盆底生物反馈电刺激联合下肢康复机器人训练对脊髓损伤患者肠道功能的影响

Effects of pelvic floor biofeedback electrical stimulation combined with lower limb rehabilitation robot training on intestinal function in patients with spinal cord injury

目的探讨盆底生物反馈电刺激联合下肢康复机器人训练对脊髓损伤患者肠道功能的影响.方法选择2018年2月至2019年10月在四川大学华西医院康复医学中心接受治疗的脊髓损伤后肠道障碍患者94例进行研究.采用随机数字表法将患者分为2组,每组各47例.对照组在常规康复训练基础上加以下肢康复机器人训练,观察组则在对照组基础上加以盆底生物反馈电刺激.比较2组患者肠道功能指标、肛管超声检查指标、神经递质及不良反应发生情况.结果治疗后两组患者Wexner便秘评分、Cleveland便失禁评分及NBDS均明显下降,但观察组下降幅度更大(P<0.05).治疗后两组患者肛门内括约肌厚度均明显下降,但观察组下降更明显,治疗后两组患者肛门外括约肌厚度及肛提肌群厚度均明显升高,但观察组升高幅度更大(P<0.05).治疗后两组患者P物质(SP)、血管活血肠肽(VIP)及5-羟色胺(5-HT)水平均明显升高,但观察组升高幅度更大(P<0.05).对照组未出现明显的不良反应,观察组出现3例(6.38%)不良反应,其中皮疹1例,肛门不适2例,两组差异无统计学意义(P>0.05).结论盆底生物反馈电刺激联合下肢康复机器人训练较单独使用下肢康复机器人训练可有效改善患者肠功能指标及肛管超声检查指标,增加神经递质的分泌且具有较高的安全性.

Objective To explore the edback electrical stimulation combined with lower limb rehabilitation robot training on intestinal function in patients with spinal cord injury.Methods From February 2018 to October 2019,94 patients with intestinal disorders after spinal cord injury treated in West China Hospital of Sichuan University were selected for study.Random number table method was used to divide patients into 2 groups,47 cases in each group.The control group was trained with lower limb rehabilitation robots on the basis of routine rehabilitation training,and the observation group was given pelvic floor biofeedback electrical stimulation on the basis of the control group.The intestinal function indexes,anal canal ultrasound indexes,neurotransmitters and adverse reactions of the two groups were compared.Results After treatment,the Wexner constipation score,Cleveland incontinence score and NBDS of the two groups of patients all decreased significantly,but the observation group had a greater decrease(P<0.05).After treatment,the thickness of the internal anal sphincter of both groups decreased significantly,but the observation group decreased more significantly(P<0.05).After treatment,the levels of Substance P(SP),Vasoactive Intestinal Peptide(VIP)and 5-Hydroxytryptamine(5-HT)in the two groups were significantly increased,but the increase in the observation group was greater(P<0.05).There were no obvious adverse reactions in the control group and 3 cases(6.38%)in the observation group,1 case of rash,2 cases of anal discomfort,There was no significant difference between the two groups(P>0.05).Conclusion Pelvic floor biofeedback electrical stimulation combined with lower limb rehabilitation robot training can effectively improve patients’intestinal function indexes and anal canal ultrasound index,increase the secretion of neurotransmitters and have higher safety than lower limb rehabilitation robot training alone.