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每年约1/4的成年妇女有一次排尿困难。在发达的西方国家排尿困难是临床医师最为常见的临床问题之一,美国每年因排尿困难就诊者达三百万次以上。近年的研究提出,我们需要改变传统的方法来对待有急性排尿困难而无急性肾盂肾炎症状或体征的妇女。传统的观点是:(1)这些病人有细菌性膀胱炎,(2)致病微生物几乎总是革兰氏阴性大肠杆菌,(3)最重要的唯一化验是尿培养,(4)每一毫升尿培养中发现多于100,000个细菌(“阳性”培养)成为尿路感染的依据,(5)“阳性”培养病人应该接受几种相对无害的抗菌剂7-14天的治疗。近年的证据对这五条中的每一条都提出了严谨的怀疑。下面的讨论概括了这些依据并对确定为急性排尿困难的妇女提出了新的方案。
About a quarter of adult women have difficulty urinating each year. Dysuria in western countries is one of the most common clinical problems clinicians, the United States each year because of dyspnea treatment up to 3 million times more. Recent research suggests that we need to change the traditional way to treat women with acute dysuria without symptoms or signs of acute pyelonephritis. The traditional viewpoints are: (1) these patients have bacterial cystitis, (2) pathogenic microorganisms are almost always Gram-negative, (3) the most important and unique test is urine culture, (4) More than 100,000 bacteria (“positive” cultures) were found to be the basis for urinary tract infections in urine cultures, and (5) “positive” patients should be treated for 7-14 days with several relatively non-hazardous antibacterials. Evidence in recent years has raised serious doubts about each of the five. The following discussion outlines these bases and proposes new options for women identified as having acute dysuria.