2019NICE女性尿失禁和盆腔器官脱垂管理指南(上)

1、2021NICE女性尿失禁和盆腔器官脱垂治理指南上导读2021年4月,英国国家卫生与临床优化研究所NICE发布了女性尿失禁和盆腔器官脱垂的治理指南,主要内容涵盖了年龄之18岁女性尿失禁和盆腔器官脱垂的评估和治理,同时也包含相关手术并发症的治理.本指南内容分两次报道,现为第一局部,主要内容为尿失禁的评估、一般治疗以及药物选择.尿失禁分类Attheinitialclinicalassessment,categorisethewoman'surinaryincontinenceasstressurinaryincontinence,mixedurinaryincontinenceorurge

2、ncyurinaryincontinence/overactivebladder.Startinitialtreatmentonthisbasis.Inmixedurinaryincontinence,directtreatmenttowardsthepredominantsymptom.2006在最初的临床评估中,将女性尿失禁分为压力性尿失禁、混合性尿失禁或急迫性尿失禁/膀胱过度活动症.在此根底上开始初步治疗.在混合性尿失禁中,直接治疗主要病症.2006尿失禁的评估IfwomenhavesymptomsofurinarytractinfectionUTIandtheirurinetestsp

3、ositiveforbothleucocytesandnitrites,sendamidstreamurinespecimenforcultureandanalysisofantibioticsensitivities.Prescribeanappropriatecourseofantibiotictreatmentpendingcultureresults.SeetheNICEguidelineonurinarytractinfectionlower:antimicrobialprescribingformoreinformation.2006,amended2021如果女性有泌尿道感染UT

4、I病症,且尿白细胞和亚硝酸盐检测阳性,那么应送一份中段尿培养并分析抗生素敏感性.根据培养结果开具适宜的抗生素处方.有关更多信息,请参阅NICE尿路感染指南下：抗菌药物处方.2006,2021年修订IfwomendonothavesymptomsofUTI,buttheirurinetestspositiveforbothleucocytesandnitrites,donotofferantibioticswithouttheresultsofmidstreamurineculture.2006如果女性没有UTI病症,但尿白细胞和亚硝酸盐检测阳性,在没有中段尿培养结果的情况下,那么不提供抗生素治

5、疗.2006IfawomandoesnothavesymptomsofUTIandherurinetestsnegativeforeitherleucocytesornitrites,donotsendaurinesampleforculturebecausesheisunlikelytohaveUTI.2006如果女性没有UTI病症,且尿白细胞或亚硝酸盐检测阳性,那么不必送尿培养,因其不太可能患有UTL(2006)FollowtherecommendationsonreferralforurinarytractcancerintheNICEguidelineonsuspectedcancer

6、;forwomenwithhaematuriaorrecurrentorpersistentunexplainedUTI.2006,amended2021对于有血尿、复发性或持续性不明原因UTI的女性,请遵循NICE可疑肿瘤指南中关于泌尿系肿瘤治疗的建议.(2006,2021年修订)尿失禁的一般治疗Consideradvisingwomenwithurinaryincontinenceoroveractivebladderandahighorlowfluidintaketomodifytheirfluidintake.2006建议尿失禁或膀胱过度活泼,以及液体摄入量高或低的女性调整液体摄入量.

7、(2006)AdvisewomenwithurinaryincontinenceoroveractivebladderwhohaveaBMIgreaterthan30toloseweight2006建议BMI指数大于30的尿失禁或膀胱过度活泼女性硼巴.(2006)Offeratrialofsupervisedpelvicfloormuscletrainingofatleast3months'durationasfirst-linetreatmenttowomenwithstressormixedurinaryincontinence.2021一线治疗：为压力性或混合性尿失禁女性提供至少

8、3个月的盆底肌练习.(2021)Pelvicfloormuscletrainingprogrammesshouldcompriseatleast8contractionsperformed3timesperday.2006盆底肌练习每次应至少8个收缩轮回,每天3次.(2006)Electricalstimulationand/orbiofeedbackshouldbeconsideredforwomenwhocannotactivelycontractpelvicfloormusclestoaidmotivationandadherencetotherapy.2006对于不能主动收缩盆底肌肉以

9、帮助锻炼和坚持治疗的女性,应考虑电刺激和/或生物反应.(2006)Offerbladdertraininglastingforaminimumof6weeksasfirst-linetreatmenttowomenwithurgencyormixedurinaryincontinence.2006一线治疗：为急迫性或混合性尿失禁女性提供至少6周的膀胱练习.(2006)Ifwomendonotachievesatisfactorybenefitfrombladdertrainingprogrammes,thecombinationofanoveractivebladdermedicinewith

10、bladdertrainingshouldbeconsiderediffrequencyisatroublesomesymptom.2006如果女性不能从膀胱练习中获得令人满意的益处,在尿失禁频繁的情况下,应考虑结合使用药物和膀胱练习.(2006)Bladdercatheterisation(intermittentorindwellingurethralorsuprapubic)shouldbeconsideredforwomeninwhompersistenturinaryretentioniscausingincontinence,symptomaticinfectionsorrenal

11、dysfunction,andinwhomthiscannototherwisebecorrected.Healthcareprofessionalsshouldbeawarezandexplaintowomen,thattheuseofindwellingcathetersinurgencyurinaryincontinencemaynotresultincontinence.2006对于持续性尿潴留导致尿失禁、病症性感染或肾功能不全,且无法纠正的女性,应考虑膀胱导尿(间歇性、留置或耻骨上导尿x(2006)药物选择Donotofferwomenflavoxate,propanthelineo

12、rimipraminetotreaturinaryincontinenceoroveractivebladder.2021不建议女性服用黄酮哌酯、丙氨酸或丙咪嗪以治疗尿失禁或膀胱过度活动症.(2021)Donotofferoxybutynin(immediaterelease)toolderwomenwhomaybeathigherriskofasuddendeteriorationintheirphysicalormentalhealth.2021,amended2021不建议年龄较大女性服用奥昔布宁立即释放,这些女性身心健康忽然恶化的风险可能更高.2021,2021年修订Offerthea

13、nticholinergicmedicinewiththelowestacquisitioncosttotreatoveractivebladderormixedurinaryincontinenceinwomen.2021以最低购置本钱提供抗胆碱能药物治疗女性膀胱过度活动症或混合性尿失禁.2021Offeratransdermaloveractivebladdertreatmenttowomenunabletotolerateoralmedicines.2021为不能耐受口服药物的女性提供经皮膀胱过度活动症治疗.2021Theuseofdesmopressinmaybeconsidereds

14、pecificallytoreducenocturiainwomenwithurinaryincontinenceoroveractivebladderwhofinditatroublesomesymptom.Useparticularcautioninwomenwithcysticfibrosisandavoidinthoseover65yearswithcardiovasculardiseaseorhypertension.2021对于严重尿失禁或膀胱过度活动症的女性,可特别考虑使用去氨加压素用于减少夜尿症.囊胞性纤维症女性要特别谨慎使用,65岁以上有心血管疾病或高血压者忌服.2021Do

15、notuseduloxetineasafirst-linetreatmentforwomenwithpredominantstressurinaryincontinence.Donotroutinelyofferduloxetineasasecond-linetreatmentforwomenwithstressurinaryincontinence,althoughitmaybeofferedassecond-linetherapyifwomenpreferpharmacologicaltosurgicaltreatmentorarenotsuitableforsurgicaltreatment.Ifduloxetineisprescribed,counselwomenaboutitsadverseeffects.2006不建议主要有压力性尿失禁的女性使用度洛西汀作为一线治疗.对于压力性尿失禁女性,不建议常规提供度洛西汀作为二线治疗,但如果患者更喜欢药物或手术治疗,或者不适合手术治疗,可作为二线治疗.如果使用度洛西汀,请告知女