八正散配合推拿手法治疗脊髓损伤后尿潴留的机制研究

Study on Mechanism of Bazheng Powder Combined with Massage in Treatment of Urinary Retention after Spinal Cord Injury

目的:探讨八正散配合推拿手法治疗脊髓损伤后尿潴留的疗效,及对血清中P物质(SP)和降钙素基因相关肽(CGRP)水平及抗氧化作用的影响。方法:选择脊髓损伤后尿潴留患者104例作为研究对象,按数字表法随机分为观察组和对照组各52例。所有患者予常规治疗。对照组给予膀胱功能训练及常规尿潴留治疗。观察组在对照组治疗的基础上采用八正散配合推拿手法治疗。两组患者连续治疗4周。比较两组患者治疗后单次尿量和尿管留置时间、尿动力学参数、中医主要症状评分及临床疗效。检测两组患者血清中SP和CGRP及黄嘌呤氧化还原酶(XOD),丙二醛(MDA),超氧化物歧化酶(SOD)水平。结果:治疗后观察组的单次尿量、最大尿流量、最大尿流率时逼尿肌压及最大尿意膀胱容量明显高于对照组,尿管留置时间明显少于对照组(P <0. 01);与对照组相比较观察组治疗后排尿无力、小腹坠胀、怠倦乏力评价均有降低(P <0. 01);观察组总有效率为90. 2%,显著高于对照组的72%(P <0. 05);观察组治疗后血清中SP和CGRP水平均显著高于对照组(P <0. 01);与对照组相比,观察组治疗后血清中XOD,MDA水平降低更明显,而SOD升高更显著(P <0. 01)。结论:八正散配合推拿手法治疗脊髓损伤后尿潴留取得了一定疗效,其上调体内SP和CGRP水平及增强抗氧化作用可能与上述治疗作用有关。

Objective:To explore the effect of Bazheng Powder combined with massage on the retention of urine after spinal cord injury,and the effect on the serum levels of substance P(SP)and calcitonin gene related peptide(CGRP)and antioxidation in serum.Methods:Totally 104 patients with urinary retention after spinal cord injury were selected as the research subjects.They were randomly divided into the observation group and the control group,52 cases in each group.All patients were treated with routine treatment.The control group was given bladder function training and routine urinary retention.The observation group was treated with Bazheng Powder combined with massage manipulation on the basis of the control group’s treatment.Two groups were treated for 4 weeks.We compared catheter retention time,urodynamic parameters,TCM main symptom score and clinical efficacy.Serum levels of SP and CGRP,xanthine oxidoreductase(XOD),malondialdehyde(MDA)and superoxide dismutase(SOD)in two groups of patients were detected.Results:After treatment,the single urine volume,maximum urine flow,maximum urine flow rate and maximum urinary bladder capacity in the observation group were significantly higher than those in the control group.The retention time of urethral catheter was significantly less than that of the control group(P<0.01),and the evaluation of urination weakness,small abdominal distention and fatigue fatigue after treatment was lower than that of the control group(P<0.01).The total effective rate of the observation group was 90.2%,significantly higher than that of the control group(72%)P<0.05).The serum levels of SP and CGRP in the observation group were significantly higher than those of the control group(P<0.01).Compared with the control group,the levels of XOD,MDA in the serum of the observation group were more obvious,and the SOD increased significantly(P<0.01).Conclusion:The treatment of urinary retention after spinal cord injury by Bazheng Powder combined with massage has a certain effect on the retention of urinary retention after spinal cord injury.The up regulation of SP and CGRP levels in the body and the enhancement of antioxidant effect may be related to the effect of the above treatment.