中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
3期
944-950
,共7页
卫中庆%王永胜%丁留成%黄懿%沈百欣%易超然%孙则禹
衛中慶%王永勝%丁留成%黃懿%瀋百訢%易超然%孫則禹
위중경%왕영성%정류성%황의%침백흔%역초연%손칙우
超声检查,多普勒,脉冲%尿潴留%糖尿病膀胱%逼尿肌无力
超聲檢查,多普勒,脈遲%尿潴留%糖尿病膀胱%逼尿肌無力
초성검사,다보륵,맥충%뇨저류%당뇨병방광%핍뇨기무력
Ultrasound,Doppler,impulse%Urinary retention%Diabetic cystopathy%Amyasthenia
目的通过尿动力学及超声等检查方法观察经皮低频脉冲电刺激对糖尿病膀胱（ DCP ）患者的临床疗效，探讨无创而有效治疗DCP的方法。方法选择2008年6月至2011年3月在泌尿外科、内分泌科及门诊DCP患者30例，随机分为对照组15例和治疗组15例，对照组按常规糖尿病治疗方法并进行膀胱训练或留置尿管，治疗组在对照组治疗基础上加用LGT-1000 A力合膀胱仪进行治疗，电刺激参数为：电压36～70 V，电脉冲频率25～65 Hz，刺激部位为两侧膀胱角和膀胱前、后壁方位，每次治疗40 min，2次/d，5 d一疗程，两疗程之间间隔1～2 d，共3个疗程，各组患者治疗前后做尿动力学全套测定。治疗后观察两组患者排尿情况、膀胱残余尿（ PVR）及最大尿流率、最大逼尿肌压、残余尿/膀胱最大容量（ PVR/Vmax ）的变化，作相关参数的统计学处理，比较疗效差异。结果 DCP患者经经皮低频脉冲电刺激治疗后，治疗组总有效率为73.3％，对照组总有效率53.3％，治疗组高于对照组，差异有统计学意义（ P＜0.05）。治疗组治疗前后PVR变化值（ΔPVR）为（118.6±33.4）ml，对照组治疗前后ΔPVR为（54.9±14.2）ml，两组比较，治疗组高于对照组，差异有统计学意义（P＜0.05）；治疗组治疗后PVR/Vmax[（32.2±11.8）％]与治疗前[（61.0±19.1）％]相比明显减少（P＜0.01）。对照组治疗后PVR/Vmax[（42.6±12.4）％]与治疗前[（55.6±21.1）％]相比，减少不明显（P＞0.05）。尿动力学参数的变化：治疗组治疗后最大尿流率[（6.7±2.3）ml/s]较治疗前[（3.9±1.3）ml/s]明显增大（P＜0.01），对照组治疗后最大尿流率[（5.2±2.5）ml/s]较治疗前[（3.6±1.7）ml/s]增大不明显（P＞0.05）。治疗组治疗后最大逼尿肌压[（17.9±4.6）cm H2O]较治疗前[（11.9±3.3）cm H2O]明显增大（P＜0.01），对照组治疗后最大逼尿肌压[（14.4±1.9）cm H2O]较治疗前[（12.1±2.0）cm H2O]增大不明显（P＞0.05）。结论经皮低频脉冲电刺激膀胱可有效减少或消除DCP患者的PVR，治疗DCP患者逼尿肌无力，提高了DCP患者的生活质量和生存率，且无明显副作用。
目的通過尿動力學及超聲等檢查方法觀察經皮低頻脈遲電刺激對糖尿病膀胱（ DCP ）患者的臨床療效，探討無創而有效治療DCP的方法。方法選擇2008年6月至2011年3月在泌尿外科、內分泌科及門診DCP患者30例，隨機分為對照組15例和治療組15例，對照組按常規糖尿病治療方法併進行膀胱訓練或留置尿管，治療組在對照組治療基礎上加用LGT-1000 A力閤膀胱儀進行治療，電刺激參數為：電壓36～70 V，電脈遲頻率25～65 Hz，刺激部位為兩側膀胱角和膀胱前、後壁方位，每次治療40 min，2次/d，5 d一療程，兩療程之間間隔1～2 d，共3箇療程，各組患者治療前後做尿動力學全套測定。治療後觀察兩組患者排尿情況、膀胱殘餘尿（ PVR）及最大尿流率、最大逼尿肌壓、殘餘尿/膀胱最大容量（ PVR/Vmax ）的變化，作相關參數的統計學處理，比較療效差異。結果 DCP患者經經皮低頻脈遲電刺激治療後，治療組總有效率為73.3％，對照組總有效率53.3％，治療組高于對照組，差異有統計學意義（ P＜0.05）。治療組治療前後PVR變化值（ΔPVR）為（118.6±33.4）ml，對照組治療前後ΔPVR為（54.9±14.2）ml，兩組比較，治療組高于對照組，差異有統計學意義（P＜0.05）；治療組治療後PVR/Vmax[（32.2±11.8）％]與治療前[（61.0±19.1）％]相比明顯減少（P＜0.01）。對照組治療後PVR/Vmax[（42.6±12.4）％]與治療前[（55.6±21.1）％]相比，減少不明顯（P＞0.05）。尿動力學參數的變化：治療組治療後最大尿流率[（6.7±2.3）ml/s]較治療前[（3.9±1.3）ml/s]明顯增大（P＜0.01），對照組治療後最大尿流率[（5.2±2.5）ml/s]較治療前[（3.6±1.7）ml/s]增大不明顯（P＞0.05）。治療組治療後最大逼尿肌壓[（17.9±4.6）cm H2O]較治療前[（11.9±3.3）cm H2O]明顯增大（P＜0.01），對照組治療後最大逼尿肌壓[（14.4±1.9）cm H2O]較治療前[（12.1±2.0）cm H2O]增大不明顯（P＞0.05）。結論經皮低頻脈遲電刺激膀胱可有效減少或消除DCP患者的PVR，治療DCP患者逼尿肌無力，提高瞭DCP患者的生活質量和生存率，且無明顯副作用。
목적통과뇨동역학급초성등검사방법관찰경피저빈맥충전자격대당뇨병방광（ DCP ）환자적림상료효，탐토무창이유효치료DCP적방법。방법선택2008년6월지2011년3월재비뇨외과、내분비과급문진DCP환자30례，수궤분위대조조15례화치료조15례，대조조안상규당뇨병치료방법병진행방광훈련혹류치뇨관，치료조재대조조치료기출상가용LGT-1000 A력합방광의진행치료，전자격삼수위：전압36～70 V，전맥충빈솔25～65 Hz，자격부위위량측방광각화방광전、후벽방위，매차치료40 min，2차/d，5 d일료정，량료정지간간격1～2 d，공3개료정，각조환자치료전후주뇨동역학전투측정。치료후관찰량조환자배뇨정황、방광잔여뇨（ PVR）급최대뇨류솔、최대핍뇨기압、잔여뇨/방광최대용량（ PVR/Vmax ）적변화，작상관삼수적통계학처리，비교료효차이。결과 DCP환자경경피저빈맥충전자격치료후，치료조총유효솔위73.3％，대조조총유효솔53.3％，치료조고우대조조，차이유통계학의의（ P＜0.05）。치료조치료전후PVR변화치（ΔPVR）위（118.6±33.4）ml，대조조치료전후ΔPVR위（54.9±14.2）ml，량조비교，치료조고우대조조，차이유통계학의의（P＜0.05）；치료조치료후PVR/Vmax[（32.2±11.8）％]여치료전[（61.0±19.1）％]상비명현감소（P＜0.01）。대조조치료후PVR/Vmax[（42.6±12.4）％]여치료전[（55.6±21.1）％]상비，감소불명현（P＞0.05）。뇨동역학삼수적변화：치료조치료후최대뇨류솔[（6.7±2.3）ml/s]교치료전[（3.9±1.3）ml/s]명현증대（P＜0.01），대조조치료후최대뇨류솔[（5.2±2.5）ml/s]교치료전[（3.6±1.7）ml/s]증대불명현（P＞0.05）。치료조치료후최대핍뇨기압[（17.9±4.6）cm H2O]교치료전[（11.9±3.3）cm H2O]명현증대（P＜0.01），대조조치료후최대핍뇨기압[（14.4±1.9）cm H2O]교치료전[（12.1±2.0）cm H2O]증대불명현（P＞0.05）。결론경피저빈맥충전자격방광가유효감소혹소제DCP환자적PVR，치료DCP환자핍뇨기무력，제고료DCP환자적생활질량화생존솔，차무명현부작용。
Objective To investigate the effect of external low frequency electric pulse stimulation on the patients with DCP by the methods of urodynamic and B-type ultrasonic inspection , and explore an optimal and noninvasive therapeutic method for the treatment of patients with diabetic cystopathy .Methods Totally 30 patients with diabetic cystopathy admitted to Nanjing Drum Tower Hospital from June 2008 to March 2011 were randomly grouped into experiment and control group with 15 cases in each.All patients were signed the informed consent . Patients in control group were treated with DM normal treatment accompanied by bladder training or indwelling urethral,while the external low frequency electric pulse stimulation by LGT-1000A were applied in the experiment group besides the methods used in the control group:voltage 36-70 V,pulse stimulation rate 25-65 Hz,at the bladder horns and the backside and foreside of the bladder ,once for 40 minutes,twice a day,5 days in one period,1-2 days break,totally 2-3 period.The urodynamic examination by Laborie Medical Technologies′apparatus were treated to the patients of both groups before and after the treatment , and the post-voided residual volume ( PVR ) , the maximum urinary flow rate,the maximum pressure of detrusor and the PVR/Vmax were used as the main indices in evaluation of the therapeutic effect .Results After a session of treatment , the effectiveness of experiment group ( 73.3%) was higher than the control group(53.3%),P<0.05.The changes of PVR(ΔPVR)of the treatment group[(118.6 ± 33.4)ml]was significantly different from the ΔPVR of control group[(54.9 ±14.2)ml,P<0.05].The PVR/Vmax of experiment group reduced significantly [(32.2 ±11.8)% vs.(61.0 ±19.1)%,P<0.01],while there was no significant reduce in the control group[(42.6 ±12.4)% vs.(55.6 ±21.1)%,P>0.05].Urodynamic indices:the maximal urinary flow rate of experiment group [(6.7 ±2.3)ml/s]was higher than before[(3.9 ±1.3)ml/s,P<0.05],while the maximal urinary flow rate of control group [(5.2 ±2.5)ml/s]was a little higher than before[(3.6 ±1.7)ml/s,P>0.05];The maximal pressure of detrusor of both groups [(17.9 ±4.6)cm H2O]was higher than before[(11.9 ±3.3)cm H2O,P<0.01],while the maximal pressure of detrusor of control groups [(14.4 ±1.9)cm H2O]was higher than before[(12.1 ±2.0)cm H2O,P<0.01].Conclusions The PVR of the patient with DCP can be reduced after the external low frequency electric pulse stimulation therapy and favourable effect can also be expected in treating DCP adynamia of detrusor muscle .This method can improve DCP patients′vesical dysfunction and enhance patients′life quality and survival rate without triggering significant side effects .
