电针配合盆底肌电生物反馈治疗对脊髓损伤后神经源性膀胱的疗效观察

Effectiveness of electroacupuncture with pelvic floor muscles biofeedback treatment on neurogenic bladder after spinal cord injury

目的:观察电针配合盆底肌电生物反馈治疗对脊髓损伤所致神经源性膀胱患者膀胱功能的临床疗效。方法:将38例脊髓损伤伴膀胱功能障碍患者随机分为对照组和观察组,每组19例。对照组患者在饮水计划的基础上实施清洁间歇导尿,并给予盆底肌电生物反馈治疗;观察组在对照组治疗的基础上给予电针治疗。治疗前后分别采用排尿日记、尿流动力学检查评估患者膀胱功能。结果:治疗后排尿日记指标比较,2组每次排尿量较治疗前明显增多(P<0.05)、膀胱残余尿量较治疗前明显减少(P<0.05)。观察组24h尿失禁次数较治疗前明显减少(P<0.01)。治疗后,观察组24h尿失禁次数、膀胱残余尿量均较对照组明显减少(P<0.01),每次排尿量较对照组改善增加(P<0.05)。治疗后尿流动力学指标比较,2组最大膀胱容积较治疗前均明显提高(P<0.05),观察组充盈期逼尿肌压力及逼尿肌漏尿点压均较治疗前及对照组治疗后明显降低(P<0.05)。结论:电针配合盆底肌电生物反馈疗法治疗脊髓损伤所致神经源性膀胱患者具有协同疗效,能提高膀胱排尿功能、降低膀胱输尿管返流风险。

Objective：To investigate the effectiveness of electroacupuncture with pelvic floor muscles biofeedback treatment on neurogenic bladder after spinal cord injury.Methods：Thirty-eight patients with neurogenic bladder after spinal cord injury were randomly divided into observation group（n=19）and control group（n=19）.The patients in the control group and observation group were given intermittent clean catheterization,and pelvic floor muscles biofeedback treatment on the basis of the drinking plan.The observation group was given electroacupuncture additionally.Voiding diary and urine flow dynamic test were used to evaluate the bladder function.Results：After treatment for 6weeks,the times of urine incontinence in 24 hwere significantly reduced,every time urine output significantly increased and bladder residual urine volume significantly decreased in both two groups as compared with those before treatment（P〈0.05）.The times of urine incontinence in 24 hand bladder residual urine volume were significantly reduced,and every time urine output significantly increased in observation group as compared with those in the control group（P〈0.05,or P〈0.01）.The maximum bladder volume after treatment was significantly increased in both two groups as compared with that before treatment（P〈0.05）.The detrusor pressure during filling and detrusor urine leakage point pressure after treatment were obviously reduced in observation group as compared with those in the control group and before treatment（P〈0.05）.Conclusions：Electroacupuncture with pelvic floor muscles biofeedback treatment for patients with neurogenic bladder caused by spinal cord injury exerts a synergistic effect,and can improve the bladder function after spinal cord injury,and reduce the risk of bladder ureter reflux.