火针联合膀胱功能训练治疗脊髓损伤所致神经源性膀胱:随机对照试验

Fire needle therapy combined with bladder function training for neurogenic bladder caused by spinal cord injury:a randomized controlled trial

目的:观察火针联合膀胱功能训练治疗脊髓损伤所致神经源性膀胱(NB)的临床疗效及安全性。方法:将60例脊髓损伤所致NB患者随机分为观察组和对照组,各30例。在常规西医治疗基础上,对照组采用膀胱功能训练治疗,每日1次,治疗4周;观察组在对照组治疗基础上,于双侧三阴交及关元、中极穴行火针治疗,隔日1次,治疗4周(共14次)。分别于治疗前及治疗2、4周后,记录两组排尿情况(日均排尿次数、日均漏尿次数、日均单次排尿量),检测两组患者尿流动力学参数[最大尿流率(Qmax)、最大尿流率时最大逼尿肌压力(Pdet Qmax)、膀胱残余尿量(RUA)、最大膀胱容量(MCC)、膀胱压力],观察两组患者神经源性膀胱症状评分(NBSS)、泌尿症状困扰评分(USDS)。观察两组患者治疗前后世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分。并评价两组患者疗效、尿路感染发生率及安全性。结果:两组患者治疗2、4周后日均排尿次数、日均漏尿次数、RUA及NBSS、USDS评分较治疗前降低(P<0.05),治疗4周后以上指标低于治疗2周后(P<0.05),且观察组治疗2、4周后以上指标低于对照组(P<0.05);两组患者治疗2、4周后日均单次排尿量、Qmax、Pdet Qmax、MCC、膀胱压力较治疗前升高(P<0.05),治疗4周后以上指标高于治疗2周后(P<0.05),且除治疗2周后膀胱压力外,观察组治疗2、4周后以上指标高于对照组(P<0.05)。治疗4周后,两组患者WHOQOL-BREF心理、生理、环境、社会关系各维度评分及总分较治疗前升高(P<0.05),观察组高于对照组(P<0.05)。观察组尿路感染发生率为0%(0/30),对照组为10.0%(3/30),差异无统计学意义(P>0.05);观察组总有效率为93.3%(28/30),高于对照组的73.3%(22/30,P<0.05)。观察组患者均未出现严重不良反应。结论:火针联合膀胱功能训练治疗可有效改善脊髓损伤所致NB患者的临床症状,改善患者排尿情况,恢复患者膀胱功能,提高患者生活质量,且安全性高。

Objective To observe the clinical effect and safety of fire needle therapy combined with bladder function training on neurogenic bladder(NB) caused by spinal cord injury.Methods A total of 60 patients with NB caused by spinal cord injury were randomly divided into an observation group and a control group,with 30 cases in each group.On the basis of conventional treatment with western medicine,the bladder function training was adopted in the control group,once a day and for 4 weeks.In the observation group,on the basis of the interventions as the control group,fire needling was operated at bilateral Sanyinjiao(SP 6) and Guanyuan(CV 4) and Zhongji(CV 3),once every two days and for 4 weeks(14 interventions in total).Separately,at the baseline and in 2 and 4 weeks of interventions,the urination conditions(average daily urination frequency,average daily leakage frequency,average daily single urination volume) were recorded in the two groups;the urodynamic parameters(maximum flow rate [Qmax],maximum detrusor pressure at maximum flow rate [PdetQmax],residual urine volume [RUA],maximum cystometric capacity [MCC],and bladder pressure) were detected;the neurogenic bladder symptom score(NBSS),urinary symptom distress score(USDS) were observed.Before and after treatment,the score of World Health Organization quality of life assessment scale-brief(WHOQOL-BREF) was observed in the two groups.The therapeutic effect,the incidence of urinary infection,and the safety were evaluated.Results In 2 and 4 weeks of interventions,the average daily urination frequency,the average daily leakage frequency,RUA,and the scores of NBSS and USDS decreased in the two groups when compared with the baseline(P<0.05).In 4 weeks of interventions,the above-mention outcomes were lower than those in 2 weeks of interventions(P<0.05);and the results in the observation group were lower in 2 and 4 weeks of interventions when compared with the control group(P<0.05).In 2 and 4 weeks of interventions,the average daily single urination volume,Qmax,PdetQmax,MCC,and bladder pressure increased in the two groups compared with the baseline(P<0.05).In 4 weeks of interventions,the above-mention outcomes were elevated in comparison with those in 2 weeks of interventions(P<0.05);and except for bladder pressure,the results in the observation group in 2 and 4 weeks of interventions were higher when compared with the control group(P<0.05).In 4 weeks of interventions,the scores of each dimension and the total scores of WHOQOL-BREF increased in comparison with the baseline in the two groups(P<0.05),and the scores of the observation group were higher than those of the control group(P<0.05).The incidence of urinary infection was 0%(0/30) in the observation group and 10.0%(3/30) in the control group,without significant difference(P>0.05).The total effective rate of the observation group was 93.3%(28/30),which was higher than that(73.3%,22/30) of the control group(P<0.05).No serious adverse reactions occurred in the patients of the observation group.Conclusion Fire needle therapy combined with bladder function training can effectively relieve the clinical symptoms,ameliorate urination,restore bladder function and improve the quality of life in the patients with NB caused by spinal cord injury.This therapeutic regimen presents a high safety in practice.