功能性磁刺激对脊髓损伤患者神经源性膀胱的治疗(英文)

Functional magnetic stimulations for the autonomous neurogenic bladder of patients with spinal injury

背景:神经源性膀胱尿道功能障碍(神经源性膀胱)是脊髓损伤康复治疗中常见问题和难题之一。功能性磁刺激具有安全、无创、无副作用等优点,目前已逐步用于中枢神经传导、疲劳恢复、骨愈合、神经疾病治疗及脑功能研究等各方面,但对脊髓损伤患者神经源性膀胱的治疗尚未深入系统地研究。目的:观察功能性磁刺激治疗脊髓损伤患者神经源性膀胱的疗效。设计:以患者为研究对象,纵向观察研究。单位:华中科技大学同济医学院附属同济医院康复医学科。对象:选择2003-05/2004-05华中科技大学同济医学院附属同济医院康复医学科就诊的脊髓损伤康复期神经源性膀胱患者12例,其中男9例,女3例。方法:对12例脊髓损伤后神经源性膀胱患者,采用Dantec公司(丹麦)生产的MagLite型磁刺激仪,经S3神经根和膀胱区的功能性磁刺激治疗,2次/d,5d/周,4～8周1个疗程。主要观察指标:治疗前、后尿流动力学(如残余尿、最大尿道闭合压力、最大膀胱容量、膀胱压力、最大尿流率)指标;排尿次数、平均尿量及单次最大排尿量;生活质量评分和国际下尿路综合征症状评分。结果:患者接受功能性磁刺激治疗前、后尿流动力学(如残余尿、最大尿道闭合压力、最大膀胱容量、膀胱压力、最大尿流率)变化除膀胱压力变化不明显外(P>0.05),其余均有明显变化(P<0.01～0.

BACKGROUND:The autonomous neurogenic bladder(ANB) is one of the common problems and difficulty in rehabilitation of patients with spine injury.Having the advantages of safety,non invasion and no side effects,functional magnetic stimulation(FMS) has been applied in central nervous system(CNS) neurotransmission,recovery from nervous exhaustion,bone healing, treatment of neural disorders and research of brain function,and so on.But the studies on treatment of ANB after spine injury are not as profound and systematic as they were needed.OBJECTIVE:To investigate the therapeutic effect of FMS in patients with ANB caused by spine injury.DESIGN:A longitudinal observation based on patients.SETTING:Department of Rehabilitative Medicine, Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology.PARTICIPANTS:From May 2003 to May 2004,12 patients with ANB hospitalized in the Rehabilitative Medicine Department of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology were selected,9 were male and 3 were female.METHODS:By using MagLite FMS Devices(made by Dantec, Danmark),a FMS therapy was employed at the sacral 3(S3) nerve root region and the bladder region,twice a day,5 days a week,and a duration of 4- 8 weeks.MAIN OUTCOME MEASURES:The pre and post treatment dynamics of urine flow variables(such as,residual urine volume,maximum urethral closure pressure(MUCP),the maximum bladder capacity, the bladder pressure,and the maximum urine flow rate),the frequency of urination,the average daily amount of urine,the maximum urine volume(V max),influence of urinary symptoms on the quality of life scale and the symptom score of lower urinary tract syndrome(LUTS) were selected as main outcomes measurements.RESULTS:Nearly all of the pre and post treatment dynamics of urine flow variables(such as,residual urine volume,MUCP,the maximum bladder capacity,the bladder pressure and the maximum urine flow rate) exhibited significant difference(P< 0.01- 0.001),except for the bladder pressure(P >0.05);After FMS therapy,the frequency of urination decreased and the daily amount of urine and the V max increased significantly(P< 0.01 - 0.001);Also,the influence of urinary symptoms on the quality of life scale and the symptom score of LUTS changed significantly(PCONCLUSION:FMS therapy can greatly and partly ameliorate the bladder function of the patients with ANB after spine injury, and it can also improve their quality of life significantly.