经皮穴位电刺激联合骶神经调节术治疗脊髓损伤后神经源性膀胱的疗效和安全性观察

Efficacy and safety observation of percutaneous acupoint electrical stimulation combined with sacral nerve modulation in the treatment of neurogenic bladder after spinal cord injury

目的分析经皮穴位电刺激联合骶神经调节术应用于脊髓损伤后神经源性膀胱中的价值。方法选取2017年4月至2019年11月该院纳入的24例脊髓损伤后神经源性膀胱患者为研究对象,采用随机数字表法分为观察组与对照组,每组各12例。观察组实施经皮穴位电刺激联合骶神经调节术治疗,对照组仅采用骶神经调节术治疗,比较各组总有效率、单次排尿量、日均排尿次数、日均尿失禁次数、残余尿量、最大膀胱容量、最大尿流率、不良反应、症状积分、生活质量综合评定问卷(GQOLI-74)评分。结果观察组总有效率为91.67%,明显高于对照组的50.00%,差异有统计学意义(P<0.05)。干预前,两组排尿情况、尿动力学指标、症状积分、GQOLI-74评分比较,差异无统计学意义(P>0.05)。干预后,观察组单次排尿量大于对照组,残余尿量、日均排尿次数、日均尿失禁次数少于对照组,各项症状积分低于对照组,最大膀胱容量、最大尿流率大于对照组,GQOLI-74评分高于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率为16.67%,与对照组的41.67%比较,差异无统计学意义(P>0.05)。结论经皮穴位电刺激联合骶神经调节术的治疗效果较单纯骶神经调节术的治疗效果更为理想,可有效改善患者排尿能力,增强膀胱功能,快速减轻症状,不良反应少,使患者生活质量得到改善。

Objective To analyze the value of percutaneous acupoint electrical stimulation combined with sacral nerve modulation in neurogenic bladder after spinal cord injury.Methods A total of 24 patients with neurogenic bladder after spinal cord injury were selected from April 2017 to November 2019 and divided into observation group and control group by random number table method,with 12 cases in each group.The observation group underwent percutaneous acupoint electrical stimulation combined with sacral nerve modulation,while the control group underwent sacral nerve modulation.The total effective rate,single urination volume,average daily frequency of urination,average daily frequency of incontinence,residual urine volume,maximum bladder capacity,maximum urinary flow rate,adverse reactions,symptom score and quality of life(GQOLI-74)score of the two groups were compared.Results The total effective rate of the observation group was 91.67%,which was significantly higher than that of the control group(50.00%),the difference was statistically significant(P<0.05).Before intervention,there was no significant difference on urinary status,urodynamic index,symptom score and GQOLI-74 score between the two groups(P>0.05).After intervention,the single urinary volume of observation group was higher than that of control group,the residual urine volume,average daily frequency of urination,the average daily frequency of incontinence were less than those of control group,and the symptom score was lower than that of control group,the maximum bladder volume,maximum urinary flow rate and GQOLI-74 score were higher than those of control group,with statistical significance (P <0.05).The incidence rates of adverse reactions were 16.67% in the observation group and 41.67% in the control group,with no statistical significance (P >0.05).Conclusion The effect of percutaneous acupoint e-lectrical stimulation combined with sacral nerve modulation is more ideal compared with the simple use of sa-cral nerve modulation,which can effectively improve the urination ability of patients,enhance bladder func-tion, reduce symptoms rapidly,reduce adverse reactions,and improve the quality of life of patients.