重灸关元结合间歇导尿对脊髓损伤后神经源性膀胱患者排尿日记影响的回顾性队列研究

Retrospective cohort study on the effect of double moxibustion combined with intermittent catheterization on urination diary of neurogenic bladder patients after spinal cord injury

目的探讨重灸关元结合间歇导尿对脊髓损伤后神经源性膀胱(neurogenic bladder,NB)患者排尿日记的影响。方法回顾性纳入2014年8月—2016年8月住院的脊髓损伤NB患者,分为常规组、艾灸组,观察指标为排尿日记相关指标、国际尿失禁咨询委员会尿失禁问卷简表(International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire Short Form,ICI-Q-SF)评分、尿常规白细胞阳性数。结果共入组278例,资料不完整96例,失访26例,纳入统计156例,其中常规组70例,艾灸组86例。两组在性别、年龄、平均病程、脊髓损伤节段及损伤程度分级方面比较,差异无统计学意义(P>0.05)。治疗2个月后,常规组与艾灸组尿常规白细胞计数分别减至(5.72±0.36)、(3.22±0.27)个/μL,ICI-Q-SF评分分别减至(8.61±0.45)、(5.07±0.38)分,两组均较治疗前减少,艾灸组治疗后低于常规组,差异均有统计学意义(P<0.05)。治疗后第7～8周,常规组单次平均尿量达(300±70)mL、两次排尿间隔时间(3.5±0.6)h、尿失禁次数(3.3±0.4)次/周、平均残余尿量(125±42)mL,艾灸组单次平均尿量达(326±78)mL、两次排尿间隔时间(3.8±1.1)h、尿失禁次数(2.3±0.3)次/周、平均残余尿量(103±37)mL;艾灸组上述指标较治疗第1～2周均改善,常规组则只在平均单次尿量改善,且艾灸组治疗后优于常规组,差异均有统计学意义(P<0.05)。结论对于脊髓损伤后NB患者,重灸关元结合间歇导尿治疗可以改善膀胱功能,减少残余尿,减少尿失禁,提高生活质量。

ObjectiveTo investigate the efficiency of double moxibustion combined with intermittent catheterization on urination diary in patients with neurogenic bladder （NB） after spinal cord injury （SCI）.MethodsFrom August 2014 to August 2016, hospitalized patients with NB after SCI were reviewed retrospectively and classified into the moxibustion group and the routine group. The urination diary related indicators, International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire Short Form （ICI-SQ-SF） score, and routine urine leucocyte count were collected.ResultsA total of 278 patients were enrolled in the study, in whom, the data of 96 were incomplete, and 26 got lost to follow-up. The routine group and the moxibustion group finally contained 70 and 86 respectively. There was no significant difference between the two groups in sex, age, average course of the disease, SCI segment or grading of injury （P〉0.05）. After 2 months treatment, the urine routine leucocyte count decreased to （5.72± 0.36）/μL in the routine group and （3.22±0.27）/μL in the moxibustion group, and the ICI-Q-SF score decreased to 8.61±0.45 in the routine group and 5.07±0.38 in the moxibustion group. The urine routine leucocyte count and ICI-Q-SF score were lower than those before treatment, and were lower in the moxibustion group than those in the routine group （P〈0.05）. In the 7th to 8th week, in the routine group, the average single urine volume was （300±70） mL, the interval between two micturition was （3.5±0.6） hours, the frequency of urinary incontinence was （3.3±0.4） times per week, and the average residual urine volume was （125±42） mL; in the moxibustion group, they were （326±78） mL, （3.8±1.1） hours, （2.3±0.3） times per week, and （103±37） mL, respectively. The indexes were not statistically significant different from those in the 1st to 2nd week （P〉0.05）, except the average single urine volume in the routine group and all the indexes in the moxibustion group （P〈0.05）. They were all better in the moxibustion group than those in the routine group （P〈0.05）.ConclusionThe treatment of moxibustion and intermittent catheterization may improve bladder function, reduce residual urine, reduce urinary incontinence and improve the quality of life for patients with NB after SCI.