基于“温督强肾”思路的中医特色护理在脊髓损伤神经源性膀胱尿潴留的应用研究

Application of Traditional Chinese Medicine Characteristic Nursing Based on “Warming Kidney and Strengthening Du” for the Treatment of Neurogenic Bladder Urinary Retention in SCI

目的:观察基于"温督强肾"思路的中医特色护理在脊髓损伤神经源性膀胱尿潴留的应用研究。方法:使用单中心单盲随机对照方法,将50例住院患者按抽签方法简单随机分成两组。对照组25例采用电针配合常规间隙导尿;治疗组25例例予中医特色护理,即中国灸配合新型揿针以及中医情志护理,中国灸在神阙穴、中极穴、关元穴、命门穴、腰阳关穴、肾俞穴上进行交替穴位敷贴,每天1贴;新型揿针,取患者受损脊髓节段位置的督脉经穴及华佗夹脊穴,再增加肾俞、次髎、膀胱俞、气海、关元穴进行埋针;中医情志护理则针对患者的恐、悲、怒、忧等负面情绪进行相应的指导,上述干预30天为1疗程,持续3个疗程后观测膀胱容量、残余尿量(RUV)、漏尿次数、尿动力学检测排尿期最大尿流率(Qmax)、充盈期最大逼尿肌压力(Pdet.max)。结果:除了漏尿次数指标外,治疗组在RUV、膀胱容量、Qmax、Pdet.max均优于对照组(P<0.05)。结论:基于"温督强肾"思路的中医特色护理,针、灸并用,内外皆固,有较好的临床应用价值,且无严重不良反应,值得推广。

Objective：Observing the application on traditional Chinese medicine characteristic nursing based on ＂warming kidney and strengthening Du＂ for the treatment of neurogenic bladder urinary retention in SCI.Methods：Using a single center,single blind,randomized controlled method,50 patients were randomly divided into two groups according to the draw method.The controlled group of 25 cases treated by electro-acupuncture combined with routine urinary clearance;25 cases in the treatment group were treated with TCM nursing care,namely China model needle and moxibustion combined with TCM mental nursing,Chinese moxibustion Shenque,Zhongji,Guan Yuan,Mingmen,Yaoyangguang,Shenshu,acupoint sticking on alternate,1/d model;press needle,take Huauuo and Du meridian in patients with spinal cord segment position Jiaji,add Shenshu,Ciliao,Pangguangshu,Qihai,Guanyuan buried needle;TCM mental nursing for patients with fear,sadness,anger,fear and other negative emotions for the corresponding guidance,the intervention of 30 days as 1 course of treatment,continuous observation after 3 courses of bladder capacity,residual urine volume（RUV）,urine leakage frequency,Qmax,Pdet.max.Results：In addition to the number of missed urine,the RUV,bladder volume,Qmax and Pdet.max in the treatment group were better than those in the controlled group（P〈0.05）.Conclusion：Traditional Chinese medicine characteristic nursing based on the concept of ＂warming the Du and strengthening the kidney＂,acupuncture and moxibustion combined with both internal and external solid,have good clinical value,and no serious adverse reactions,it is worth of promoting.