秩边透水道针法治疗脊髓圆锥以上脊髓神经损伤后神经源性膀胱的疗效观察

Efficacy of Zhibian(BL54) through Shuidao(ST28) acupuncture for neurogenic bladder following spinal cord injury above the conus medullaris level

目的探讨秩边透水道针法应用于脊髓圆锥以上脊髓神经损伤后神经源性膀胱的治疗效果。方法选取2016年2月-2018年2月重庆市某医院收治的31例脊髓圆锥以上脊髓神经损伤后神经源性膀胱患者为研究对象。采用随机数字表法将患者分为研究组(n=16)与对照组(n=15)。对照组患者采用间隙导尿法、经皮膀胱电刺激法进行治疗。研究组患者在对照组治疗基础上采用秩边透水道针法治疗。比较2组患者治疗前后日平均排尿次数、日平均单次尿量、日平均尿失禁次数、膀胱最大容量、膀胱逼尿肌压力、最大尿道闭合压、最大尿流率及膀胱残余尿量。结果治疗前,2组患者日平均排尿次数、日平均单次尿量及日平均尿失禁次数比较,差异无统计学意义(P>0.05)。治疗后,2组患者日平均单次尿量均多于治疗前,且研究组多于对照组,差异均有统计学意义(P<0.05)。治疗前,2组患者膀胱最大容量、膀胱逼尿肌压力、最大尿道闭合压、最大尿流率及膀胱残余尿量比较,差异无统计学意义(P>0.05)。治疗后,2组患者膀胱最大容量大于治疗前,且研究组大于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者膀胱逼尿肌压力及最大尿道闭合压均低于治疗前,且研究组患者膀胱逼尿肌压力低于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者膀胱残余尿量均少于治疗前,且研究组少于对照组,差异均有统计学意义(P<0.05)。结论在间隙导尿、经皮膀胱电刺激的基础上采用秩边透水道针法治疗脊髓圆锥以上脊髓神经损伤后神经源性膀胱的效果优于仅用间隙导尿及经皮膀胱电刺激,其可增加日平均单次尿量、增加膀胱最大容量、降低膀胱逼尿肌压力,并减少膀胱残余尿量,说明秩边透水道针法可显著改善膀胱逼尿肌的过度活动以及膀胱逼尿肌与尿道外括约肌的功能失调,效果显著,值得临床推广应用。

Objective To assess the efficacy of Zhibian （BL54） through Shuidao （ST28） acupuncture for neuro genie bladder following spinal cord injury above the conus medullaris level. Methods Thirty one patients with neurogenic bladder following spinal cord injury above the conus medullaris level treated at a Chongqing hospital between February 2016 and February 2018 were included in our study. Based on a random number table, patients were divided into the trial group （n=16） and the control group （n =15）. Patients in the control group received conventional treatment （intermittent catheterization and transcutaneous bladder electrical stimulation）; while those in the trial group received conventional treatment plus Zhibian （BL54） through Shuidao （ST28） acupunc ture. The average daily frequency of urination, average daily single urine output, average daily frequency of urina ry incontinence, maximum cystometric capacity, detrusor pressure, maximum urethral closure pressure, maxi mum flow rate, and residual urine volume were measured before treatment and 2 weeks after treatment, which were also compared between the two groups. Results The pre treatment average daily frequency of urination, average daily single urine output, and average daily frequency of urinary incontinence were similar between the two groups （P〉0.05）. After treatment, the average daily single urine output was increased in both groups, with a greater increase in the trial group （P〈0.05）. Before treatment, the maximum cystometric capacity, detrusor pressure, maximum urethral closure pressure, maximum flow rate, and residual urine volume were comparable between the two groups （P〉0.05）. After treatment, the maximum cystometric capacity was increased in both groups, with a greater increase in the trial group （P〈0.05）; the detrusor pressure and maximum urethral clo sure pressure were lower than their baseline levels in both groups, and the detrusor pressure in the trial group was lower than that in the control group （P〈0.05） ; the residual urine volume were reduced in both groups, with a greater reduction in the trial group （P〈0.05）. Conclusion For patients with neurogenic bladder following spinal cord injury above the conus medullaris level, Zhibian （BL54） through Shuidao （ST28） acupuncture added to conventional treatment is superior to conventional treatment alone, which may increase the average daily single u rinc output and maximum cystometric capacity, as well as decrease the dctrusor pressure and residual urine vol ume. These findings suggest that Zhibian （BL54） through Shuidao （ST28） aculpuncture is associated with signifi cant improvement in dctrusor overactivity and dctrusor external sphincter dyssynergia, which deserves wide spread clinical application.