芒针对脊髓损伤后尿潴留患者的尿动力学影响

Urodynamic effects of elongated needle on patients with urinary retention after spinal cord injury

目的:探索芒针在治疗脊髓损伤后尿潴留方面的临床意义。方法:2016年1月至2018年6月收治60例脊髓损伤后尿潴留的患者,分为芒针组和毫针组,每组30例,治疗穴位选取秩边和水道。芒针组男23例,女7例,年龄(52±9)岁,治疗予以芒针偶刺双侧穴位,并接电针仪30 min,频率3 Hz,治疗30 min;毫针组男24例,女6例,年龄(56±10)岁,治疗予毫针针刺双侧穴位后,留针30 min;两组的治疗频率都是隔日1次,在治疗2个月后通过分析两组患者达到平衡膀胱的时间、排尿日记、尿动力学指标和尿路感染情况等指标,发掘芒针在治疗该疾病的临床意义。结果:(1)平衡膀胱达到的时间:芒针组(39.5±1.2) d,毫针组(46.5±2.1) d;两组达到平衡膀胱的时间比较差异有统计学意义(P<0.05)。(2)两组患者的排尿日记比较,通过组内比较,两组患者治疗后的每日导尿次数、每次导尿量、每日排尿次数、每次排尿量优于治疗前(P<0.05);通过组间比较,在治疗后芒针组患者的每日导尿次数、每次导尿量、每日排尿次数、每次排尿量等指标的改善优于毫针组(P<0.05)。(3)两组患者的尿路感染改善情况比较:两组患者治疗后尿路感染情况均改善,芒针组的尿路感染改善率优于毫针组(P<0.05)。(4)两组患者尿动力学指标的比较:通过组内比较,两组患者治疗后的膀胱容量(VH2O),膀胱压力(pressure vesical,Pves),逼尿肌压力(pressure detrusor,Pdet),平均尿流速(Qave),最大尿流速(Qmax),膀胱顺应性(bladder compliance,BC)等优于治疗前(P<0.05);通过组间比较,在治疗后芒针组患者的VH2O、Pves、Pdet、Qave、Qmax、BC等指标的改善优于毫针组(P<0.05)。结论:芒针在改善脊髓损伤后尿潴留患者的排尿状况、尿路感染和尿动力学方面要优于毫针针刺,对提高脊髓损伤后尿潴留患者生活质量具有积极意义,值得在临床上推广应用。

Objective:To explore the clinical significance of elongated needle in the treatment of urinary retention after spinal cord injury.Methods:From January 2016 to June 2018,60 patients with urinary retention after spinal cord injury were divided into elongated needle acupuncture group and needle acupuncture group,30 cases in each group.The Shuidao(ST28)and Zhibian(BL54)were selected as the treatment of acupoints.In the elongated needle group,there were 23 males and 7 females,with a mean age of(52±9)years old.The patients in this group were treated on both sides,and the electro acupuncture apparatus was used for 30 minutes at frequencies of 3 Hz for 30 minutes.In needle group,there were 24 males and 6 females,with a mean age of(56±10)years old.After treatment,the needles were retained for 30 minutes.The treatment frequencies of both groups were once every other day and passed for 2 months.After 2 months of treatment,the clinical significances of the treatment of the disease were explored by analyzing the time between the two groups of patients to reach the equilibrium bladder,diary urinary diary,urodynamics and urinary tract infection between the two groups.Results:(1)Time to reach the equilibrium bladder:(39.5±1.2)days in elongated needle group and(46.5±2.1)days in needle group;the time to reach the equilibrium bladder in the two groups was significantly different(P<0.05).(2)Comparison of urination diary between the two groups:the daily number of catheterization,the amount of each catheterization,the number of daily urination,and the amount of urine per urination after treatment were better than those before treatment by intra group comparison(P<0.05);the number of daily catheterization,the amount of daily catheterization,the number of daily urination,and the amount of urine output per patient in elongated needle group were better than those in needle group by comparison between two groups(P<0.05).(3)Comparison of improvement of urinary tract infection between the two groups:the urinary tract infection were better than that before treatmant in each group by intra group comparison;the improvement rate of urinary tract infection in awn needle group(1/3.3%)was higher than that in needle group(5/16.7%),with significantly differences.(4)Comparison of urodynamic index between two groups:by intra group comparison,the VH2O,Pves,Pdet,Qave,Qmax,and BC of the two groups were better than those before treatment(P<0.05);By comparison between two groups,the improvement of VH2O,Pves,Pdet,Qave,Qmax and BC were better than those of the needle group(all P<0.05).Conclusion:The elongated needle is better than conventional needle in improving urinary retention,urinary tract infection and urodynamic index in patients with urinary retention after spinal cord injury.It has positive significance in improving patients’quality of life and is worth applying to clinical.