电针调节骶3神经治疗神经源性逼尿肌过度活动的效果研究

S3 neuromodulation using Chinese electro-acupuncture on BL-33 to treat neurogenic detrusor overactivity in patients with spinal cord injury

目的 观察电针调节骶3神经治疗脊髓损伤患者逼尿肌过度活动及尿失禁的临床疗效. 方法 20例脊髓损伤后经影像尿动力学检查证明存在逼尿肌过度活动的患者纳人本研究.男18例,女2例.年龄17～58岁.取侧卧位,在尿动力学检查过程中逼尿肌刚开始收缩时对双侧骶3神经予电针治疗,改变电刺激的强度,选择出抑制逼尿肌收缩的最适合刺激强度.予适合强度的电刺激治疗同时行膀胱充盈测压,观察即时效应.有效者进行长期治疗,每日30 min,10 d为一疗程,3及9个疗程后复查尿动力学检查,观察长期效应.结果患者平均每天尿失禁次数、尿垫使用量分别从治疗前的8.93±3.27、3.93±1.54减至治疗后的7.00±2.51、3.21±0.89（P〈0.05）.出现首次逼尿肌收缩的膀胱容量明显增加,最大膀胱压力明显下降（P〈0.05）.2例完成3个疗程,1例完成9个疗程.此3例患者平均每天尿失禁次数、尿垫使用量分别从治疗前11.67±7.64、6.67±4.16减至4.00±1.73、2.33±0.58,首次逼尿肌收缩的膀胱容积均值从（73.9±10.3）ml增加至（111.6±17.6）ml.6例进行0.025 V和0.080 V的2个强度刺激,2组结果相比认为0.025 V更有效.结论电针调节双侧中髎穴骶3神经可显著增大出现首次逼尿肌收缩的容积,减少每周尿失禁的实际次数.以0.025 V进行电刺激,延长疗程,疗效可能更佳.

Objective To observe the effects of electrical acupuncture for the treatment of neurogenic detrusor overactivity （DO） caused by spinal cord injury （SCI）.Methods Twenty SCI patients with DO were included in this study. There were 18 males and 2 females;age ranged from 17 to 58 years. Patients were given electro-acupuncture treatment at the bilateral S3 foramen at the lateral position during the vidio-urodynamic investigation when the detrusor of the patients began to contract.The different intensities of electrical stimulation were used when the DO appeared during cystometry and the most effective intensity to inhibit DO was determined. Then, the bladder was emptied and the stimulation with selected intensity was used at the beginning of cystometry. The changes of parameters in the urodynamics, the urinary incontinence times per day and the pad used per day were recorded. The acute effects were observed. Ten days were set as one course and after 3 courses and 9 courses the patients underwent urodynamic test again. The long-term effects were observed.Results After treatment, the urinary incontinence times per day and the pad used per day decreased obviously （P〈0. 05）. The bladder capacity increased significantly and the maximum intravesical pressure decreased significantly. There were 3 patients having the long terms treatment. Conclusions The Chinese electro-acupuncture at S3 foramen in the SCI patients with DO is demonstrated effective. After the treatment bladder capacity could increase and the times of the urinary incontinence per week decrease.