穴位贴敷干预在糖尿病神经源性膀胱中的应用

Application of acupoint application intervention in diabetic neurogenic bladder.

目的探究穴位贴敷干预在糖尿病神经源性膀胱(DNB)中的应用效果,为临床干预提供参考。方法选取2021年7月至2023年7月河南省中西医结合医院收治的200例DNB患者作为研究对象,采用随机数字表法分为对照组和观察组各100例。对照组予以常规治疗,观察组在对照组治疗的基础上予以穴位贴敷,连续治疗2周后,比较两组患者的临床疗效,以及治疗前后的膀胱功能、尿流动力学指标、神经活性指标[神经肽Y(NPY)、脑源性神经营养因子(BDNF)、P物质(SP)]、负性情绪[汉密尔顿焦虑量表(HAMA)、抑郁量表(HAMD)量表]及生活质量Qualiveen评分,并比较两组患者治疗期间的不良反应发生情况。结果观察组患者的治疗总有效率为93.00%,明显高于对照组的80.00%,差异有统计学意义(P<0.05);观察组患者治疗后的日平均尿失禁次数、日平均排尿次数分别为(2.12±1.01)次、(9.21±1.12)次,明显少于对照组的(3.55±1.33)次、(13.26±2.52)次,差异均有统计学意义(P<0.05);观察组患者的日单次最大尿量、日平均单次尿量分别为(329.62±15.39)mL、(238.52±13.26)mL,明显多于对照组的(285.64±13.25)mL、(185.41±15.04)mL,差异均有统计学意义(P<0.05);观察组患者治疗后的膀胱内压、膀胱残余尿量分别为(33.23±3.69)cmH2O、(96.08±23.25)V/mL,明显低(少)于对照组的(40.16±4.27)cmH2O、(132.74±30.11)V/mL,平均尿流速为(7.23±0.56)mL/s,明显高于对照组的(6.84±0.37)mL/s,差异均有统计学意义(P<0.05);观察组患者治疗后的血清SP、NPY分别为(7.36±1.08)pg/mL、(98.29±12.37)ng/mL,明显低于对照组的(8.14±1.25)pg/mL、(106.62±13.11)ng/mL,BDNF为(31.26±5.02)ng/mL,明显高于对照组的(28.59±4.92)ng/mL,差异均有统计学意义(P<0.05);观察组患者治疗后的HAMA、HAMD及Qualiveen评分分别为(6.12±1.05)分、(6.02±0.98)分、(46.57±6.25)分,明显低于对照组的(8.19±1.37)分、(8.04±1.35)分、(50.63±7.83)分,差异均有统计学意义(P<0.05);治疗期间观察组患者的不良反应发生率为9.00%,略高于对照组的5.00%,但差异无统计学意义(P>0.05)。结论穴位贴敷应用于DNB患者中,可促进患者膀胱功能恢复,改善神经活性及负性情绪,提高生活质量,疗效显著且安全性高。

Objective To explore the effect of acupoint application intervention in diabetic neurogenic bladder(DNB)and provide reference for clinical intervention.Methods A total of 200 patients with DNB admitted to the Henan Integrated Traditional Chinese and Western Medicine Hospital from July 2021 to July 2023 were selected and randomly divided into a control group and an observation group,each with 100 cases.The patients in the control group received conventional treatment,while those in the observation group received acupoint application on the basis of the control group's treatment.After 2 weeks of continuous treatment,the clinical efficacy was compared between the two groups,as well as the bladder function,urodynamic parameters,neuroactive indicators[neuropeptide Y(NPY),brain-derived neurotrophic factor(BDNF),substance P(SP)],negative emotions[Hamilton Anxiety Rating Scale(HAMA),Hamilton Depression Rating Scale(HAMD)],and quality of life(Qualiveen score)before and after treatment.The incidence of adverse reactions during treatment were also compared between the two groups.Results The total effective rate of treatment in the observation group was 93.00%,which was significantly higher than 80.00%in the control group(P<0.05).The average daily urinary incontinence and urination times in the observation group were(2.12±1.01)times and(9.21±1.12)times,respectively,which were significantly lower than(3.55±1.33)times and(13.26±2.52)times in the control group(P<0.05).The maximum daily urine volume and average daily urine volume in the observation group were(329.62±15.39)mL and(238.52±13.26)mL,respectively,which were significantly higher than(285.64±13.25)mL and(185.41±15.04)mL in the control group(P<0.05).The intra-vesical pressure and residual urine volume in the observation group were(33.23±3.69)cmH2O and(96.08±23.25)V/mL,respectively,which were significantly lower(less)than(40.16±4.27)cmH2O and(132.74±30.11)V/mL in the control group(P<0.05).The average urinary flow rate in the observation group was(7.23±0.56)mL/s,which was significantly higher than(6.84±0.37)mL/s in the control group(P<0.05).The serum SP and NPY levels in the observation group after treatment were(7.36±1.08)pg/mL and(98.29±12.37)ng/mL,respectively,which were significantly lower than(8.14±1.25)pg/mL and(106.62±13.11)ng/mL in the control group;the BDNF level was(31.26±5.02)ng/mL,which was significantly higher than(28.59±4.92)ng/mL in the control group;the differences were statistically significant(P<0.05).The HAMA,HAMD,and Qualiveen scores in the observation group after treatment were(6.12±1.05)points,(6.02±0.98)points,and(46.57±6.25)points,respectively,which were significantly lower than(8.19±1.37)points,(8.04±1.35)points,and(50.63±7.83)points in the control group(P<0.05).Conclusion Acupoint application in patients with DNB can promote the recovery of bladder function,improve neuroactivity and negative emotions,and improve the quality of life,with significant efficacy and high safety.