中药熏蒸辅助艾灸用于脊髓损伤截瘫后神经源性膀胱患者的回顾性队列研究

Traditional Chinese medicine fumigation assisted with moxa⁃wool moxibustion in patients with neurogenic bladder after spinal cord injury and paraplegia:a retrospective cohort study

目的探讨中药熏蒸辅助艾灸对脊髓损伤(SCI)截瘫后神经源性膀胱(NB)患者的疗效。方法采用回顾性队列研究方法,收集南京医科大学附属淮安第一医院2019年1月至2021年6月收治的90例SCI截瘫后患者的临床资料,根据治疗方案的不同将患者分为2组,其中采用艾灸治疗的49例患者为对照组,进行中药熏蒸辅助艾灸治疗的41例患者为观察组。治疗4周后,评估2组患者的疗效,比较治疗前、治疗4周后的中医症候积分,尿流动力学变化[最大尿流率(Qmax)、膀胱漏尿点压力、膀胱最大容量、膀胱顺应性]、单次排尿量、每日排尿次数及残余尿量(RUV),并观察不良反应发生情况。结果观察组治疗有效率(87.80%)高于对照组(67.35%),差异有统计学意义(P<0.05);与治疗前比较,治疗后2组NB患者主症、次症及总积分均降低,且观察组低于对照组(P<0.05);治疗后,2组NB患者Qmax、膀胱顺应性及膀胱最大容量均升高,膀胱漏尿点压力降低,且观察组各指标均优于对照组,差异均有统计学意义(P<0.05);与治疗前比较,治疗后2组NB患者单次排尿量升高,每日排尿次数及RUV均降低,观察组各指标均优于对照组,差异均有统计学意义(P<0.05);观察组不良反应发生率为7.32%,与对照组(14.29%)比较,差异无统计学意义(P>0.05)。结论中药熏蒸辅助艾灸能够提高SCI截瘫后NB患者的治疗效果,改善中医症候及尿流动力学水平,有助于恢复膀胱功能,同时具有较好的安全性。

Objective To explore the efficacy of traditional Chinese medicine(TCM)fumigation assisted with moxa-wool moxibustion in patients with neurogenic bladder after spinal cord injury and paraplegia.Methods A retrospective cohort study was used to collect the general data of 90 patients with neurogenic bladder(NB)after paraplegia with spinal cord injury(SCI),who were admitted to The Affiliated Huai’an No.1 People’s Hospital of Nanjing Medcial University from January 2019 to June 2021.According to different treatment profiles,the NB patients were divided into 2 groups,of whom 49 patients were treated with moxa-wool moxibustion(control group)and 41 patients were treated with traditional Chinese medicine fumigation assisted with moxa-wool moxibustion(observation group).After 4 weeks of treatment,the efficacy of the 2 groups of the NB patients was evaluated.The TCM symptom scores and urodynamic changes(including the maximum flow rate[Qmax],bladder leakage point pressure,maximum bladder capacity,and bladder compliance),single voided volume,daily urine frequency and residual urine volume(RUV)before treatment and 4 weeks after treatment were compared between the 2 groups.Adverse reactions were also observed in the process.Results The effective rates of the observation group(87.80%)was significantly higher than that of the control group 67.35%(P<0.05).The main symptoms,secondary symptoms,and total scores of the NB patients in the 2 groups after treatment were all decreased,with the observation group being lower than the control group(P<0.05).After treatment,Qmax,bladder compliance and maximum bladder capacity of the 2 groups of the NB patients were all increased,and the pressure of bladder leakage point was decreased,with various indexes of the observation group all being superior to those of the control group(P<0.05).After treatment,the single voided volume of the NB patients in the 2 groups were all increased,daily urine frequency and RUV were all decreased,with the indexes in the observation group being superior to those of the control group(P<0.05).The incidences of adverse reactions in the observation group and the control group were 7.32%and 14.29%,respectively,without statistical significance(P>0.05).Conclusion Traditional Chinese medicine fumigation assisted with moxa-wool moxibustion can improve the therapeutic effects of NB patients,improve symptoms of traditional Chinese medicine and the function of urodynamics,and displayed good safety in the recovery of bladder function.