盆底肌生物反馈和电刺激联合针刺治疗脊髓损伤后神经源性膀胱的疗效

Efficacy of Pelvic Floor Muscle Biofeedback and Electrical Stimulation Combined with Acupuncture in the Treatment of Neurogenic Bladder after Spinal Cord Injury

目的:观察盆底肌生物反馈和电刺激联合针刺八髎穴对脊髓损伤(SCI)后神经源性膀胱(NB)的临床疗效。方法:60例SCI后NB患者,随机分为针刺治疗组(对照A组)、盆底肌生物反馈和电刺激治疗组(对照B组)以及盆底肌生物反馈和电刺激联合针刺治疗组(联合组),每组20例,均执行每日定时定量饮水和定时间歇清洁导尿;分别于治疗前后行尿流动力学检查比较患者的膀胱安全容量、残余尿量,患者通过排尿日记记录自解小便次数、漏尿次数、清洁导尿次数以及尿路感染情况。结果:与治疗前比较,治疗8周后3组患者最大膀胱安全容量和残余尿量均有一定程度改善(P<0.05);联合组患者的膀胱安全容量和残余尿量明显优于对照A组和对照B组(P<0.05);治疗后,3组患者的每次尿量增加,日排尿次数明显减少,漏尿和清洁导尿次数明显减少(P<0.05),其中以联合组减少最明显(P<0.05);治疗后,3组患者自解小便次数均明显减少(P<0.05),3组之间比较差异无统计学意义(P>0.05)。结论:针刺八髎穴、盆底肌生物反馈和电刺激治疗均能改善SCI后NB患者的排尿功能,而两者联合治疗效果更好。

Objective：To observe the efficacy of pelvic floor muscle biofeedback and electrical stimu-lation combined with acupuncture in the treatment of neurogenic bladder after spinal cord injury. Methods：60 patients with SCI after NB were randomly divided into acupuncture treatment group （ control group A）,pelvic floor muscles biological feedback and electrical stimulation treatment group （ control group B）,and pelvic floor muscles biological feedback and electrical stimulation of acupunc-ture treatment group（ combination group）;20 cases in each group,enforced by regular quantitative drinking water and regular daily clean intermittent catheterization;in row urine flow dynamic test com-parison before and after the treatment respectively in patients with bladder capacity,residual urine vol-ume,recording by a diary about the number of pee,urine leakage number,number of clean urethral catheterization and urinary tract infections. Results：Compared with before treatment,biggest bladder security capacity and residual urine volume of patients treated after eight weeks were improved to some extent（ P〈0 . 05 ）;bladder capacity and residual urine volume of joint group patients was better than control group A and control group B（P〈0. 05）;after treatment,patients of three groups increased volume of urine,daily urine decreased significantly,reduced the frequency of leakage and the number of clean urethral catheterization（ P〈0 . 05 ）,among which joint group decreased most obviously（ P〈0 . 05 ）;differences showed no statistical difference among three groups（ P〉0 . 05 ）. Conclusion：Ac-upuncture Baliao points,pelvic floor biofeedback and electrical stimulation therapy can improve the SCI patients with Nb voiding function,and the combined treatment effect is better.