盆底肌电刺激法与膀胱训练法治疗不完全脊髓损伤术后排尿障碍的比较研究

Postoperative treatment of urinary dysfunction in patients with incomplete spinal cord injury: electrical pelvic floor stimulation versus bladder training therapy

目的比较盆底肌电刺激法与膀胱训练法治疗不完全脊髓损伤术后患者排尿功能障碍的疗效。方法选取不完全脊髓损伤术后患者73例,采用随机数字表法分为治疗组35例和对照组38例。治疗组采用盆底肌电刺激法;对照组采用膀胱训练法,并控制饮水量。比较两组患者治疗前后膀胱残余尿量(RUV)、最大膀胱容量(MBC)、最大尿流率(MFR)、平均尿流率(AFR)、充盈期末逼尿肌压力(Pdet Qmax)及治疗后拔除尿管成功率、留置导尿管天数和尿路感染发生率。结果治疗组拔除尿管成功率为94.3%,明显高于对照组的73.7%,差异有统计学意义(P<0.05)。与治疗前比较,两组患者治疗后的MBC、MFR和AFR均有所增加,RUV减少,PDet Qmax下降,差异均有统计学意义(均P<0.05)。随访终末期,治疗组各项尿流动力学指标与对照组相近,差异均无统计学意义(均P>0.05)。治疗组留置导尿管天数与尿路感染发生率均低于对照组,差异均有统计学意义(均P<0.05)。结论盆底肌电刺激法和膀胱训练法均可改善不完全脊髓损伤术后患者的排尿功能,但盆底肌电刺激法恢复速度优于膀胱训练法,应早期应用。

Objective To compare electrical pelvic floor stimulation with bladder training therapy in treatment of urinarydysfunction in patients with incomplete spinal cord injury after operation.Methods Seventy three patients with incomplete spinalcord injury were randomly assigned to study group(n=35)and control group(n=38).Patients in study group was given electricalpelvic floor stimulation while those in control group were given bladder training therapy for urinary dysfunction.Residual volume ofurine was evaluated with ultrasonography,the urinary function was assessed with urodynamic examinations,the urinary catheterextraction rate and the urinary tract infection rate were recorded.Results The successful rate of urinary catheter extraction ratein study group was significant higher than that in control group(P<0.05).The residue urine volume(RUV),maximum urinary flowrate(MFR),average urinary flow rate(AFR),and detrusor pressure at peak flow(PdetQmax)after treatment were all higher thanthose before treatment in both groups(all P<0.05).There was no significant difference in the improvement of urodynamicparameters between two groups at the end of follow up(all P>0.05).The time of indwelling catheter was shorter and urinary tractinfection rate was lower in study group than those in control group(all P<0.05).Conclusion The electrical stimulation of thepelvic floor and bladder training therapy can both improve the function of urination in patients with incomplete spinal cord injuryafter operation.However,the time of recovery is shorter with electrical pelvic floor stimulation than that with bladder trainingtherapy.