神经源性膀胱功能障碍患者不同治疗效果评价

Curative effects of different therapeutic regimes in patients with neurogenic bladder dysfunction

目的比较不同方法治疗神经源性膀胱功能障碍患者的效果。方法选择2013年3月—2014年10月在海南医学院附属医院康复医学科住院的神经源性膀胱功能障碍患者64例,分为A组(32例)和B组(32例),B组给予膀胱功能训练,A组在B组的基础上给予骶神经刺激,治疗前、治疗后分别评定患者的尿流动力学,膀胱压力、残余尿量等。结果治疗前后A、B组内各项指标均有不同程度的变化,慢性尿潴留患者的平均尿流率增加、尿残留量显著下降,逼尿肌过度活动症患者平均最大膀胱容量增加,最大膀胱内压减低,平均排尿次数、尿失禁发作次数与夜尿次数减少(P<0.05)。治疗后,慢性尿潴留患者的平均尿残留量A组明显少于B组[(41.2±13.6)vs(128.6±43.9)m L,P<0.05];逼尿肌过度活动症患者平均排尿次数A组明显少于B组[(6.67±2.2)vs(9.53±3.17)次/24 h,P<0.05],组间各指标的改善A组明显优于B组。结论骶神经刺激配合膀胱功能训练可有效改善患者的尿频、尿急、尿失禁的现象及尿流动力学特征,更有利于患者的康复。

Objective To compare curative effects of different therapeutic regimes in patients with neurogenic blad- der dysfunction. Methods Totally 64 inpatients with neurogenic bladder dysfunction were recruited and assigned equally into an observation group （group A）administered with sacral nerve stimulation and bladder function training and a con- trol group （ group B） with bladder function training in the Affiliated Hospital of Hainan Medical College from March 2013 to October 2014. We assessed urinary flow dynamics, bladder pressure, residual urine volume for the inpatients before and after the treatments. Results The indicators changed after the treatments among all the inpatients. The aver- age urinary flow rate increased and the average residual urine volume decreased among the inpatients with chronic urinary retention. For the patients with detrusor hyperactive disorder, the average number of urination, urinary incontinence, and night urination decreased and the average maximum intravesical pressure declined but the average maximum bladder capacity increased after the treatments （ P 〈 0. 05 ）. The average residual urine volume of the chronic urinary retention patients in group A was significantly lower than that of the patients in group B（41.2 ± 13.6 vs. 128.6 ±43.9 ml,P 〈 0. 05 ） ; the average micturition frequency of the inpatients with detrusor hyperactive disorder in group A was significantly lower than the inpatients in group B （6. 67 ± 2. 2 vs. 9. 53 ± 3.17 per day, P 〈 0. 05 ）. The indicators among the patients of group A showed better improvement than those among the patients of group B. Conclusion Sacral nerve stimulation combined with bladder function training can effectively improve micturition frequency ,urgent urination,incontinence of urine and urine flow dynamic characteristics among the patients with neurogenic bladder dysfunction.