运动想象疗法联合肌电生物反馈疗法对脊髓损伤后神经源性膀胱患者康复及尿路感染发生率的影响

Effects of motor imagery therapy combined with electromyographic biofeedback therapy on rehabilitation and incidence rate of urinary tract infection in patients with neurogenic bladder after spinal cord injury

目的:分析运动想象疗法联合肌电生物反馈疗法(electromyographic biofeedback therapy,EMGBFT)对脊髓损伤(spinal cord injury,SCI)后神经源性膀胱(neurogenic bladder,NB)患者康复及尿路感染发生率的影响。方法:采用前瞻性随机对照研究,选取四川省骨科医院2018年1月至2021年12月收治的90例SCI后NB患者,采用随机数字表法分为生物反馈组(n=45)和联合治疗组(n=45),所有患者均给予NB常规康复治疗,在此基础上,生物反馈组行EMGBFT进行治疗,联合治疗组在生物反馈组基础上联合运动想象疗法进行治疗,比较治疗后2组的临床疗效、盆底肌电值、排尿功能指标、尿路感染发生情况及生活质量评分。结果:治疗后,联合治疗组临床总有效率显著高于生物反馈组(P<0.05);治疗后,2组静息阶段、快速收缩阶段、紧张收缩阶段、耐力收缩阶段盆底肌电值均显著升高(均P<0.05),且联合治疗组各肌电值均明显高于生物反馈组(均P<0.05);治疗后,2组尿失禁次数和排尿次数均显著减少(均P<0.05),2组单次排尿量均显著增加(均P<0.05),且联合治疗组上述指标与生物反馈组比较差异均有统计学意义(均P<0.05);治疗期间,联合治疗组尿路感染发生率(2.22%)与生物反馈组(13.33%)比较差异有统计学意义(χ^(2)=3.873,P=0.049);2组生活质量各领域评分及总分均显著升高(均P<0.05),且联合治疗组各分数均明显高于生物反馈组(均P<0.05)。结论:运动想象疗法联合EMGBFT治疗SCI后NB疗效显著,可明显改善患者盆底肌电值和排尿功能,并有效降低尿路感染发生率,从而提高生活质量促进康复,值得临床推广应用。

Objective:To analyze the effects of motor imagery therapy combined with electromyographic biofeedback therapy(EMGBFT)on rehabilitation and incidence rate of urinary tract infection in patients with neurogenic bladder(NB)after spinal cord injury(SCI).Methods:A total of 90 patients with NB after SCI admitted to Sichuan Province Orthopedic Hospital from January 2018 to December 2021 were selected as the observation subjects by adopting prospective randomized controlled trial,and the above patients were divided into a biofeedback group and a combined treatment group by the random number table method,with 45 cases in each group.All patients were given NB routine rehabilitation treatment.On this basis,the biofeedback group received EMGBFT,whereas the combined treatment group was treated with motor imagery therapy on the basis of the biofeedback group.The clinical efficacy,pelvic floor electromyography values,urination function indicators,occurrence of urinary tract infection and quality of life scores were compared between the 2 groups after treatment.Results:After treatment,the total clinical effective rate of 95.56%in the combined treatment group was significantly higher than 82.22%in the biofeedback group(P<0.05).The pelvic floor electromyography values in the resting stage,rapid contraction stage,tension contraction stage and endurance contraction stage were significantly increased in the 2 groups after treatment(all P<0.05),and the electromyography values in the combined treatment group were significantly higher than those in the biofeedback group(all P<0.05).After treatment,the frequency of urinary incontinence and frequency of urination in the 2 groups were significantly reduced(all P<0.05)while the single urine output was significantly increased(P<0.05),and the above indicators in the combined treatment group were significantly different from those in the biofeedback group(all P<0.05).During treatment,there was significant difference in the incidence rate of urinary tract infection between the combined treatment group(2.22%)and the biofeedback group(13.33%)(χ^(2)=3.873,P=0.049).The scores of various fields of quality of life and total score in the 2 groups were significantly enhanced(all P<0.05),and the scores in the combined treatment group were significantly higher than those in the biofeedback group(all P<0.05).Conclusion:Motor imagery therapy combined with EMGBFT in the treatment of NB after SCI has a significant efficacy,and it can significantly improve the pelvic floor electromyography values and urination function and effectively reduce the incidence rate of urinary tract infection,thereby enhancing the quality of life and promoting the rehabilitation.