电刺激治疗脊髓损伤后神经源性肠道功能障碍

Electrical stimulation therapy for neurogenic bowel dysfunction after spinal injury

目的:了解电刺激疗法治疗脊髓损伤后神经源性肠道功能障碍的临床研究现状.方法:计算机检索PubMed、MEDLINE、EMbase、Cochrane Central Register of Controlled Trials(CENTRAL)、ISI Web of Knowledge、OVID、中国知网、万方和维普数据库中关于电刺激疗法治疗脊髓损伤后神经源性肠道功能障碍的临床研究报道,同时检索已纳入文献的参考文献.检索时间从建库至2012-10.研究人员对纳入文献进行深入阅读及资料提取.结果:共纳入11篇文献,通过分析发现:电刺激疗法主要包括经皮电刺激疗法、经直肠电刺激疗法、经膀胱电刺激疗法、骶神经调节疗法,通过调节脊髓损伤患者包括脊柱裂患儿、脊髓脊膜膨出患者、腰椎间盘突出症患者的肠道内、外的神经支配,改善胃肠道的局部血流,促进蛋白质合成,提高患者的肠道控制能力,改善患者的大便失禁或便秘的症状.结论:电刺激疗法在一定程度上能改善脊髓损伤患者的神经源性肠道功能障碍,但目前关于这方向的临床研究报道数量较少,且其中的随机对照试验数量尤为稀少,同时纳入研究中样本量小,干预强度、结局指标、随访周期不一致,故仍需开展大样本量、实验设计更完善的临床研究,来进一步验证电刺激疗法对脊髓损伤后神经源性肠道功能障碍的治疗效果.

AIM： To assess the efficacy of electrical stimu- lation therapy in the treatment of neurogenic bowel dysfunction after spinal injury. METHODS： PubMed, MEDLINE, EMbase, Co- chrane Central Register of Controlled Trials （CEN- TRAL）, ISI Web of Knowledge, OVID, CNKI, VIP, and Wanfang Data were searched for clinical stud- ies that evaluated electrical stimulation therapy for neurogenic bowel dysfunction after spinal injury from the date of creation of databases to October 2012. The bibliographies of the retrieved studieswere also searched. Researchers read included studies carefully and extracted data strictly. RESULTS： A total of 11 studies were included. Electrical stimulation therapies mainly included transcutaneous electrical stimulation, transrectal electrostimulation, intravesical electrical stimu- lation, and sacral nerve modulation. Electrical stimulation could adjust gut innervation, in- crease the local blood flow of the gastrointestinal tract, promote protein synthesis, and improve bowel control of bowel and symptoms of fecal incontinence or constipation in patients with spinal injury. CONCLUSION： The current evidence shows that to some extent, electrical stimulation ther- apy could improve neurogenic bowel dysfunc- tion after spinal injury. However, the number of clinical studies that have been reported on this direction was small, especially the number of randomized controlled trials. In addition, the number of subjects included in the retrieved studies was small, and the intensity, outcomes and follow-up cycles were inconsistent. More large-sample and high-quality clinical studies need to be done to evaluate the efficacy of elec- trical stimulation therapy in the management of bowel function in patients with spinal injury.