耳针配合间歇导尿治疗脊髓损伤后逼尿肌- 尿道外括约肌协同失调的临床研究

Clinical study of auricular acupuncture combined with intermittent catheterization in the treatment of detrusor external urethral sphincter dyssynergia after spinal cord injury

目的:观察耳针配合间歇导尿法(IC)对脊髓损伤(SCI)后逼尿肌-尿道外括约肌协同失调(DSD)的临床疗效。方法:把80例患者随机分为2组,治疗组(40例)采用耳针配合IC治疗,对照组(40例)采用IC治疗,治疗4周,检测最大膀胱容积(MBC)、残余尿量(RU)、最大尿道压(MUP)、充盈期逼尿肌压力(Pdet.max)、排尿开始和最大尿流率时括约肌肌电图电势比值的常用对数(TL值)、双肾最大肾盂分离宽度、尿中白细胞数、中医证候积分、膀胱平衡状态变化并进行疗效评价。结果:与本组治疗前比较,治疗组治疗后中医证候积分、MUP、Pdet.max、TL值有显著改善(P<0.05),两组治疗后RU、双肾最大肾盂分离宽度、膀胱功能平衡状态、尿中白细胞数及疗效评价均有显著改善(P<0.05),且除尿中白细胞数外,其余指标的改善治疗组均优于同期对照组(P<0.05)。结论:耳针配合IC可使DSD患者改善部分尿动力学指标和中医证候积分,调整膀胱功能平衡状态,从而改善逼尿肌-膀胱外括约肌协同性,缓解症状,治疗肾积水。

Objective:To observe the clinical effect of auricular acupuncture combined with intermittent catheterization on detrusor-external urethral sphincter dyssynergia(DSD)after spinal cord injury(SCI).Methods:Eighty patients were randomly divided into 2 groups.The intervention group(40 cases)was treated with auricular acupuncture combined with intermittent catheterization;The control group(40 cases)was treated with intermittent catheterization.After 4 weeks of treatment,the curative effect was determined by the maximum bladder capacity(MBC),residual urine volume(RU),maximum urethral pressure(MUP),detrusor pressure during filling period(Pdet.max),common logarithm of the ratio of sphincter EMG potential at the beginning of urination and maximum urinary flow rate(TL),the maximum separation width of renal pelvis,the number of white blood cells in urine,TCM syndrome score,changes in bladder balance and efficacy evaluation were used to determine the therapeutic effect.Results:After treatment,the TCM syndrome score,MUP,Pdet.max,TL value of the intervention group had been significantly improved than themselves before treatment(P<0.05).The RU,the maximum separation width of renal pelvis,bladder function balance,the number of white blood cells in urine and efficacy evaluation data of both groups had been significantly improved than themselves before treatment(P<0.05).Except the number of white blood cells in urine,the other factors of the intervention group were significantly better than the control group at the same time(P<0.05).Conclusion:Auricular acupuncture combined with intermittent catheterization can improve the TCM syndrome score of DSD patients,adjust the bladder function balance state,so as to improve the detrusor-bladder external sphincter synergy,relieve symptoms and treat hydronephrosis.