阴部神经电刺激干预脊髓损伤后神经源性膀胱:功能重建的文献研究

Electrical stimulation of the pudendal nerve for neurogenic bladder dysfunction after spinal cord injury:a literature research on functional reconstruction

背景:研究证实,以阴部神经为作用靶点,通过对频率、强度、脉宽的调整,调节膀胱逼尿肌和尿道括约肌的协同作用,可改善脊髓损伤后神经源性膀胱功能障碍。目的:了解阴部神经电刺激干预脊髓损伤后神经源性膀胱功能障碍的研究现状。方法:计算机检索PubM ed、Cochrane Central Register of Controlled Trials(CENTRAL)、中国知网、万方和维普数据库中关于阴部神经电刺激干预脊髓损伤后神经源性膀胱功能障碍的研究报道,并追溯已纳入文献的参考文献。检索时间从建库至2014年7月。由2名研究人员独立进行文献筛选及资料提取。结果与结论:共纳入14篇文献。分析发现:阴部神经电刺激疗法对于脊髓损伤后神经源性膀胱功能障碍有一定疗效。该疗法通过调控阴部神经-膀胱反射及脊髓膀胱反射,从而调节逼尿肌及尿道括约肌的协同运动,改善膀胱壁的顺应性,促进膀胱功能恢复。针对脊髓损伤后神经源性膀胱功能障碍,阴部神经电刺激是一种可行的方法。但因目前临床研究较少,频率双向调节机制背后的神经生理学基础不明,干预强度的选择不明确,故仍需开展更多高质量的研究,以便更好地明确阴部神经电刺激疗法对脊髓损伤后神经源性膀胱功能障碍的干预效果及作用机制。

BACKGROUND：Stimulation of the pudendal nerve as a target can improve neurogenic bladder dysfunction after spinal cord injury, by adjusting the frequency, intensity, pulse width, as wel as regulating synergistic effect of detrusor and urethral sphincter. OBJECTIVE： To assess the research status of electrical stimulation of the pudendal nerve in the treatment of neurogenic bladder dysfunction after spinal cord injury. METHODS： We searched the folowing databases for articles addressing electrical stimulation of the pudendal nerve for neurogenic bladder dysfunction after spinal cord injury： PubMed, Cochrane Central Register of Controled Trials （CENTRAL）, China National Knowledge Infrastructure, Wanfang Database, and VIP Database. The search was updated to July 2014, and the reference lists of the identified studies were manualy screened for additional studies. The study selection and data extraction were independently conducted by two reviewers. RESULTS AND CONCLUSION：Fourteen studies were included in this review. We derived the folowing points by analyzing the included studies： Electrical stimulation of the pudendal nerve has positive effects on rehabilitation of neurogenic bladder dysfunction after spinal cord injury; pudendal nerve electrical stimulation can modulate the＆amp;nbsp;coordination of the detrusor and the external urethral sphincter, improve the bladder compliance and restore bladder function by regulating pudendal-to-bladder reflex and spinal reflexes to the bladder. Electrical stimulation of the pudendal nerve may be potentialy implemented as a feasible treatment of neurogenic bladder dysfunction after spinal cord injury. More high quality researches should be conducted to clarify the efficacy and the potential active mechanisms of pudendal nerve electrical stimulation for neurogenic bladder dysfunction after spinal cord injury because the number of clinical reports published in this study area is limited, neurophysiological mechanisms underlying biphasic regulation of frequency on bladder function are not wel known, and which intensity of pudendal nerve electrical stimulation is more effective than others for the treatment of neurogenic bladder dysfunction after spinal cord injury remains unknown.