针药结合治疗脊髓占位术后神经源性膀胱验案一则

A test case of combination of acupuncture and medicine in the treatment of neurogenic bladder after spinal cord space occupation surgery

神经源性膀胱(Neurogenic Bladder,NB)是一类由神经系统(中枢、周围)病变引起的膀胱和/或尿道功能障碍(储尿和/或排尿的功能障碍),从而产生一系列下尿路症状和并发症的疾病总称,尿不畅或尿潴留是其最常见的症状。临床主要通过间歇导尿和留置尿管进行治疗,但都存在不同的缺点而影响疗效。现代医学研究发现,中西医结合疗法是临床上值得尝试的选择,可以改善患者预后,提高患者生活质量。中医学认为,本病与肾和膀胱关系密切,其病因主要是肾与膀胱气化不利,且根据其不同临床表现,将本病归属于“癃闭”和“遗溺”范畴,临床常见的中医治疗方法包括中药汤剂、针灸疗法、推拿按摩等,也可以多法并用,共同发挥温补肾阳、助膀胱气化的效果。现代研究证实,桥脑排尿中心、骶脊髓和下尿路之间的协同作用对于控制排尿至关重要,针刺可以激发神经调节功能,加强逼尿肌和膀胱括约肌的协同反射活动,改善尿动力学,加快下尿路的气血循环,促进排尿功能恢复。中药、艾灸也在NB的治疗过程中发挥着重要作用。天津中医药大学针灸科丁淑强主任医师以针药结合治疗脊髓占位术后NB取得良好疗效。现通过医案介绍,为各位同道提供临床参考。

Neurogenic bladder is a general term for for a series of bladder and/or urethral dysfunction(dysfunction of urine storage and/or urination)caused by nervous system(central,peripheral)lesions,resulting in a range of lower urinary tract symptoms and complications,with impaired urine or urine retention being one of the most common symptoms.The clinical treatment is mainly through intermittent catheterization and indentation of urinary tube,but there are different shortcomings which affect the curative effect.Modern medical research has found that the combination of traditional Chinese and western medicine therapy is a clinically worthwhile choice,which can improve the prognosis of patients and improve the quality of life of patients.TCM believes that this disease is closely related to the kidney and bladder,and the main cause is unfavorable gasification of kidney and bladder,and according to its different clinical manifestations,the disease is classified into the categories of“uroschesis”and“incontinence”.Common clinical TCM treatment methods include traditional Chinese medicine decoction,acupuncture and moxibustion therapy,massage,etc.,which can also be used in multiple ways to jointly exert the effect of warming and tonifying kidney Yang(阳)and promoting bladder gasification.Modern studies have confirmed that the synergistic effect of the pontine urination center,the sacral spinal cord and the lower urinary tract is crucial for controlling urination.Acupuncture can stimulate the neuroregulation function,strengthen the synergistic reflex activity of the detrusor muscle and the bladder sphincter,improve urodynamics,accelerate the circulation of qi and blood in the lower urinary tract,and promote the recovery of urination function.Traditional Chinese medicine and moxibustion also play an important role in the treatment of neurogenic bladder.DING Shuqiang,chief physician of the Department of Acupuncture and Moxibustion of Tianjin University of Chinese Medicine,has achieved a good effect in the treatment of neurogenic bladder after spinal cord spacegery.It is expected to provide clinical reference for all fellow learners through the introduction of this medical case.