体外冲击波联合肝素四联药物灌注治疗间质性膀胱炎/膀胱疼痛综合征的疗效观察

Observation on the effect of extracorporeal shock wave combined with heparin quadruple drug infusion in the treatment of interstitial cystitis/bladder pain syndrome

目的:观察体外冲击联合肝素+利多卡因+碳酸氢钠+庆大霉素膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征的临床疗效。方法:61例间质性膀胱炎/膀胱疼痛综合征患者随机分为对照组和观察组,对照组(n=31)采用肝素等四联药物膀胱灌注治疗(肝素、碳酸氢钠、庆大霉素、利多卡因),每周灌注2次,灌注6~8周之后每月2次,共灌注3个月,灌注液保留1 h后排出。观察组(n=30)在对照组基础上联合体外冲击波疗法治疗,每周治疗3次,每次治疗20 min,共治疗3个月;记录两组患者在治疗前、治疗1个月、3个月及治疗结束后6个月随访的O’Leary-Sant评分、盆腔疼痛和尿急/尿频症状(PUF)评分、24 h排尿次数、VAS疼痛评分、焦虑自评量表(SAS)评分并记录治疗期间不良反应,并同时对两组患者临床疗效进行比较。结果:两组患者治疗1个月、3个月O’Leary-Sant、PUF、VAS、SAS评分、24 h排尿次数均较治疗前有明显改善(P<0.05),且随治疗时间越长,疗效更加明显;治疗结束后6个月随访时各项指标稍有升高,但均较治疗前仍有明显改善(P<0.05)。与对照组比较,观察组在各时间点各项指标均较对照组改善更加明显(P<0.05)。O’Leary-Sant评分改善的疗效评估,治疗3个月结束时观察组的疗效虽优于对照组,但差异无统计学意义(P>0.05);但6个月后随访时观察组疗效明显优于对照组,差异有统计学意义(P<0.05)。观察组治疗3个月和6个月随访时总有效率分别为83.33%(25/30)、63.33%(19/30),对照组分别为64.52%(20/31)、38.71%(12/31)。结论:体外冲击波疗法联合肝素等四联药物膀胱灌注能够有效改善间质性膀胱炎/膀胱疼痛综合征患者的临床症状,且对患者疼痛症状改善更加明显,具有起效快、非侵袭性、并发症少等优势,且具有一定的长期疗效。

Objective:To investigate the clinical effect of extracorporeal shock wave combined with heparin-lidocaine-sodium bicarbonate-gentamicin in the treatment of interstitial cystitis/bladder pain syndrome.Methods:Sixty-one patients with interstitial cystitis/bladder pain syndrome were randomly divided into the control group(n=31)treated with quadruplets of drug perfusion therapy(heparin,sodium bicarbonate,gentamicin,lidocaine).Perfusion was performed twice a week for 6-8 weeks,then twice a month for a total of 3 months.The perfusion solution was retained for 1 h and then discharged.The observation group(n=30)was treated with extracorporeal shock wave(ESW)therapy on the basis of the control group,3 times a week,each time for 20 min,for a total of 3 months.O’Leary-Sant scores were separately recorded in both groups before the treatment,after 1 month and 3 months of treatment,six months after the end of treatment.Pelvic pain,urgency and frequency score(PUF),frequency of urination 24 hours,VAS pain score,Self-Rating Anxiety Scale(SAS),adverse reactions during treatment were recorded and the clinical efficacy of the two groups of patients were compared.Results:Patients in the two groups showed significant improvement in O’Leary-Sant,PUF,VAS,SAS score and 24 h urination frequency after 1 month and 3 months of treatment compared with those before treatment(P<0.05).The longer patients received the treatment,the better they received the effect.After 6 months of follow-up,the symptoms were slightly repeated,but the indicators were still significantly improved compared with those before treatment(P<0.05).Compared with the control group,the indexes of the observation group improved more obviously at each time point(P<0.05).At the end of 3 months of treatment,O’Leary-Sant score of the observation group was better than that of the control group,but there was no significant statistical difference.However,after 6 months of follow-up,the efficacy of the observation group was significantly better than that of the control group,with statistically significant difference(P<0.05).In the observation group,the total effective rate was 83.33%(25/30)and 63.33%(19/30),while in the control group,it was 64.52%(20/31)and 38.71%(12/31).Conclusion:Extracorporeal shock wave therapy combined with quadruple drug bladder perfusion therapy(heparin,sodium bicarbonate,gentamicin,lidocaine)can effectively improve the clinical symptoms of patients with interstitial cystitis/bladder pain syndrome,with the advantages of fast onset,non-invasion,less complications and certain long-term efficacy.