Rehabilitacija pacijenata sa povredom kičmene moždine i posledičnom disfunkcijom mokraćne bešike
Sažetak
Sažetak: Neurogena disfunkcija mokraćne bešike nastala kao posledica oštećenja nervnih struktura kod spinalnih lezija predstavlja veliki problem za pacijenta, njegovu okolinu i zdravstvene radnike. Pravilno dijagnostikovanje neurogene disfunkcije mokraćne bešike omogućava primenu odgovarajućeg terapijskog i rehabilitacionog plana koji će omogućiti adekvatno pražnjenje i sprečavanje pojave komplikacija koje mogu ugroziti život pacijenta. U evoluciji povreda kičmene moždine mogu se razlikovati tri faze: 1) faza spinalnog šoka, 2) faza oporavka, 3) finalna faza. Posle spinalne traume m. bešika je zhvaćena najčešće na dva načina: 1) Spastična (refleksna) bešika nastaje zbog lezije iznad centra za mokrenje (segmenti S2-S4), 2) Flakcidna (atonična) neuropatska bešika nastaje kao posledica lezije u nivou centra za mokrenje (S2-S4) ili ispod njega, kao i lezije periferne inervacije bešike, 3) Sindrom autonomne disrefleksije se razvija u bolesnika sa cervikalnim ili visokim torakalnim lezijama kičmene moždine, iznad Th1 segmenta, 4) Neinhibirana neurogena bešika razvija se zbog inkompletnih lezija nervnih puteva u cerebralnom korteksu, piramidalnom putu ili u kičmenoj moždini oslabljena je cerebralna kontrola mokrenja. Dijagnoza neurogene disfunkcije se postavlja na osnovu urodinamskih ispitivanja, laboratorijskih pregleda urina i krvi, kao i rentgena, kompjuterizovane tomografije i nuklearne magnetne rezonance kičmenog stuba. Pražnjenje mokraćne bešike moguće je intermitetnom kateterizacijom, Credeovim postupkom, suprapubičnom stimulacijom, elektrostimulacijom glatke muskulature mokraćne bešike i medikamentima. Neophodnost interdisciplinarnog pristupa lečenju ovih pacijenata ukazuje na svu težinu problema kod pacijenata sa povredama kičmenog stuba i posledične disfunkcije mokraćne bešike.
Ključne reči: povreda kičmene moždine, neurogena disfunkcija m. bešike, rehabilitacija.Reference
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