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1、泌尿道保健--關(guān)於泌尿道感染慈濟(jì)醫(yī)院泌尿科陳景亮腎臟輸尿管膀胱泌尿道泌尿道感染最常見於：生育年齡的女性，懷孕婦女、男士前列腺增大、上廁所的習(xí)慣差劣、患有糖尿病或患有鐮刀型紅血球疾病的人士罹患泌尿道感染的風(fēng)險也較高。嬰兒、小孩（小於六歲）和小於50歲男性極少出現(xiàn)泌尿道感染，如有則通常和泌尿道結(jié)構(gòu)畸型（膀胱逆流、尿路阻塞）有關(guān)。下泌尿道感染（lowerurinarytractinfections）和膀胱炎的主因通常是細(xì)菌通過尿道進(jìn)入，但上泌尿道感染（upperurinarytractinfections）如腎盂腎炎則不然。上泌尿道感染的主因可能是血原性（hem
2、atogenous）的。Definitions(定義)Bacteriuria(菌尿癥)-bacteriainurinePyuria(膿尿癥)-WBCsinurineUncomplicated-healthypatientwithastructurallyandfunctionallynormalurinarytract.Complicated-obstruction,anatomicorfunctionaldisorder,calculi,instrumentation,incontinence,pregnancy.Unresolvedbacteriuri
3、a-resistence,multipleorganisms,rapidreinfection,azotemia,papillarynecrosis,infectedstonesorforeignbody,patientnoncomplianceRecurrentinfection-persistenceorreinfectionPathogenesis(1)Ascendinginfection-mostcommonHematogenousspread-immunocompromisedandneonates-uncommonexceptStaphyloc
4、occus,CandidaandTBLymphatogenousspread-littleevidence,iatrogenic?Directextension-intraperitonealabscess,vesicointestinalorV-VfistulaPathogenesis(2)Hostfactor-Anatomicorfunctionalabnormalities-SecretionofIL-8fromrenalcellsmayparticipateintheinitiationandmaintenanceofrenalinflammati
5、on.-Increaseadherenceduetomorereceptors-ChangeofpHorestrogenlevels,ZnBacterialfactors-UropathogenicE.coli(O,K,H)havepili(type1,P)andhemolysin,resistanttoserumbactericidalactivityPathogenesis(3)Causativepathogens-aerobic?Escherichiacoli(80%),Proteusmirabilis,Klebsiella?Staphylococc
6、i,Pseudomonas(nosocomial)-anaerobicbacteria(suppurativeinfections)?Bacteroidesfragilis,Clostridiumperfringens…DiabetesmorelikelycausedbyKlebsiella,groupBstreptococci…S.saprophyticuscausingapproximately10%ofsymptomaticlowerUTIsinyoung,sexuallyactivefemales膀胱感染的癥狀尿急（urinaryurgency）尿
7、頻（urinaryfrequency），並且在只有少量尿液時仍覺得需要排尿（urinate）夜尿（nocturia）：需要在夜間排尿。尿道炎（urethritis）：排尿時尿道口感到不適或疼痛，或是整個尿道有燒灼感排尿困難（dysuria）膿尿（pyuria）：尿液含膿或尿道排膿血尿：尿中帶血發(fā)燒：輕微發(fā)燒尿液臭和混濁小便失禁（urinaryincontinence）腎臟感染的癥狀尿液檢查可能正常!!腎臟感染的癥狀噁心嘔吐背痛（backpain）、腰痛（flankpain）或腹股溝疼痛（groinpain）腹痛（Abdominalpain）Knocking
8、painatCVangleShakingchillsandhigh
