中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
9期
665-669
,共5页
秦江%赵亚杰%任能%唐家广%任东风%石秀秀%曹峥%于宁%唐金树
秦江%趙亞傑%任能%唐傢廣%任東風%石秀秀%曹崢%于寧%唐金樹
진강%조아걸%임능%당가엄%임동풍%석수수%조쟁%우저%당금수
电刺激疗法%膀胱,神经原性%排尿障碍%脊髓损伤%康复%骶尾部
電刺激療法%膀胱,神經原性%排尿障礙%脊髓損傷%康複%骶尾部
전자격요법%방광,신경원성%배뇨장애%척수손상%강복%저미부
Electric stimulation therapy%Urinary bladder,neurogenic%Urination disorders%Spinal cord injuries%Rehabilitation%Sacrococcygeal region
目的：观察骶神经电刺激对马尾神经损伤后患者神经源性膀胱排尿功能重建的影响。方法2012年9月至2013年7月，我院收治的马尾神经损伤致神经源性膀胱的患者20例，其中男16例，女4例，年龄37.37(17～63)岁。所有患者入院后经实验室及生化检查排除上尿路积水、尿路感染及结石等并发症后给予骶神经电针刺激，20次为1个疗程。再行间歇导尿配合行为疗法、扳机点叩击排尿法以及 Kegel 训练(盆底肌训练)，并做好排尿日记。在治疗结束后从导尿到首次反射排尿用时、平衡膀胱建立的时间、排尿量及残余尿量比、膀胱安全容量生活质量评估( quality of life，QOL )、生化及影像学检查等方面对患者进行功能评价。并在治疗结束后半年随访，对资料进行整理分析。结果本组未发现严重副作用患者，出现漏尿8例，其中有2例因反复低热、全身乏力以及不能接受家庭清洁导尿而最终选择手术治疗。首次排尿用时(7.80±4.82)天。平衡膀胱建立用时(22.20±7.17)天，有效建立平衡膀胱率75%。反射性排尿量与残余尿量比治疗结束时和治疗结束后半年均有明显提升，分别为4.06±5.21、7.51±6.80。在膀胱安全容量方面，治疗前后变化不大( P＞0.05)。QOL评分由治疗前(4.35±1.27)分减少到治疗结束时(2.40±0.99)分( P＜0.05)，治疗结束后半年更低为(1.15±2.45)分( P＜0.05)。在评价菌尿的指标中，WBC及BAC检出率均明显降低，分别由治疗前90%、80%降低到治疗结束时的65%、57.9%以及治疗结束后半年的40%、40%( P＜0.05)；治疗结束时尿菌落数82.6%与治疗前92.6%比较，变化不大( P＞0.05)，但治疗结束后半年菌落数明显减少到50%，和治疗前比较，差异有统计学意义( P＜0.05)；而尿路出血指标RBC检出率及B超显示上尿路积水情况治疗前、治疗结束时、治疗结束后半年的变化都不明显(P＞0.05)。结论骶神经电针刺激对于马尾神经损伤所致神经源性膀胱患者的排尿功能的重建具有促进作用，能明显促进排尿、减少残余尿量，建立平衡膀胱后能有效减少感染率、明显改善患者的生活质量。
目的：觀察骶神經電刺激對馬尾神經損傷後患者神經源性膀胱排尿功能重建的影響。方法2012年9月至2013年7月，我院收治的馬尾神經損傷緻神經源性膀胱的患者20例，其中男16例，女4例，年齡37.37(17～63)歲。所有患者入院後經實驗室及生化檢查排除上尿路積水、尿路感染及結石等併髮癥後給予骶神經電針刺激，20次為1箇療程。再行間歇導尿配閤行為療法、扳機點叩擊排尿法以及 Kegel 訓練(盆底肌訓練)，併做好排尿日記。在治療結束後從導尿到首次反射排尿用時、平衡膀胱建立的時間、排尿量及殘餘尿量比、膀胱安全容量生活質量評估( quality of life，QOL )、生化及影像學檢查等方麵對患者進行功能評價。併在治療結束後半年隨訪，對資料進行整理分析。結果本組未髮現嚴重副作用患者，齣現漏尿8例，其中有2例因反複低熱、全身乏力以及不能接受傢庭清潔導尿而最終選擇手術治療。首次排尿用時(7.80±4.82)天。平衡膀胱建立用時(22.20±7.17)天，有效建立平衡膀胱率75%。反射性排尿量與殘餘尿量比治療結束時和治療結束後半年均有明顯提升，分彆為4.06±5.21、7.51±6.80。在膀胱安全容量方麵，治療前後變化不大( P＞0.05)。QOL評分由治療前(4.35±1.27)分減少到治療結束時(2.40±0.99)分( P＜0.05)，治療結束後半年更低為(1.15±2.45)分( P＜0.05)。在評價菌尿的指標中，WBC及BAC檢齣率均明顯降低，分彆由治療前90%、80%降低到治療結束時的65%、57.9%以及治療結束後半年的40%、40%( P＜0.05)；治療結束時尿菌落數82.6%與治療前92.6%比較，變化不大( P＞0.05)，但治療結束後半年菌落數明顯減少到50%，和治療前比較，差異有統計學意義( P＜0.05)；而尿路齣血指標RBC檢齣率及B超顯示上尿路積水情況治療前、治療結束時、治療結束後半年的變化都不明顯(P＞0.05)。結論骶神經電針刺激對于馬尾神經損傷所緻神經源性膀胱患者的排尿功能的重建具有促進作用，能明顯促進排尿、減少殘餘尿量，建立平衡膀胱後能有效減少感染率、明顯改善患者的生活質量。
목적：관찰저신경전자격대마미신경손상후환자신경원성방광배뇨공능중건적영향。방법2012년9월지2013년7월，아원수치적마미신경손상치신경원성방광적환자20례，기중남16례，녀4례，년령37.37(17～63)세。소유환자입원후경실험실급생화검사배제상뇨로적수、뇨로감염급결석등병발증후급여저신경전침자격，20차위1개료정。재행간헐도뇨배합행위요법、반궤점고격배뇨법이급 Kegel 훈련(분저기훈련)，병주호배뇨일기。재치료결속후종도뇨도수차반사배뇨용시、평형방광건립적시간、배뇨량급잔여뇨량비、방광안전용량생활질량평고( quality of life，QOL )、생화급영상학검사등방면대환자진행공능평개。병재치료결속후반년수방，대자료진행정리분석。결과본조미발현엄중부작용환자，출현루뇨8례，기중유2례인반복저열、전신핍력이급불능접수가정청길도뇨이최종선택수술치료。수차배뇨용시(7.80±4.82)천。평형방광건립용시(22.20±7.17)천，유효건립평형방광솔75%。반사성배뇨량여잔여뇨량비치료결속시화치료결속후반년균유명현제승，분별위4.06±5.21、7.51±6.80。재방광안전용량방면，치료전후변화불대( P＞0.05)。QOL평분유치료전(4.35±1.27)분감소도치료결속시(2.40±0.99)분( P＜0.05)，치료결속후반년경저위(1.15±2.45)분( P＜0.05)。재평개균뇨적지표중，WBC급BAC검출솔균명현강저，분별유치료전90%、80%강저도치료결속시적65%、57.9%이급치료결속후반년적40%、40%( P＜0.05)；치료결속시뇨균락수82.6%여치료전92.6%비교，변화불대( P＞0.05)，단치료결속후반년균락수명현감소도50%，화치료전비교，차이유통계학의의( P＜0.05)；이뇨로출혈지표RBC검출솔급B초현시상뇨로적수정황치료전、치료결속시、치료결속후반년적변화도불명현(P＞0.05)。결론저신경전침자격대우마미신경손상소치신경원성방광환자적배뇨공능적중건구유촉진작용，능명현촉진배뇨、감소잔여뇨량，건립평형방광후능유효감소감염솔、명현개선환자적생활질량。
Objective To explore the effects of sacral nerve electro-acupuncture stimulation on the urinary function reconstruction in the patients with neurogenic bladder ( NB ) after cauda equina injury.Methods From September 2012 to July 2013, 20 patients with NB caused by cauda equina injury were adopted. There were 16 males and 4 females, whose average age was ( 37.37±15.83 ) years old. The complications such as upper urinary hydrops, urinary tract infections and calculi were excluded by laboratory and biochemical examinations, and then sacral nerve electro-acupuncture stimulation was performed, with 20 times as a treatment course. Intermittent catheterization combined with behavior therapy, triggering roilet and Kegel exercise ( pelvic lfoor muscle training ) was carried out, and a voiding diary was recorded. At the end of the treatment, the patients were evaluated in respects of the time of establishing a balanced bladder, ratio of voiding and residual urine volume, Quality of Life ( QOL ), biochemical examination and imaging examination. All the patients were followed up for half a year, and the relevant data were collected and analyzed so as to draw a conclusion.Results No severe side effects were noticed in all the patients. <br> There were 8 patients with urinary leakage, among whom 2 patients chose surgical treatment due to repeated low-grade fever, generalized weakness and refusal to accept clean catheterization at home. The ifrst effective micturition time was ( 7.80±4.82 ) d, and it took ( 22.20±7.17 ) d to establish a balanced bladder. The effective rate in the reconstruction of a balanced bladder was about 75%. The ratios of voiding and residual urine volume on reflex micturition were obviously improved at the end of the treatment and at half a year after the treatment, which were 4.06±5.21 and 7.51±6.80 respectively. As to the bladder capacity, little change was found before and after the treatment (P>0.05 ). The QOL score was ( 4.35±1.27 ) points before the treatment, which was decreased to ( 2.40±0.99 ) points at the end of the treatment and ( 1.15±2.45 ) points at half a year after the treatment respectively (P<0.05 ). The detection rates of bacteriuria indicators of white blood cell ( WBC ) and bacteria ( BAC ) were obviously reduced from 90% and 80% before the treatment to 65% and 57.9% at the end of the treatment and 40% and 40% at half a year after the treatment respectively (P<0.05 ). The urine colony counts were 82.6% and 92.6% at the end of the treatment and before the treatment respectively, which changed a little (P>0.05 ). However, it was obviously reduced to 50% at half a year after the treatment, and there were statistically signiifcant differences when compared with the count before the treatment (P<0.05 ). Based on the detection rates of urinary tract bleeding index of red blood cell ( RBC ) and B ultrasound images, no obvious change in the hydronephrosis was detected before the treatment, at the end of the treatment and at half a year after the treatment (P>0.05 ).Conclusions The sacral nerve electro-acupuncture stimulation can help the urinary function reconstruction in the patients with NB caused by cauda equina injury, which can promote urination and reduce residual urine volume. When the balanced bladder is established, the infection rate will be effectively reduced and the QOL of the patients will be obviously improved.
