针灸、微波配合盆底肌锻炼治疗脑卒中后尿失禁106例分析

Treatment of poststroke urinary incontinence with acupuncture and moxibustion,microwave and pelvic floor muscle exercise:Analysis of 106 cases

目的:分析脑卒中后尿失禁患者尿动力学异常情况以及针灸、微波配合盆底肌锻炼治疗脑卒中后尿失禁的效果。方法:选择2004-07/2006-05在华中科技大学同济医学院附属中西医结合医院神经内科住院脑卒中后尿失禁患者106例,随机分为治疗组59例与对照组47例,对照组给予脑卒中常规治疗,治疗组在脑卒中常规治疗的基础上,给予针刺、艾灸以及微波配合盆底肌锻炼等综合治疗。分别于治疗前及治疗30d后行尿动力学检查,分析膀胱尿道功能。结果:106例患者均进入结果分析。①两组患者最常见的尿动力学异常为逼尿肌反射亢进、尿道外括约肌无抑制性松弛,治疗组占37%(22/59),对照组占41%(19/47),两组比较差异无显著性(P>0.05)。②脑卒中性质和病灶部位对患者尿动力学结果无显著影响(P>0.05)。③治疗组经综合治疗后尿动力学检查结果较治疗前明显改善[膀胱最大收缩压:(5.16±2.04),(6.65±2.43)kPa;膀胱最大容积:(363.50±194.14),(317.11±159.72)mL;尿道闭合压:(8.53±3.23),(5.23±2.17)kPa;膀胱充盈初始量:(174.73±105.32),(188.30±84.95)mL,P<0.05]。④治疗组显效率和有效率明显高于对照组(显效率:26%,53%;有效率:80%,71%,P<0.05)。结论:脑卒中后尿失禁患者尿动力学改变以逼尿肌反射亢进和尿道外括约肌无抑制性松弛为主;针刺、艾灸、微波配合盆底肌锻炼治疗脑卒中后尿失禁效果显著。

AIM： To analyze the abnormality in urodynamics of incontinent patients after stroke, and evaluate the treating effect of combination of acupuncture and moxibustion, microwave and pelvic floor muscle exercise. METHODS：106 inpatients with urinary incontinence after stroke were selected from the Department of Neurology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine of Tongji Medical College, Huazhong University of Science and Technology between July 2004 and May 2006, and randomly divided into treatment group （n=59）, which was treated with acupuncture, moxibustion, micro wave and pelvic floor muscle exercise besides the routine treatment of stroke, and control group （n =47）, which was only given routine treatment of stroke. Urodynamic examination was carried out before and 30 days ＇after treatment to analyze the functions of bladder and urinary canal. RESULTS：106 patients were all involved in the result analysis. ① Common urodynamic abnormalities in the two groups included detrusor hyperreflexia and uninhibited sphincter relaxation mainly in lesions of the frontal lobe as well as the basal ganglia, which accounted for 37% （22/59） in the treatment group and 41% （19/47） in the control group, and there were no significant differences （P 〉 0.05）. ②Stroke property and focus of infection showed no obvious effect on the urodynamics of patients （P 〉 0.05）. ③ The urodynamic examination results of the treatment group were improved significantly compared with that before treatment [maximum systolic pressure of bladder： （5.16±2.04）, （6.65 ±2.43） kPa; maximum volume of bladder： （363.50±194.14）, （317.11 ±159.72） mL; urethral close pressure： （8.53±3.23）, （5.23±2.17） kPa; initial volume of bladder filling： （174.73±105.32）, （188.30±84.95） mL, P 〈 0.05]. ⑤The excellent efficacy and efficacy of the treatment group were remarkably higher than the control group （excellent efficacy： 26%, 53%; efficacy： 80%, 71%, P 〈 0.05）. CONCLUSION： Common urodynamic abnormalities are detrusor hyperreflexia and uninhibited sphincter relaxation in incontinent patients after stroke; combination of acupuncture, moxibustion, microwave and pelvic floor muscle exercise present excellent treatment effect.