骶神经根功能性磁刺激治疗糖尿病神经源性膀胱的疗效观察

Functional magnetic stimulation of the sacral nerve roots in treating diabetic neurogenic bladder

目的探讨骶神经根功能性磁刺激(FMS)治疗糖尿病神经源性膀胱(DNB)的临床疗效。方法采用随机数字表法将134例DNB患者分为观察组及对照组, 每组67例。2组患者均给予常规药物治疗及膀胱功能训练, 观察组患者在此基础上辅以骶神经根FMS干预。于治疗前、治疗4周后对2组患者排尿相关指标及尿流动力学参数进行检测, 并对2组患者临床疗效进行评定。结果治疗4周后2组患者日均单次排尿量均较治疗前显著增加(P<0.05), 日均排尿次数、日均尿失禁次数均较治疗前显著减少(P<0.05), 并且观察组治疗后日均单次排尿量[(196.9±31.7)ml]较对照组显著增加(P<0.05), 日均排尿次数[(8.87±1.42)次/天]及日均尿失禁次数[(3.04±1.93)次/天]均显著少于对照组(P<0.05)。治疗后2组患者最大尿流率时逼尿肌压力(Pdet-Qmax)、膀胱初始尿意容量(BS)、膀胱残余尿量(RUV)均较治疗前显著降低(P<0.05), 而最大尿流率(MFR)则显著升高(P<0.05), 并且治疗后观察组Pdet-Qmax[(26.49±2.47)cmH2O]、BS[(288.11±26.04)ml]及RUV[(70.36±23.77)ml]均显著低于对照组水平, MFR[(18.94±3.18)ml/s]则显著高于对照组水平(P<0.05)。治疗后观察组总有效率(88.06%)较对照组总有效率(71.64%)显著增高(P<0.05)。结论在常规膀胱功能训练基础上辅以骶神经根FMS干预, 能进一步促进DNB患者膀胱功能重建, 改善尿流动力学参数, 提高患者生活质量, 该联合疗法值得临床推广、应用。

Objective:To explore the clinical effectiveness of functional magnetic stimulation(FMS)of the sacral nerve root in the treatment of diabetic neurogenic bladder(DNB).Methods:A total of 134 DNB patients were divided into an observation group and a control group,each of 67.Both groups were given conventional drug therapy and bladder function training,while the observation group was additionally provided with sacral nerve root FMS for 4 weeks.The urine and urine flow dynamics of both groups were tested before and after the experiment.Results:After treatment the average daily volume of single urination had increased significantly in both groups and the average daily urinations and incidence of incontinence had decreased significantly.The observation group′s average single urination volume was then significantly greater than that of the control group.The observation group′s average daily urinations(8.87±1.42)and incontinence incidents(3.04±1.93)were then significantly fewer than the control group′s.After the treatment the detrusor pressure at maximum flow,bladder sense initial volition and residual urine volume of both groups had decreased significantly compared with before the treatment,while their average maximum flow rates had increased significantly.But the observation group′s averages were in all cases significantly better than those of the control group.The treatment′s total effectiveness rate among the observation group(88%)was significantly better than among the control group(72%).Conclusions:Supplementing routine bladder function training with FMS applied to the root of the sacral nerve can further promote the regaining of bladder function among DNB patients,improve their urinary flow dynamics and improve their quality of life.Such combination therapy is worthy of clinical promotion and application.