3种膀胱引流策略对脊髓损伤后神经源性膀胱的影响OA

Objective To investigate the effects of indwelling catheterization with free drainage,intermittent urinary catheter clamping,and clean intermittent catheterization on patients with neurogenic bladder(NB)after spinal cord injury(SCI),so as to provie evidence-based support for clinical catheterization decision-making.Methods A total of 47 patients with NB after SCI who were hospitalized in the Department of Rehabilitation Medicine,the First Affiliated Hospital of Air Force Medical University,from June 2023 to June 2025 were recruited.Patients were randomly assigned using a random number table into the indwelling catheteriza‐tion with free drainage group(n=16),the intermittent urinary catheter clamping group(n=15),and the clean intermittent catheteriza‐tion group(n=16).During the intervention period,one patient in the indwelling catheterization with free drainage group and one patient in the clean intermittent catheterization group withdrew due to early discharge,and 15 patients in each group were included in the final analysis.All groups received basic treatment.The indwelling catheterization with free drainage group used latex indwell‐ing catheters for continuous drainage;the intermittent urinary catheter clamping group used latex indwelling catheters with clamping intervals adjusted according to fluid intake and output;and the clean intermittent catheterization group used hydrophilic-coated poly‐urethane catheters for intermittent catheterization.Before treatment and after 2 weeks of intervention,the Neurogenic Bladder Symp‐tom Score(NBSS)was used to evaluate NB-related symptoms,the Short-Form Health Survey Qualiveen(SF-Qualiveen)scores was adopted to assess quality of life and treatment satisfaction,and a bladder pressure‑volume assessment system was applied to measure residual urine volume and bladder safe capacity.Urine specimens were collected before treatment,at 1 weeks and 2 weeks after treat‐ment,and when patients presented clinical symptoms suggestive of urinary tract infection during the intervention for quantitative bacterial culture and antimicrobial susceptibility testing.Results Compared with that before treatment,NBSS increased significantly in the clean intermittent catheterization group after treatment(P<0.05),whereas no significant differences were observed in the in‐dwelling catheterization with free drainage group or the intermittent urinary catheter clamping group(P>0.05).No significant differ‐ences were found in NBSS among the three groups after treatment(P>0.05).Compared with those before treatment,SF-Qualiveen scores increased significantly in the indwelling catheterization with free drainage group after treatment(P<0.05),whereas no signifi‐cant differences were observed in the intermittent urinary catheter clamping group or clean intermittent catheterization group(P>0.05).Compared with the indwelling catheterization with free drainage group,the SF-Qualiveen scores in both the intermittent urinaty catheter clamping group and the clean intermittent catheterization group were lower after treatment(P<0.05).No significant within-group differences were found in residual urine volume or bladder safe capacity in the three groups after treatment(P>0.05),and no inter-group differences were observed among the three groups after treatment(P>0.05).During treatment,the incidence of urinary tract infection was 20.00%(3/15),33.33%(5/15),and 33.33%(5/15)in the indwelling catheterization with free drainage group,in‐termittent urinary catheter clamping group,and clean intermittent catheterization group,respectively,with no significant difference among groups(P>0.05).Conclusion For short-term management of patients with NB after SCI,indwelling catheterization with free drainage,intermittent urinary catheter clamping,and clean intermittent catheterization showed comparable overall effects on ob‐jective bladder function protection.However,clean intermittent catheterization may exacerbate bladder-related symptoms,whereas indwelling catheterization with free drainage may negatively affect quality of life.