盆底肌康复联合耳穴阳性反应点刺激治疗中风后急迫性尿失禁的临床疗效观察

Clinical observation of pelvic floor muscle rehabilitation training combined with auricular acupuncture in the treatment of post-stroke urinary incontinence

目的:观察盆底肌康复联合耳穴阳性反应点刺激治疗中风后急迫性尿失禁的临床疗效。方法:将180例中风后急迫性尿失禁的患者随机分为对照组、盆底肌康复组、耳穴阳性反应点刺激组、联合治疗组,每组45例。各组均给予常规基础治疗,包括调控血压、血糖及血脂,抗血小板聚集、营养神经、对症支持治疗等。对照组给予留置导尿及膀胱冲洗治疗;盆底肌康复组给予盆底肌康复治疗;耳穴阳性反应点刺激组采用耳穴探测器探测阳性反应点,并据此进行揿针耳部穴位贴压;联合治疗组采用耳穴阳性反应点刺激及盆底肌康复治疗;各组疗程均为4周。比较患者治疗前后尿代动力学、临床症状评分及疗效。结果:治疗后,联合治疗组尿道最大闭合压(MUCP)、膀胱最大容积(VMAX)显著高于其他3组(P<0.05),残余尿量(RUV)、临床症状评分显著低于其他3组(P<0.05,P<0.01)。联合治疗组总有效率(91.1%,41/45)显著优于对照组(62.8%,27/43)、盆底肌康复组(81.8%,36/44)和耳穴阳性反应点刺激组(83.7%,36/43)(P<0.05)。结论:盆底肌康复联合耳穴阳性反应点刺激治疗中风后急迫性尿失禁疗效确切,可明显提高患者生活质量。

Objective:To observe the clinical effect of pelvic floor muscle rehabilitation training combined with auricular acupuncture in the treatment of post-stroke urinary incontinence.Methods:A total of 180 patients with stroke and urinary incontinence were randomly divided into control group,pelvic floor muscle rehabilitation group,auricular acupuncture group,and combined treatment group.There were 45 cases in each group.Each group was given routine basic treatment,including the regulation of blood pressure,blood glucose and blood lipids,antiplatelet aggregation,nerve nutrition,symptomatic support and other treatment.The control group was given indwelling catheterization and bladder irrigation.The pelvic floor muscle rehabilitation group was given pelvic floor muscle rehabilitation treatment.The auricular acupuncture group used the auricular point detector to detect the positive reaction point,and according to the positive reaction point to paste prssure.The combined treatment group used the auricular acupuncture positive reaction point stimulation and pelvic floor muscle rehabilitation training combined therapy.Each group was treated for 4 weeks.Urodynamics,clinical symptom score and efficacy were compared before and after treatment.Results:After treatment,maximum urethral closure pressure(MUCP),vesica max(VMAX) in the combined treatment group were significantly higher than those of other three group(P<0.05),residual urine volume(RUV) and clinical symptom scores in the combined treatment group were significantly lower than those of other three group(P<0.05,P<0.01).The total effective rate of the combined treatment group(91.1%,41/45) was better than that of the control group(62.8%,27/43),the pelvic floor muscle rehabilitation group(81.8%,36/44) and the auricular acupuncture group(83.7%,36/43)(P<0.05).Conclusion:Pelvic floor muscle rehabilitation training combined with auricular acupuncture is effective in treating urinary incontinence after stroke,which can significantly improve the quality of patient’s life.