动剂、α受体阻滞剂、肉毒杆菌毒素A等（1B）
	3.3手术治疗：括约肌切开术、尿道填充术、人工尿道括约肌植入术、骶神经调控等（1A）
4.老年脑卒中患者泌尿功能障碍常见并发症	4.1尿路感染：主要与膀胱排空障碍及长期留置导尿有关（1A）
	4.2肾功能损害：与膀胱高压引发尿液反流、肾积水有关（1A）
	4.3膀胱结石：与尿液浓缩、感染及逼尿肌低活动性相关（1A）
5.老年脑卒中患者泌尿功能障碍随访管理	5.1推荐随访周期：2周、1个月、2个月、3个月、6个月，1年，此后每半年随访1次，出现不适症状立即返院复诊（GPS）
5.老年脑卒中患者泌尿功能障碍随访管理	5.2随访内容：根据患者病情需要，选择进行尿常规、尿细菌培养、泌尿系彩超、膀胱残余尿测定、尿动力学检查、肾功能检查、影像学检查、膀胱镜检查等（GPS）

表2 中国老年脑卒中患者泌尿功能障碍管理指南（2025）临床问题与推荐意见汇总表

临床问题	推荐意见
1.老年脑卒中患者泌尿功能障碍分类	1.1神经源性膀胱（1A）
1.老年脑卒中患者泌尿功能障碍分类	1.2非神经源性膀胱：膀胱过度活动症、夜尿症、尿潴留（1B）
2.老年脑卒中患者泌尿功能障碍评估诊断方法	2.1病史采集及重点体格检查（GPS）
	2.2问卷调查及排尿日记（GPS）
	2.3专科检查：实验室检查、泌尿系超声、尿流率、膀胱残余尿量测定、尿垫试验、影像学检查、尿动力学检查等（GPS）
3.老年脑卒中患者泌尿功能障碍治疗方法	3.1保守治疗：行为训练、健康教育、盆底肌肉训练、间歇导尿、心理康复等（GPS）
	3.2药物治疗：抗毒蕈碱药、β-3肾上腺素能受体激动剂、α受体阻滞剂、肉毒杆菌毒素A等（1B）
	3.3手术治疗：括约肌切开术、尿道填充术、人工尿道括约肌植入术、骶神经调控等（1A）
4.老年脑卒中患者泌尿功能障碍常见并发症	4.1尿路感染：主要与膀胱排空障碍及长期留置导尿有关（1A）
	4.2肾功能损害：与膀胱高压引发尿液反流、肾积水有关（1A）
	4.3膀胱结石：与尿液浓缩、感染及逼尿肌低活动性相关（1A）
5.老年脑卒中患者泌尿功能障碍随访管理	5.1推荐随访周期：2周、1个月、2个月、3个月、6个月，1年，此后每半年随访1次，出现不适症状立即返院复诊（GPS）
5.老年脑卒中患者泌尿功能障碍随访管理	5.2随访内容：根据患者病情需要，选择进行尿常规、尿细菌培养、泌尿系彩超、膀胱残余尿测定、尿动力学检查、肾功能检查、影像学检查、膀胱镜检查等（GPS）

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Guidelines for the management of related urinary dysfunction in elderly stroke patients in China (2025 edition)

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Guidelines for the management of related urinary dysfunction in elderly stroke patients in China (2025 edition)