追加：第 33 节第 21 条（脊髓损伤后的排尿方式与终身复查），并入第 7 条（辅助器具评估适配与工伤辅具）

2026-10-14。查重：全书 grep「导尿」「神经源性膀胱」「尿管」「辅具」「假肢」「辅助器具」，第 33 节以外只有第 24 节第 10 条备注提了一句「辅助器具优惠」，没有同一件事。第 21 条追加在节末，节首导览挂进「身体和康复」，短名「脊髓损伤后别长期插着尿管」。

第 21 条

四问

  1. 会碰上：本节读者里脊髓损伤是常见致残原因，几乎都要面对排尿管理。
  2. 不知道：家属常以为插上尿管就一劳永逸，不知道要终身复查肾。
  3. 动作是新的：本节第 1 条只讲自主神经反射异常的现场处理。
  4. 有原始来源：两项期刊研究加欧洲泌尿外科学会指南原文。

1. Savic 2017，Spinal Cord 55(10):891-897，doi:10.1038/sc.2017.64，PMID 28631749

  • 摘要取自 Europe PMC REST。
  • 「The sample consisted of 5483 patients with tSCI admitted to Stoke Mandeville and Southport spinal centres who were injured between 1943 and 2010, survived first year post injury, had residual neurological deficit on discharge and were British residents. Mortality information, including causes of death, was collected up to 31 December 2014.」
  • 「In total, 2322 persons (42.3% of the sample) died, with 2170 (93.5%) having a reliable cause of death established. The most frequent causes of death were respiratory (29.3% of all certified causes), circulatory, including cardiovascular and cerebrovascular diseases (26.7%), neoplasms (13.9%), urogenital (11.5%) ...」
  • 「Compared to the general population, age-standardised cause-specific mortality rates were higher for all causes, especially skin, urogenital and respiratory; rates showed improvement over time for suicides, circulatory and urogenital causes」

2. Weld & Dmochowski 2000，J Urol 163(3):768-772，doi:10.1016/s0022-5347(05)67800-7，PMID 10687973

  • 「We retrospectively reviewed the medical records, upper tract imaging and video urodynamics of 316 posttraumatic spinal cord injured patients. Mean followup plus or minus standard deviation since injury was 18.3+/-12.4 years.」
  • 「Of the 398 complications recorded 236 developed in 61 (53.5%) patients on chronic urethral catheterization, 57 in 25 (27.2%) on clean intermittent catheterization, 57 in 24 (32.4%) who voided spontaneously and 48 in 16 (44.4%) on suprapubic catheterization.」
  • 「Infection, stone disease, urethral complications and radiographic abnormalities were recorded.」
  • 回顾研究，没有随机分组，正文已写明。

3. EAU Guidelines on Neuro-Urology（2026 版）

  • URL：https://uroweb.org/guidelines/neuro-urology/chapter/the-guideline，静态抓取只有壳页，带代理用无头 Chrome dump DOM 取到正文。页面附的全文 PDF 文件名为 Neuro-Urology-2026.pdf，据此定为 2026 版。
  • 3.4.2.e.1：「Indwelling transurethral catheterisation and, to a lesser extent, suprapubic cystostomy are associated with a range of complications as well as an enhanced risk for UTI [...]. Therefore, both procedures should be avoided, when possible. Silicone catheters are preferred」
  • 同节（反方，写进备注「争议」）：「Intermittent and indwelling catheterisation are standard treatments for patients who are unable to empty their bladder.」（LE 3）；推荐「Use a shared decision-making approach when discussing intermittent or indwelling catheterisation」（Strong）；「in the SCI population, IC is associated with worse reported QoL compared to indwelling catheters, particularly if recurrent (> 4 per year) UTIs complicate management」；「Adequate hand function is an independent risk factor for cessation of intermittent catheterisation (IC)」。
  • 同节频次：「The average frequency of catheterisations per day is four to six times」，成本栏「一天四到六次」出自这里。
  • 3.3 节（诊断评估）开头：「Long-term follow-up (life-long) is mandatory to assess risk of UUT damage and renal failure」
  • 3.3.8：「Patients with SCI or SB have a higher risk of developing renal failure compared with patients with slowly progressive non-traumatic neurological disorders」
  • 3.7：「the interval between initial investigations and control diagnostics [...] in many cases, should not exceed one to two years. [...] The UUT should be checked by means of ultrasonography at regular intervals in high-risk patients approximately once every six months [...]. In these patients, physical examination and urine laboratory should be carried out every year」
  • 3.5（备注里的感染信号）：「The most common signs and symptoms suspicious of a UTI [...] are fever, new onset or increase in incontinence, including leaking around an indwelling catheter, increased spasticity, malaise, lethargy or sense of unease, cloudy urine with increased urine odour [...]」

定级

  • 证据等级 B：两项研究都是观察性的，指南对导尿方式的证据等级是 LE 3，复查间隔是 LE 4。指南本身也说间歇导尿和留置尿管都是标准做法，所以标「争议」。
  • 收益量级「中」，凭判断：Weld 的并发症比例差约一半，按阈值够「大」；但它是回顾对比，没扣掉选择偏差，终点也只是并发症不是死亡。Savic 只说明泌尿生殖死因占一成多，没比较不同做法。所以降一档定中。
  • 没取到：国内《脊髓损伤神经源性膀胱诊疗指南》原文；美国脊髓医学联盟 2006 年膀胱管理指南（PMC1949036）全文 PDF 抓下来是跳转壳页，没引。

第 7 条并入（辅助器具评估适配）

四问

动作「先问清评估和配置流程再买」不算全新，但第 7 条原来只写了补贴依据，没写要先评估、工伤另走一套，所以并进第 7 条，不另开。

1. 残疾预防和残疾人康复条例

2. 国务院关于加快发展康复辅助器具产业的若干意见（国发〔2016〕60 号）

3. 康复辅助器具产业扩能提质三年行动方案（2026-2028年）（民函〔2026〕48 号，民政部等，成文 2026-07-09）

4. 工伤保险辅助器具配置管理办法（人社部、民政部、国家卫生计生委令第 27 号，2016-04-01 施行）

  • URL：https://www.gov.cn/gongbao/content/2016/content_5074060.htm
  • 第二条：「工伤职工因日常生活或者就业需要，经劳动能力鉴定委员会确认，配置假肢、矫形器、假眼、假牙和轮椅等辅助器具的，适用本办法。」
  • 第十五条：「工伤职工配置辅助器具的费用包括安装、维修、训练等费用，按照规定由工伤保险基金支付。」
  • 第二十四条：「有下列情形之一的，经办机构不予支付配置费用：（一）未经劳动能力鉴定委员会确认，自行配置辅助器具的；（二）在非协议机构配置辅助器具的；（三）配置辅助器具超目录或者超出限额部分的；（四）违反规定更换辅助器具的。」
  • 2016 年之后有没有修订没查到，条文按公报原文引。

没写的

  • 「基本型辅具免费」：全国文件只写「给予补贴」「有条件的地方」，没有全国免费的说法，没写。
  • 中国残联辅助器具适配补贴的专门文件：政策库没收，没取到。