经皮低频脉冲电刺激治疗糖尿病膀胱的临床疗效观察

Elementary clinical study of external low frequency electric pulse stimulation treating diabetic cystopathy

目的通过尿动力学及超声等检查方法观察经皮低频脉冲电刺激对糖尿病膀胱(DCP)患者的临床疗效,探讨无创而有效治疗DCP的方法。方法选择2008年6月至2011年3月在泌尿外科、内分泌科及门诊DCP患者30例,随机分为对照组15例和治疗组15例,对照组按常规糖尿病治疗方法并进行膀胱训练或留置尿管,治疗组在对照组治疗基础上加用LGT-1000A力合膀胱仪进行治疗,电刺激参数为:电压36～70V,电脉冲频率25～65Hz,刺激部位为两侧膀胱角和膀胱前、后壁方位,每次治疗40min,2次/d,5d一疗程,两疗程之间间隔1～2d,共3个疗程,各组患者治疗前后做尿动力学全套测定。治疗后观察两组患者排尿情况、膀胱残余尿(PVR)及最大尿流率、最大逼尿肌压、残余尿/膀胱最大容量(PVR/Vmax)的变化,作相关参数的统计学处理,比较疗效差异。结果 DCP患者经经皮低频脉冲电刺激治疗后,治疗组总有效率为73.3%,对照组总有效率53.3%,治疗组高于对照组,差异有统计学意义(P<0.05)。治疗组治疗前后PVR变化值(ΔPVR)为(118.6±33.4)ml,对照组治疗前后ΔPVR为(54.9±14.2)ml,两组比较,治疗组高于对照组,差异有统计学意义(P<0.05);治疗组治疗后PVR/Vmax[(32.2±11.8)%]与治疗前[(61.0±19.1)%]相比明显减少(P<0.01)。对照组治疗后PVR/Vmax[(42.6±12.4)%]与治疗前[(55.6±21.1)%]相比,减少不明显(P>0.05)。尿动力学参数的变化:治疗组治疗后最大尿流率[(6.7±2.3)ml/s]较治疗前[(3.9±1.3)ml/s]明显增大(P<0.01),对照组治疗后最大尿流率[(5.2±2.5)ml/s]较治疗前[(3.6±1.7)ml/s]增大不明显(P>0.05)。治疗组治疗后最大逼尿肌压[(17.9±4.6)cmH2O]较治疗前[(11.9±3.3)cmH2O]明显增大(P<0.01),对照组治疗后最大逼尿肌压[(14.4±1.9)cmH2O]较治疗前[(12.1±2.0)cmH2O]增大不明显(P>0.05)。结论经皮低频脉冲电刺激膀胱可有效减少或消除DCP患者的PVR,治疗DCP患者逼尿肌无力,提高了DCP患者的生活质量和生存率,且无明显副作用。

Objective To investigate the effect of external low frequency electric pulse stimulation on the patients with DCP by the methods of urodynamic and B-type ultrasonic inspection,and explore an optimal and noninvasive therapeutic method for the treatment of patients with diabetic cystopathy.Methods Totally 30 patients with diabetic cystopathy admitted to Nanjing Drum Tower Hospital from June 2008 to March 2011 were randomly grouped into experiment and control group with 15 cases in each.All patients were signed the informed consent.Patients in control group were treated with DM normal treatment accompanied by bladder training or indwellingurethral,while the external low frequency electric pulse stimulation by LGT-1000A were applied in the experiment group besides the methods used in the control group：voltage 36-70 V,pulse stimulation rate 25-65 Hz,at the bladder horns and the backside and foreside of the bladder,once for 40 minutes,twice a day,5 days in one period,1-2 days break,totally 2-3 period.The urodynamic examination by Laborie Medical Technologies＇ apparatus were treated to the patients of both groups before and after the treatment,and the post-voided residual volume （PVR）,the maximum urinary flow rate,the maximum pressure of detrusor and the PVR/Vmax were used as the main indices in evaluation of the therapeutic effect.Results After a session of treatment,the effectiveness of experiment group （73.3％） was higher than the control group （53.3 ％）,P ＜ 0.05.The changes of PVR （△PVR） of the treatment group [（118.6 ±33.4） ml] was significantly different from the △PVR of control group [（54.9 ± 14.2） ml,P ＜ 0.05].The PVR/Vmax of experiment group reduced significantly[（32.2 ± 11.8） ％ vs.（61.0 ± 19.1） ％,P ＜ 0.01],while there was no significant reduce in the control group [（42.6 ＋ 12.4） ％ vs.（55.6 ± 21.1） ％,P ＞ 0.05].Urodynamic indices：the maximal urinary flow rate of experiment group [（6.7 ± 2.3） ml/s] was higher than before [（3.9 ± 1.3） ml/s,P ＜0.05],while the maximal urinary flow rate of control group[（5.2 ±2.5）ml/s]was a little higher than before[（3.6 ± 1.7）ml/s,P ＞ 0.05] ;The maximal pressure of detrusor of both groups [（17.9 ± 4.6）cm H2O] was higher than before [（11.9 ± 3.3） cm H2O,P ＜ 0.01],while the maximal pressure of detrusor of control groups [（14.4 ± 1.9） cm H2O] was higher than before [（12.1 ± 2.0） cm H2O,P ＜ 0.01].Conclusions The PVR of the patient with DCP can be reduced after the extemal low frequency electric pulse stimulation therapy and favourable effect can also be expected in treating DCP adynamia of detrusor muscle.This method can improve DCP patients＇vesical dysfunction and enhance patients＇life quality and survival rate without triggering significant side effects.