盆底肌生物反馈刺激治疗脊髓损伤排尿功能障碍的疗效

Effect of biofeedback stimulation of pelvic floor muscles on micturition dysfunction in spinal cord injury

目的观察盆底肌生物反馈刺激治疗脊髓损伤(SCI)患者排尿功能障碍的疗效。方法2016年10月至2018年10月,将64例SCI伴排尿功能障碍的患者采用随机数字表法分为对照组(n=32)和治疗组(n=32)。两组均接受盆底肌功能锻炼,治疗组在此基础上增加生物反馈刺激治疗,共8周;两组患者治疗前、后均进行Glazer盆底表面肌电(sEMG)曲线[选取5次快速收缩的最大值(Flick-Max)、持续60 s收缩的平均值(Edu-Mean)]的检测、膀胱残余尿量的检测、以及国际脊髓损伤下尿路功能数据集问卷的调查,以评估疗效。结果治疗后,两组Flick-Max及治疗组Edu-Mean较治疗前提高(P均<0.05);治疗组Flick-Max和Edu-Mean均高于对照组(P均<0.01)。治疗后,两组膀胱残余尿量较治疗前减少(P均<0.01),且治疗组少于对照组(P<0.01)。问卷调查结果提示,治疗后,治疗组尿意、泌尿系症状、膀胱排空情况较治疗前改善(P<0.05,P<0.01),对照组仅尿意情况改善(P<0.01);且治疗组治疗后尿意、泌尿系症状、膀胱排空情况优于对照组(P<0.05,P<0.01),尿失禁情况两组相当(P>0.05)。结论盆底肌生物反馈刺激联合盆底肌功能锻炼治疗对SCI患者排尿功能障碍的临床疗效优于单纯盆底肌功能锻炼。

Objective To observe the effect of biofeedback stimulation of pelvic floor muscles on micturition dysfunction in patients with spinal cord injury(SCI).Methods micturition dysfunction were randomly divided into the control group(n=32)and the treatment group(n=32).Both groups received pelvic floor muscle function exercises,and the treatment group added biofeedback stimulation therapy for a total of 8 weeks.The Glazer pelvic floor surface electromyography(sEMG)curve test[select the maximum value of 5 fast shrinks(Flick-Max),the average value of the 60-s contraction(Edu-Mean)],bladder residual urine volume test,and International Spinal Cord Injury Data Sets-Lower Urinary Tract Function Basic Data Set were performed before and after treatment in patients of the two groups to evaluate the efficacy.Results After treatment,Flick-Max in two groups and EduMean in treatment group were significantly higher than those before treatment(all P<0.05);Flick-Max and Edu-Mean in the treatment group were higher than those in the control group(all P<0.01).After treatment,the bladder residual urine volume was significantly reduced in both groups than before treatment(all P<0.01),and which in the treatment group was less than that in the control group(P<0.01).The results of the questionnaire survey indicated that after treatment,the urination,urinary symptoms,and bladder emptying in the treatment group were significantly improved than those before treatment and in the control group(P<0.05,P<0.01),while only the urination in the control group was improved(P<0.01);the urinary incontinence was comparable in both groups(P>0.05).Conclusion The clinical effect of pelvic floor muscle biofeedback stimulation combined with pelvic floor muscle exercise on micturition dysfunction in SCI patients is better than that of pelvic floor muscle exercise alone.