针刺对广泛性子宫切除术后膀胱功能影响的研究

Effect of Acupuncture on Bladder Function in Patients with Radical Hysterectomy

目的:探讨针灸对广泛性子宫切除术后膀胱功能障碍患者尿动力学的影响及其治疗作用。方法:64例广泛性子宫切除术后7d膀胱功能恢复不良患者,随机分成3组:留置尿管组19例、针刺三阴交组23例、针刺八髎穴组22例。重新置管,治疗5d后,拔除尿管,比较3组间尿动力学的改变及膀胱功能恢复情况。结果:术后12d,留置尿管组有16例膀胱功能未恢复,占84.21%;三阴交组有18例膀胱功能未恢复,占78.26%;八髎穴组有7例膀胱功能未恢复,占31.82%。八髎穴组膀胱功能恢复评价与留置尿管组、三阴交组相比,差异显著(P<0.05)。留置尿管组残余尿(218.0±17.6)mL,膀胱容量(476.1±11.3)mL,平均尿流率(6.5±2.1)mL/s;三阴交组三项分别为(184.1±10.6)mL,(434.9±12.7)mL,(8.6±1.1)mL/s;八髎穴组三项分别为(47.6±13.6)mL,(475.6±14.3)mL,(9.5±0.8)mL/s。三阴交组和八髎穴组残余尿均显著低于留置尿管组(P<0.05),两针刺组间比较有显著性差异(P<0.05);三阴交组和八髎穴组平均尿流率均显著高于留置尿管组(P<0.05),两针刺组间比较差异不显著(P>0.05);3组间膀胱容量比较差异不显著。术后12d尿路感染发生率(24例,37.5%)高于术后7d(5例,7.81%),差异显著。结论:针灸对广泛性子宫切除术后膀胱功能障碍患者尿动力有良好的改善作用,八髎穴的疗效最佳。

Objective： To observe the effect of acupuncture on the urodynamics of bladder dysfunction in patients with radial hysterectomy. Methods ： A total of 64 cases of bladder dysfunction patients with radial hysterectomy were divided into urinary canal indwelling group （control group, 19 cases）, Sanyinjiao （SP 6） group （23 cases） and Baliao （bilateral BL 31, BL 32, BL 33 and BL 34） group （22 cases）. EA （4 Hz, 4-6 V） was applied to the abovementioned acupoints for 30 min, once daily. Catheters were replaced on the 7^th day after surgical operation in all the patients and then removed after 5 days＇ treatment. Postvoid residual urine volume （PVR）, maximum cystometric capacity （MCC）, and average flow rate （Qave） of urine were detected after seven days＇ treatment. Results： On the 7^th day after operation, no significant differences were found among 3 groups in PVR, MOO and Qave. On the 12^th day, PVR of 3 groups decreased significantly （P〈0.05） and Qave of SP6 and Baliao groups increased considerably （P〈0.05）. In comparison with control group, PVR of SP6 and Baliao groups decreased considerably, while Qave of the two acupuncture groups increased significantly （P〈0.05）, and the therapeutic effects of Baliao group were obviously superior to those of SP6 group （P〈0.05）. Of the 19, 23 and 22 patients with urinary canal indwelling in control, SP6 and Baliao groups, 16 （84. 21%）, 18 （78.26%） and 7 （31.82%） had no marked improvement in the bladder function on the 12^th day after operation. On the 7^th and 12^th day after operation, the urinary tract infection was found in 1 and 10 cases in control group, 2 and 8 cases in SP6 group, and 2 and 6 cases in Baliao group respectively. Conclusion： Acupuncture has a good therapeutic effect in improving the urodynamics of the bladder in radial hysterectomy patients, and the action of Baliao is the best.