神经源性膀胱(台湾-曾志龙).ppt

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1、NeurogenicbladderRi曾志龍PrefaceNeurogenicvoidingdysfunction(neurogenicbladder),neuropathicbladder/neuropathicurethraInnervationAutonomic:Para.(S2~4)-pelvicn.-bladder(detrusorcontracture)Sym.(T11~L2)-paravertebralchain-hypogastricn.-bladder/urethra(detrusorrelaxation)Somati

2、c:cortex-(S2~4)-pudendaln.-externalsphincterPhysiology排尿：pelvicfloormusculacture,externalsphincterrelaxurethralDetrusorcontractureTrigone(防止VUR)bladderpressureneckopen解畢：Detrusorrelax,bladderneckclose,externalsphinctertone排尿途中：externalsphinctercontracturedetrusorr

3、elaxCauseintracraniallesion：腦血管病變、巴金森氏症、老年痴呆症以及大腦退化等spinalcordlesions：外傷性脊髓損傷(spinalcordinjury)，多發性硬化症(multiplesclerosis)以及脊髓束緊症(tetheredcord)等等peripheralneuropathy：caudaequinasyndrome以及骨盆手術術後造成之骨盆神經叢受傷metabolicdisease：最常見的是糖尿病所引發之周邊神經病變Suprasacralcordlesion：detrusorhype

4、rreflexia,detrusor-externalsphincterdyssynergia(DESD)Supra-T6：autonomicdysreflexia(膀胱漲尿時，病人交感神經張力會有異常增加的現象，導致血壓上升、心跳加快、患部以上潮紅及冒汗頭痛)各種上神經元病變及下神經元病變之逼尿肌反射情形逼尿肌反射亢進或正常反射低下或無反射上神經元病變腦血管病變4420(45%)24(55%)巴金森氏症4028(70%)12(30%)顱內病變2014(70%)6(30%)多發性硬化症128(67%)4(33%)頸椎或胸椎傷害3221(

5、66%)11(34%)14891(61%)57(39%)下神經元病變薦椎傷害448(18%)36(82%)腦膜脊髓膨出症及脊椎裂346(18%)28(82%)骨盆腔內手術1324(3%)128(97%)糖尿病神經病變240(－)24(100%)23418(7.6%)216(92.4%)逼尿肌反射亢進Coordinatedsphincter(括約肌協調)Non-relaxedstriatedsphincter(橫紋括約肌無放鬆性)Denervatedstriatedsphincter(橫紋括約肌去神經化)Non-relaxingsmoot

6、hmusclesphincter(BN)(平滑括約肌無放鬆性)逼尿肌無反射Coordinatedsphincter(括約肌協調)Striatedsphincterdyssynergia(橫紋括約肌共濟失調)Smoothmusclesphincter(BN)dyssynergia(平滑括約肌共濟失調)Krane&SirokyclassificationStrokeInitiallyurinaryretentiondetrusorhyperreflexiaandinadequatecontractility(DHIC)incontine

7、nce,dysuriaFrontal,parietallobe,internalcapsuleexternalsphincterdysfunctiondysuriaStrokeCerebralhemorrhage-85%detrusorareflexia/Cerebralinfarction-10%detrusorhyperreflexia,maycombinewithobstruction(pseudo-dyssynergia,BPH)Otherintracranialdiseases巴金森氏症：detrusorhyperref

8、lexia,pseudo-synnergia,DHIC小腦病變（cerebellarataxia)：hyperreflexia,DESDCerebralpalsy：normalorhyperreflexia