电针膀胱经腧穴联合膀胱治疗仪治疗脊髓损伤后神经源性膀胱的临床疗效观察

Clinical Observation of Electroacupuncture at Bladder Meridian Acupoints Combined with Bladder Therapeutic Apparatus in the Treatment of Neurogenic Bladder after Spinal Cord Injury

目的:探讨电针膀胱经腧穴联合膀胱治疗仪治疗脊髓损伤(SCI)后神经源性膀胱(NB)的临床疗效及其对膀胱功能状态的影响。方法:选取42例SCI后NB患者,随机分为联合组和对照组,每组21例。对照组在基础治疗上采用膀胱治疗仪治疗,联合组在基础治疗上采用电针膀胱经腧穴联合膀胱治疗仪治疗。观察2组患者在治疗方案实施前、后排尿日记的指标:24h排尿次数、24h尿失禁次数、每次排尿量;尿流动力学指标:膀胱充盈逼尿肌压力、最大尿流率、最大尿道闭合压、残余尿量;LUTS评分,比较2组各项指标的变化。结果:治疗后,2组患者24 h尿失禁次数、24 h排尿次数及尿流动力学观察指标逼尿肌压力、残余尿量分别较治疗方案实施前均减少,联合组减少更明显,排尿日记的观察指标每次排尿量及尿流动力学观察指标最大尿流率、最大尿道闭合压较治疗方案实施前均增大,联合组增大更明显,差异均具有统计学意义(P<0.05)。治疗后2组患者的LUTS评分较前均有明显减少(P<0.05),且联合组更低于对照组(P<0.05)。结论:电针膀胱经腧穴联合膀胱治疗仪治疗SCI后NB临床疗效较好,明显减少膀胱残余尿量,膀胱功能状态有效改善,生活质量得到提高,具有联合康复应用价值。

Objective:To observe the clinical effect of electroacupuncture at bladder meridian acupoints combined with bladder therapeutic apparatus on neurogenic bladder(NB)after spinal cord injury(SCI)and its effect on bladder functional status.Methods:Totally,42 NB patients after SCI were randomly divided into combined group and control group,with 21 cases in each group.The control group was treated with bladder therapeutic apparatus after the routine treatment of NB,and the combined group was treated with electroacupuncture at bladder meridian acupoints combined with bladder therapeutic apparatus after the routine treatment.The indicators of urination diary before and after the implementation of the treatment program were observed:24 h urination frequency,24 h urinary incontinence frequency,each urination volume;urodynamic indicators:bladder filling detrusor pressure,maximum urinary flow rate,maximum urethral closure pressure,residual urine volume;LUTS score,and the changes of each index were compared between the two groups.Results:After the implementation of the treatment program,24 h urinary incontinence times,the number of 24 h micturition,detrusor pressure and residual urine volume were significantly decreased in both groups as compared with those before the treatment,more significantly in the combined group than in the control group.The maximum urine flow rate and the maximum urethral closure pressure were significantly increased after treatment in both groups as compared with those before the treatment,more significantly in the combined group than in the control group(P<0.05).After the implementation of the treatment scheme,LUTS scores in the two groups were significantly improved(P<0.05),and the curative effect in the combined group was better than that in the control group(P<0.05).Conclusion:The clinical effect of electroacupuncture at bladder meridian acupoints combined with bladder therapeutic apparatus in the treatment of NB after SCI is satisfactory,which can significantly reduce the residual urine volume of bladder,effectively improve the functional state of bladder,and improve the quality of life,which has the application value of combined rehabilitation.