神经电调节对老年男性颈脊髓损伤患者膀胱逼尿肌过度活动的影响

The effect of percutaneous electrical regulation on bladder detrusor overactivity in elderly male patients with cervical spinal cord injury

目的 通过观察三组神经(胫神经、阴茎背神经、骶神经)电调节对颈脊髓损伤后膀胱逼尿肌过度活动的影响,研究神经电调节疗法在治疗颈脊髓损伤后膀胱逼尿肌过度活动中的作用。方法 选择存在膀胱逼尿肌过度活动的颈脊髓损伤老年男性患者40例,随机分为4组:胫神经电调节组、阴茎背神经电调节组、骶神经电调节组和对照组,分别接受相应的治疗。结果 经过12周试验观察,发现神经电调节组治疗前后膀胱功能均有改善,而对照组未见明显变化;胫神经电调节组静态尿道闭合压变化有显著差异,治疗后静态尿道闭合压降低(P<0.05);阴茎背神经电调节组膀胱内压的变化有显著差异,治疗后膀胱内压降低(P<0.05);骶神经电调节组静态尿道闭合压、初感尿意膀胱容量、无抑制收缩及漏尿时的膀胱容量、逼尿肌压及尿道内压的变化均有显著性差异,治疗后静态尿道闭合压、逼尿肌压、尿道内压、无抑制收缩及漏尿时膀胱容量均降低,而初尿意的膀胱容量增加(P<0.05);三组中以骶神经电调节组的治疗效果最好。结论 神经电调节疗法可改善老年患者颈脊髓损伤后的膀胱功能,经皮骶神经电调节的治疗效果优于经皮胫神经及经皮阴茎背神经电调节。

Objective By observing the three groups(tibial nerve group,penile dorsal nerve group,sacral nerve group)of percutaneous electrical regulation effects on the cervical spinal cord injury patient with bladder detrusor excessive activity,and study the role of neural regulation therapy in the treatment of cervical spinal cord injury with bladder detrusor excessive activity.Methods In this study,we used prospective randomized controlled clinical study,and chose 40 cervical spinal cord injury elderly patients with bladder detrusor excessive activity.The patients were randomly divided into four groups,namely the tibial electrical regulation group,the penile dorsal nerve electrical regulation group,the sacral nerve electrical regulation group and the control group.Results After 12 weeks of the experiment observation found that before and after treatment the bladder function are all improved in the 3 nerve electrical regulation groups,however the control group has no significant change.In the tibial electrical regulation group,the static urethral closure pressure changes have a significant differences,and after the treatment the static urethral closure pressure decreased(P<0.05).In the penile dorsal nerve electrical regulation group,the bladder pressure changes have significant differences,and after the treatment the bladder pressure decreased(P<0.05).In the Sacral nerve electrical regulation group,early urinate urethral closure pressure capacity,no shrinkage and leakage of urine when the bladder capacity,detrusor pressure and the change of the urethral pressure have significant difference.After treatment static urethral closure pressure and detrusor pressure,urethral pressure and no shrinkage and leakage of urine bladder capacity decreased,and early urinary bladder capacity increased(P<0.05).In the three percutaneous electrical regulation groups,the sacral nerve electrical regulation group has the best.Conclusion Percutaneous electrical regulation therapy can improve the bladder function in the cervical spinal cord injury elderly patients.In the three percutaneous electrical regulation groups,the sacral nerve electrical regulation group has the best.