超声波治疗脊髓损伤后神经源性低顺应性膀胱患者感染的临床研究

Clinical study of ultrasonic therapy in patients with low compliance neurogenic bladder infection after spinal cord injury

目的探讨超声波治疗脊髓损伤后神经源性低顺应性膀胱患者泌尿系统感染的疗效及其适宜治疗频率。方法收集我院康复医学科因脊髓损伤导致的神经源性低顺应性膀胱患者40例,采用随机数字表法分为常规组、20 kHz超声波刺激组、30 kHz超声波刺激组、40 kHz超声波刺激组,每组各10例。其中常规组采用膀胱灌注疗法及抗胆碱能药物(酒石酸托特罗定)进行清洁及扩容治疗,各超声波刺激组在常规组治疗的基础上分别应用20、30、40 kHz超声波治疗。检测并比较各组治疗前后最大膀胱容量、残余尿量、尿白细胞数、尿细菌数及中段尿细菌培养结果。结果各组治疗前最大膀胱容量、残余尿量、尿白细胞数、尿细菌数及中段尿细菌培养结果比较,差异均无统计学意义。与常规组比较,20 kHz超声波刺激组、30 kHz超声波刺激组、40 kHz超声波刺激组治疗后最大膀胱容量均增大,残余尿量、尿白细胞数、尿细菌数均减少,感染大肠埃希菌和肺炎克雷伯杆菌占比均降低,差异均有统计学意义(均P<0.05);与20 kHz超声波刺激组比较,30 kHz超声波刺激组、40 kHz超声波刺激组治疗后最大膀胱容量均增大,残余尿量、尿白细胞数、尿细菌数均减少,感染大肠埃希菌和肺炎克雷伯杆菌占比均降低,差异均有统计学意义(均P<0.05);30 kHz超声波刺激组与40 kHz超声波刺激组上述参数比较,差异均无统计学意义。结论应用30 kHz超声波治疗可改善脊髓损伤后神经源性低顺应性膀胱患者尿动力,抑制泌尿系统感染的发生。

Objective To investigate the efficacy and optimal frequency of ultrasound therapy for urinary system infection in patients with low compliance neurogenic bladder after spinal cord injury.Methods Forty patients with low compliance neurogenic bladder due to spinal cord injury admitted to the rehabilitation medicine department of our hospital were collected and divided into routine group,20 kHz ultrasonic stimulation group,30 kHz ultrasonic stimulation group and 40 kHz ultrasonic stimulation group by random number table method,10 cases in each group.The routine group was treated with bladder perfusion therapy and the anticholinergic drug(tolterodine tartrate)tablets for cleaning and dilatation treatment,while each ultrasonic stimulation group was treated with 20,30,40 kHz ultrasound therapy on the basis of the conventional treatment.The maximum bladder volume,residual urine volume,urinary leukocytes count and bacteria count,the bacterial culture in the middle urine before and after treatment in each group were detected and compared.Results There were no significant differences in the maximum bladder volume,residual urine volume,urinary leukocytes count,bacterial count and bacterial culture in the middle of urine before treatment among each group.Compared with the routine group,the maximum bladder volume in 20 kHz ultrasonic stimulation,30 kHz ultrasonic stimulation and 40 kHz ultrasonic stimulation groups increased after treatment,and the residual urine volume,urinary leukocytes count,bacteria count,the proportion of Escherichia coli and Klebsiella pneumoniae decreased,the differences were statistically significant(all P<0.05).Compared with the 20 kHz ultrasound stimulation group,the maximum bladder volume in 30 kHz ultrasound stimulation group and 40 kHz ultrasound stimulation group after treatment increased,and the residual urine volume,urinary leukocytes count,bacterial count,and the proportion of Escherichia coli and Klebsiella pneumoniae decreased,the differences were statistically significant(all P<0.05).Conclusion The application of 30 kHz ultrasonic stimulation treatment could improve the urinary motility and inhibit infection in patients with low compliance neurogenic bladder after spinal cord injury.