摘要
神經性膀胱障礙具有排尿障礙與缺乏膀胱脹滿感之困擾，是造成脊髓損傷患者泌尿系統感染UTI和死亡的主要因素，以間歇性導尿將膀胱排空是目前最佳膀胱管理辦法。臨床SOP目前只能限制進水量與定時導尿將膀胱排空，如飲水過量或憋尿時間過長會導致膀胱過度充盈而引起泌尿系統疾病而感染住院治療。我們根據SCI患者問卷訪談統計，導尿的時間控制、外出如廁尋找不便與飲食攝取量控制是造成患者生活不便，品質下降的主要原因。本研究開發一套智慧膀胱管理系統，包括泌尿監控裝置與智慧管理系統兩大部分。泌尿監控裝置利用近紅外光與超音波建置穿戴式泌尿監控裝置，藉由量測血流變化與膀胱前後壁的距離（TD）推估膀胱容積量。智慧管理系統透過手機應用程式鏈結Google Map與雲端資料庫建立一套智慧管理系統，提供導尿時間提醒、無障礙廁所尋找、歷史紀錄與照護建議、導尿量量測等四項功能，幫助患者改善臨床導尿困擾。藉由本次實驗結果，期待本研究未來能進行人體臨床實驗並能製作發售，幫助患者以膀胱尿量來決定導尿時機，配合智慧管理系統，提高患者膀胱健康照護，患者與照護員的幸福指數也能增加。
關鍵詞：脊髓損傷、神經性膀胱功能異常、間歇性導尿、智慧膀胱管理系統、假體
Abstract
Neurogenic bladder dysfunction (NBD), which is characterized by dysuria and lack of bladder fullness, is a major factor in urinary tract infections (UTIs) and death in patients with spinal cord injury (SCI). Emptying the bladder with intermittent catheterization is the best bladder management method available. However, clinical Standard Operating Procedures (SOPs) currently only limit water intake and apply regular catheterization to empty the bladder. Drinking too much water or holding urine for too long can lead to overfilling of the bladder and cause urinary tract disease and hospitalization. According to the questionnaire interview of SCI patients, the time control of catheterization, the inconvenience of going out to the toilet, and the control of dietary intake are the main reasons for the inconvenience and declining quality of life. We proposed a Smart Bladder Management System (SBMS), including a Urinary Monitoring Device (UMD) and a Smart Management System (SMS). The urinary monitoring device uses near-infrared spectroscopy (NIRS) and ultrasound to build a wearable urinary monitoring device to estimate the bladder volume by measuring blood flow changes and the distance between the anterior and posterior bladder walls (TD). The Smart Management System (SMS) is built by linking Google Map and cloud database through a mobile application, providing four functions, including urinary catheterization time reminder, accessible toilet search, history, care recommendation, and urinary catheterization volume measurement, to help patients improve clinical urinary catheterization troubles. With the results of this experiment, it is expected that this study can be carried out in human clinical trials in the future and can be manufactured and distributed to help patients decide the timing of catheterization based on bladder urine volume, which, together with the smart management system, can improve bladder health care for patients and increase the happiness index of patients and caregivers.
Keywords：Spinal Cord Injury, Neurogenic Bladder Dysfunction, Intermittent Catheterization, Smart Bladder Manager System, Phantom