电针和艾灸治疗脊髓损伤后神经源性膀胱疗效差异:随机对照试验

Efficacy differences between electroacupuncture and moxibustion for neurogenic bladder after spinal cord injury:a randomized controlled trial

目的:比较电针和艾灸治疗脊髓损伤(SCI)后神经源性膀胱(NB)的临床疗效。方法:将120例SCI后NB患者随机分为电针组、艾灸组和间歇导尿组,每组40例。间歇导尿组给予常规治疗及间歇导尿,电针组和艾灸组在间歇导尿组基础上分别给予电针(断续波,频率1.3~1.6 Hz,强度以患者能耐受为度)和艾灸治疗,均穴取中极、关元,双侧足三里、阴陵泉、八髎穴,每次30 min,每日1次,每周6次,共治疗6周。比较治疗前后各组患者最大膀胱容积(MBC)、残余尿量(RUV)、充盈期逼尿肌压力(Pdet)、膀胱顺应性(BC)、双肾最大肾盂分离宽度、尿白细胞数、中医证候积分、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分,记录治疗后各组达到膀胱功能平衡状态患者例数,评定各组临床疗效。结果:治疗后,电针组和艾灸组MBC、Pdet、BC、WHOQOL-BREF评分较治疗前增加(P<0.05),RUV、双肾最大肾盂分离宽度、尿白细胞数、中医证候积分较治疗前减少(P<0.05,P<0.01);间歇导尿组MBC、RUV、双肾最大肾盂分离宽度、尿白细胞数较治疗前减少(P<0.05),BC、WHOQOL-BREF评分较治疗前增加(P<0.05)。治疗后,电针组和艾灸组MBC、Pdet、BC、WHOQOLBREF评分高于间歇导尿组(P<0.05),RUV、中医证候积分低于间歇导尿组(P<0.05);艾灸组MBC、Pdet高于电针组(P<0.05),电针组RUV、双肾最大肾盂分离宽度、中医证候积分低于艾灸组(P<0.05)。电针组和艾灸组治疗后达到膀胱功能平衡状态患者例数多于间歇导尿组(P<0.05)。电针组愈显率为85.0%(34/40),艾灸组愈显率为82.5%(33/40),均高于间歇导尿组的65.0%(26/40,P<0.05),电针组和艾灸组比较差异无统计学意义(P>0.05)。结论:电针、艾灸均能有效改善SCI后NB患者膀胱功能状态,电针在减少残余尿量、减轻尿道括约肌过度活动、缓解中医证候方面疗效更佳,艾灸则在增加充盈期逼尿肌压力、建立逼尿肌反射方面疗效更佳。

Objective To compare the clinical efficacy between electroacupuncture(EA)and moxibustion for neurogenic bladder(NB)after spinal cord injury(SCI).Methods One hundred and twenty patients with NB after SCI were randomly divided into an EA group,a moxibustion group,and an intermittent catheterization group,with 40 patients in each group.The patients in the intermittent catheterization group were treated with routine treatment and intermittent catheterization,while the patients in the EA group and the moxibustion group were treated with additional treatments of EA(discontinuous wave,with a frequency of 1.3-1.6 Hz,and intensity based on patient tolerance)and moxibustion,respectively.The acupoints used in both groups were Zhongji(CV 3)and Guanyuan(CV 4),bilateral Zusanli(ST 36),Yinlingquan(SP 9),and Baliao points.Each session lasted for 30 min,once daily,six times a week,for a total of six weeks.The maximum bladder capacity(MBC),residual urine vdume(RUV),detrusor pressure(Pdet)during the filling phase,bladder compliance(BC),maximum renal pelvis separation width of both kidneys,urine white blood cell count,TCM syndrome score,and World Health Organization quality of life assessment-BREF(WHOQOL-BREF)score were compared before and after treatment in the 3 groups.The number of patients in each group who achieved bladder functional balance was recorded,and the clinical efficacy was assessed after treatment.Results After treatment,the MBC,Pdet,BC,and WHOQOL-BREF scores in the EA group and the moxibustion group were increased(P<0.05),while the RUV,maximum renal pelvis separation width of both kidneys,urine white blood cell count,and TCM syndrome scores were decreased(P<0.05,P<0.01).In the intermittent catheterization group,MBC,RUV,maximum renal pelvis separation width of both kidneys,and urine white blood cell count were decreased(P<0.05),while BC and WHOQOL-BREF score were increased(P<0.05)after treatment.After treatment,the MBC,Pdet,BC,and WHOQOLBREF scores in the EA group and the moxibustion group were higher than those in the intermittent catheterization group(P<0.05),while the RUV and TCM syndrome scores were lower than those in the intermittent catheterization group(P<0.05).Moreover,after treatment,the MBC and Pdet in the moxibustion group were higher than those in the EA group(P<0.05),while the RUV,maximum renal pelvis separation width of both kidneys,and TCM syndrome score in the EA group were lower than those in the moxibustion group(P<0.05).The number of patients who achieved bladder functional balance after treatment in the EA group and the moxibustion group was higher than that in the intermittent catheterization group(P<0.05).The cured and effective rate was 85.0%(34/40)in the EA group and 82.5%(33/40)in the moxibustion group,which were both higher than 65.0%(26/40)in the intermittent catheterization group(P<0.05),there was no significant difference between the EA group and the moxibustion group(P>0.05).Conclusion EA and moxibustion could effectively improve the functional state of bladder in patients with NB after SCI.EA is more effective in reducing residual urine volume and excessive activity of the urethral sphincter,and relieving TCM syndromes,while moxibustion is more effective in increasing the pressure of the detrusor during the filling period and establishing the detrusor reflex.