穴位中频电刺激降低外伤性脊髓损伤尿潴留残余尿量的疗效分析

Effectiveness of Acupuncture with Intermediate-frequency Stimulation on the Residual Urine Volume in Patients with Traumatic Spinal Cord Injury

目的:比较穴位中频电刺激配合间歇导尿法、膀胱区和骶尾区中频电刺激配合间歇导尿法及单纯间歇导尿法三种方法治疗脊髓损伤后尿潴留的疗效。方法:将连续73例符合研究标准的外伤科脊髓损伤(SCI)尿潴留患者随机分为3组:治疗组1(穴位中频电刺激配合间歇导尿)、治疗组2(膀胱区和骶尾区中频电刺激配合合间歇导尿)、对照组(单纯间歇导尿)。3组患者均以口服营养神经药物及常规膀胱功能训练为基础治疗。分别记录治疗0,7,14,21及28d后的残余尿量,并计算出治疗7,14,21,及28d后残余尿量的下降幅度。结果:共有68例患者完成本研究,其中治疗组1为25例,治疗组2为23例,对照组为20例。治疗前3组患者年龄、性别、病程、损伤节段、治疗方式、ASIA分级差异均无统计学意义(P>0.05)。治疗后残余尿量及其下降幅度数据经球形统计检验,拒绝球形检验(P<0.01),经重复测量方差分析表明,3组间不考虑时间交互效应,残余尿量差异无统计学意义(P=0.15),下降幅度差异有统计学意义(P<0.01);而经LSD重复多重t检验表明,残余尿量在治疗组1与对照组间差异有统计学意义(P=0.045),而下降幅度则在任意两组间差异均有统计学意义(P<0.01)。在时间交互效应条件下,3组实验治疗前、治疗7,14,21及28d后残余尿量及其下降幅度的变化趋势均有统计学意义(P<0.01)。结论:穴位中频电刺激配合间歇导尿法对于SCI后尿潴留患者残余尿量的影响作用最明显,能有效地降低SCI后尿潴留患者残余尿量,且临床副作用小,易被患者接受,是一种值得推荐的中西医结合的综合治疗方法。

Objective：To compare the efficacy of three methods for the treatment of urinary retention after spinal cord injury：intermediate-frequency stimulation on acupuncture points combined with intermittent catheterization,intermediate-frequency stimulation of bladder area and caudal caudal region combined with intermittent catheterization and simple intermittent catheterization.Methods：73SCI patients met the study criteria were randomly assigned into three groups：treatment group 1（intermediate-frequency stimulation on acupuncture points combined with intermittent catheterization）,treatment group 2（intermediate-frequency stimulation of bladder area and caudal caudal region combined with intermittent catheterization）,and control group（simple intermittent catheterization）.The three groups were treated with oral neurotrophic drugs and routine bladder function training.The residual urine volume after treatment was recorded at 0d,7d,14d,21d,and 28d.The decrease of residual urine volume 7d,14d,21d,and 28dafter treatment was calculated.Results：A classification of the three groups had no statistical difference（P〈0.05）.After treatment,data on residual urine volume and its drop range were checked by Bartlett’s sphericity test which shows denial of spherical assumptions（P〈0.01）.Repeated measures ANOVA analysis showed that the residual urine volume was not statistically significant（P=0.15）if the time interaction effect was not taken into account between the three groups,and the difference was statistically significant（P〈0.01）.LSD repeated multiple T test showed that the residual urine volume between treatment group 1and control group was statistically significant（P=0.045）,while the drop rate was significantly different between any two groups（P〈0.01）.Under the time interaction effect,the trend of residual urine volume and its decreasing range before treatment and7d,14d,21dand 28dafter treatment in the three groups were statistically significant（P〈0.01）.Conclusions：Intermediate-frequency stimulation on acupuncture points combined with intermittent catheterization has the most obvious effect on residual urine volume in patients with SCI urinary retention.It can effectively reduce the residual urine volume in patients with urinary retention after SCI,and has fewer side effects and is easy to be accepted by patients.It is a recommended combination therapy of traditional Chinese medicine and Western medicine.