دراسة نتائج الهرمون المضاد للإدرار على تبوال الفراش
Abstract
يهدف البحث إلى الوصول للتدبير الأمثل لتبوال الفراش الليلي, ومن أجل ذلك أجريت هذه الدراسة في مشفى المواساة الجامعي في الفترة ما بين 2004-2007 بطريقة تحليلية مستقبلية لا تحمل صفة العشوائية على
110 مرضى. تم توصيف المرضى ووضعنا جداول مفصلة قمنا بمقارنتها بنسب عالمية .تم وضع خطة للتدبير وذلك بمعالجة الأعراض المرافقة وعلاج فيزيائي تأهيلي وتحديد الوارد والإقلال من المنبهات والمغاطس الحوضية. نبدأ كخط أول في المعالجة بالديسموبريسين, وعند الاستجابة الجيدة نتابع المعالجة حتى 3أشهر, و3 أشهر أخرى بعد خفض تدريجي للجرعة . ان كل مريض مصاب بتبوال الفراش يجب أن يطبق عليه بروتوكول متكامل يتضمن علاجاً سلوكياً وتأهيلياً يشترك فيه الطبيب والأهل والمريض نفسه ومن ثم دوائياً, كما أنه يحتاج لمتابعة جيدة . يعد التقييم اليوروديناميكي أساسياً وخاصة عند فشل المعالجة وحيث تحقق مضادات التشنج الكولينيرجية في حال وجود علامات لاضطراب ديناميكي في المثانة نتائج تصل لحوالي 90%, إضافة إلى كون تبوال الفراش الليلي كاشفا لمرض عضوي عصبي قد يدفع لمراقبة حثيثة للجهاز البولي العلوي, وقد ننتهي في أي مرحلة لوضع استطبابٍ جراحي منقذٍ.
The study aims to achieve the ideal protocols for diagnosing and treating enuresis and for that, a study carried out in the Al-Uuwaasat Hospital of the out -patients from 2004-2007. 110 patients were analyzed as progressive analytic way. The patients were classified in descriptive tables in comparing data with referential results. The managements took care of the additional measurements as rehabilitation of bladder. We began Desmoprossin as the first line therapy. In the case of positive results we continued the therapy evey 3 month, 6 month, ending up in gradual reduction of the dosage. We have to apply complete protocols in which there are rehabilitation and medical therapies, that all physician and parents take their roles. The urodynamic evaluation is essential, especially in case of absence of success. Anticholinergic agents has a very good results in the presence of urodynamic disturbance may reach up to 90 %. Enuresis may be relevant to syndrome of neurologic disease demand a very adherent surveillance might put in consideration a surgical solution.
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