早期院内康复联合视频APP随访指导对脊髓损伤神经性膀胱患者预后的影响

Effect of early hospital rehabilitation combined with video APP follow-up guidance on the prognosis of patients with neurogenic bladder after spinal cord injury

目的探讨早期院内康复训练联合视频APP随访指导对脊髓损伤神经源性膀胱患者预后的影响。方法选取76例脊髓损伤神经源性膀胱患者,随机分为对照组与观察组各38例,对照组给予常规康复指导,观察组则予以早期院内康复训练联合远程视频APP随访指导,均于干预前、干预3个月后予尿动力学检查,测定患者膀胱容量、尿失禁次数、自主排尿量、残余尿量及排尿次数,2组均给予为期6个月的随访调查,采用生活质量评价表及国际下尿路功能症状(LUTS)表评定患者生活质量及尿路功能的改善情况,并采用焦虑、抑郁量表评定患者心理状态的改善情况。结果干预后,2组膀胱容量、自主排尿量均上升,排尿次数、尿失禁次数、残余尿量均减少,与干预前对比差异有统计学意义(P<0.05),观察组膀胱容量、自主排尿量上升幅度与排尿次数、尿失禁次数、残余尿量减少幅度均高于对照组(P<0.05);干预前,2组下尿路症候群评分对比差异无统计学意义(P>0.05),干预3个月、末次随访2组评分均降低,观察组评分降低幅度高于对照组(P<0.05);干预前,2组SAS、SDS量表评分对比差异无统计学意义(P>0.05),干预3个月、末次随访2组量表评分均降低,观察组评分降低幅度高于对照组(P<0.05);干预前,2组生活质量评分对比差异无统计学意义(P>0.05),干预3个月、末次随访2组量表评分上升,观察组评分上升幅度高于对照组(P<0.05)。结论早期院内康复指导联合远程视频APP随访指导干预脊髓损伤后神经源性膀胱患者,可促进自主排尿,改善患者膀胱功能,提高其生活质量,改善其预后。

Objective To investigate the effect of early rehabilitation training combined with video APP follow-up guidance on the prognosis of patients with neurogenic bladder after spinal cord injury. Methods Seventy-six patients with neurogenic bladder after spinal cord injury who were treated in our hospital were randomized into control group and observation group,with 38 cases in each group. The control group was given routine rehabilitation guidance,while the observation group was given early rehabilitation training combined with remote video APP follow-up guidance. The urodynamic study was performed before intervention and after 3 months of intervention. The bladder volume,times of urinary incontinence,automatic urine output,residual urine volume and frequency of urination were determined. Both of the two groups were followed up for 6 months. The improvement of quality of life and urinary tract function was evaluated by the quality of life scale and the international lower urinary tract symptoms（ LUTS） scale. SAS and SDS scales were used to evaluate the psychological status of the patients. Results After intervention,the bladder volume and automatic urine output of the two groups increased,while frequency of urination,times of urinary incontinence andresidual urine volume decreased（ P 〈 0. 0 5）. The increasing ranges of bladder volume and automatic urine output,decreasing ranges of frequency of urination,times of urinary incontinence and residual urine volume in the observation group were more than those in the control group（ P 〈 0. 05）; Before intervention,there was no significant difference between the two groups in the lower urinary tract syndrome score（ P 〉 0. 05）. After 3 months of intervention and at the end of follow-up,the scores of the groups decreased,and the scores of observation group were lower than those of the control group（ P 〈 0. 05）; Before intervention,there was no significant difference in the scores of SAS and SDS between the two groups（ P 〉 0. 05）. After 3 months and at last time of follow-up,the scores of the two groups decreased,and the scores of the observation group were lower than those of the control group（ P 〈 0. 05）; Before intervention,there was no significant difference in quality of life score between the two groups（ P 〉 0. 05）. After 3 months of intervention and at last time of followup,the scores of the two groups increased,and those of the observation group were higher than those of the control group（ P 〈 0. 05）. Conclusion Application of early hospital rehabilitation guidance combined with remote video APP follow-up guidance for patients with neurogenic bladder after spinal cord injury can promote automatic urination,and improve bladder function,quality of life and the prognosis of patients.