重复磁刺激S_(3)神经根联合M1区治疗脊髓损伤后尿潴留

Repetitive magnetic stimulation of S_(3)nerve root and M1 area for treating urinary retention after spinal cord injury

背景:有研究证明S_(3)神经根重复磁刺激与M1区重复磁刺激均可改善脊髓损伤后尿潴留患者的排尿功能,但目前很少有将2个部位联合重复磁刺激应用于脊髓损伤后尿潴留患者的研究报道。目的:观察S_(3)神经根联合大脑M1区重复磁刺激治疗脊髓损伤后尿潴留的疗效。方法:纳入40例脊髓损伤后尿潴留的患者,按随机数字表法分为2组,联合刺激组行S_(3)神经根区+M1区重复磁刺激,S_(3)刺激组行S_(3)神经根区重复磁刺激+M1区假刺激,每组20例。两组患者均在常规膀胱功能干预的基础上给予4周重复磁刺激治疗。两组患者每日治疗时间均为21 min,每周5 d,共计4周,对比两组患者排尿日记、尿动力学检查变化。结果与结论:①治疗前,两组患者日均导尿次数、日均导尿量、日单次最大导尿量、平均单次排尿量、储尿期(最大膀胱容量、膀胱压)、排尿期(逼尿肌压、残余尿量)比较,差异均无显著性意义(P>0.05);②4周治疗结束后,联合刺激组日均导尿次数较组内治疗前降低(P<0.05),平均单次排尿量较组内治疗前升高(P<0.05);S_(3)刺激组日均导尿次数较组内治疗前降低(P<0.05);4周的治疗结束后,联合刺激组日均导尿次数较S_(3)刺激组降低、平均单次排尿量较S_(3)刺激组升高(P<0.05);③4周的治疗结束后,两组最大膀胱容量、排尿期逼尿肌压较组内治疗前增大(P<0.05);两组最大容量时膀胱压、残余尿量较组内治疗前减小(P<0.05);4周的治疗结束后,联合刺激组最大膀胱容量、排尿期逼尿肌压较S_(3)刺激组增大,最大容量时膀胱压、残余尿量较S_(3)刺激组减小(P<0.05);④提示两组均可改善脊髓损伤后尿潴留患者的排尿功能,且联合刺激组的治疗效果明显优于S_(3)刺激组,证明两部位联合重复磁刺激可有效改善脊髓损伤后尿潴留患者的排尿功能。

BACKGROUND:Repetitive magnetic stimulation of either S_(3)nerve root or M1 area can improve the urination function of patients with urinary retention after spinal cord injury,but there are few reports on the repetitive magnetic stimulation of both sites in patients with urinary retention after spinal cord injury.OBJECTIVE:To observe the effect of repetitive magnetic stimulation of both S_(3)nerve root and M1 area on urinary retention after spinal cord injury.METHODS:Forty patients with urinary retention after spinal cord injury were enrolled and were randomly divided into two groups(n=20 per group):group A(repetitive magnetic stimulation in both S_(3)nerve root and M1 area)and group B(repetitive magnetic stimulation in the S_(3)nerve root and sham stimulation in the M1 area).Patients in both groups were given 4-week repetitive magnetic stimulation based on conventional bladder function intervention.The stimulation time and duration of treatment were same in both groups,with a treatment time of 21 minutes daily,5 days per week,for 4 weeks in total.The urination diary and urodynamics were compared between two groups.RESULTS AND CONCLUSION:Before treatment,there were no statistically significant differences in the average daily catheterization times,average daily catheterization volume,average single urinary volume,urinary storage period(maximum bladder volume,bladder pressure),and urinary voiding period(detrusor pressure,residual urine volume)between the two groups(P>0.05).After 4 weeks of treatment,the average daily catheterization times in group A were lower than before treatment(P<0.05),while the average single urination volume in group A was higher than that before treatment(P<0.05);and the average daily catheterization times in group B were lower than before treatment(P<0.05).After 4 weeks of treatment,the average daily catheterization times in group A were lower than those in group B,and the average single urination volume was higher than that in group B(P<0.05).After 4 weeks of treatment,the maximum bladder volume and detrusor pressure during urination were increased in both groups compared with before treatment(P<0.05),while the bladder pressure and residual urine volume at the maximum volume of the two groups were decreased compared with those before treatment(P<0.05).Compared with group B,the maximum bladder volume and detrusor pressure during urination were higher in group A,while the bladder pressure and residual urine volume at maximum volume were lower in group A(P<0.05).To conclude,two treatments can both improve the urination function of patients with urinary retention after spinal cord injury,and repetitive magnetic stimulation of both S_(3)nerve root and M1 area is superior to repetitive magnetic stimulation of S_(3)nerve root alone.Repetitive magnetic stimulation of both S_(3)nerve root and M1 area can effectively improve the urination function of patients with urinary retention after spinal cord injury.