经皮电刺激治疗老年女性难治性下尿路症状的疗效观察

Effectiveness of transcutaneous electrical stimulation for refractory lower urinary tract symptoms in elderly female patients

目的评估经皮电刺激治疗老年女性难治性下尿路症状的临床疗效。方法收集难治性下尿路症状老年女性患者,根据膀胱镜检查结果分组,均接受膀胱区经皮低频脉冲电刺激治疗,40 min/次,4次/d,疗程7 d,共3个疗程。记录治疗前后排尿日记、疼痛评分、膀胱过度活动症状评分,进行参数统计学处理比较差异。结果患者女性,平均74.3岁,经膀胱镜下水扩张可见黏膜渗血且黏膜标本电镜检查可见肥大细胞者9例(间质性膀胱炎组);仅膀胱黏膜充血5例(可疑间质性膀胱炎组);膀胱镜下未见异常13例(单纯膀胱过度活动症组)。间质性膀胱炎组治疗前后24 h排尿次数分别为(15.4±2.5)次和(11.9±2.0)次(P<0.05),疼痛指数评分分别为(8.3±2.0)分和(8.2±1.6)分(P>0.05);可疑间质性膀胱炎组治疗前后24 h排尿次数分别为(11.8±1.5)次和(8.4±1.1)次(P<0.05),疼痛指数评分分别为(6.40±1.14)分和(4.2±1.1)分(P<0.05);单纯膀胱过度活动症组治疗前后24 h排尿次数分别为(19.2±2.0)次和(15.9±1.3)次(P<0.05),膀胱过度活动评分分别为(8.9±1.6)分和(5.9±1.6)分(P<0.05)。结论经皮电刺激对于治疗老年女性难治性下尿路症状是一种易于操作,安全有效的方法,临床中可进一步广泛应用。

Objective To assess the clinical effects of percutaneous electrical stimulation on refractory lower urinary tract symptoms in elderly female patients.Methods Elderly female patients with refractory lower urinary tract symptoms from July 2016 to December 2017 were recruited.According to cystoscopy results,patients were divided into an interstitial cystitis group,a suspected interstitial cystitis group and an overactive bladder group.All patients received 3 courses of transcutaneous low-frequency electrical stimulation treatment in the suprapubic bladder area,with 40 min per time,4 times per day,7 days per course.Bladder diaries,pain scores and overactive bladder symptom scores were recorded before and after treatment.Results A total of 27 patients with a mean age of 74.3 years were enrolled.Under the cystoscope with water dilatation,9 cases were found to have mucosal bleeding,with mast cells detected in mucosal specimens examined via electron microscopy(in the interstitial cystitis group),5 cases had superficial mucosal congestion(in the suspected interstitial cystitis group)and 13 cases showed normal imaging(in the overactive bladder group).In the interstitial cystitis group,the 24-h urinary frequency improved from 15.4±2.5 times before treatment to 11.9±2.0 times after treatment(P<0.05),but pain scores had no significant difference before and after treatment[(8.3±2.0)and(8.2±1.6),P>0.05].In the suspected interstitial cystitis group,the 24-h urinary frequency improved from(11.8±1.5)times before treatment to(8.4±1.1)times after treatment,and pain scores decreased from(6.4±1.1)to(4.2±1.1)(P<0.05).In the overactive bladder group,the 24-h urinary frequency improved from(19.2±2.0)times before treatment to(15.9±1.3)times after treatment(P<0.05),and the overactive bladder symptom score(OABSS)decreased from(8.9±1.6)to(5.9±1.6)(P<0.05).Conclusions Percutaneous electrical stimulation is an easy,safe and effective treatment in elderly females with refractory lower urinary tract symptoms,and should be encouraged in clinical practice.