CAJ | 학술논문

目的探讨经皮胫神经电刺激(PTNS)治疗女性膀胱过度活动症(OAB)的疗效.方法前瞻性选取2011年11月至2014年1月收治的212例女性OAB患者,抽签法随机分成3组,分别为M受体拮抗剂组73例,口服酒石酸托特罗定2 mg,每日2次;PTNS组70例,采用PTNS治疗,每周1次;联合治疗组69例,两者联合治疗.第1疗程持续12周,观察患者治疗前后的OAB症状评分(OABSS)、排尿次数、尿失禁次数等的变化情况.PTNS组继续进行第2疗程治疗(每周1次,共12周),其中临床有效患者进行第3疗程治疗(每周1次共24周,随后每2周1次共24周),观察患者治疗前后的OABSS、排尿次数、尿失禁次数等的变化情况. 结果第1疗程结束时,M受体拮抗剂组、PTNS组和联合治疗组治疗前后患者OABSS分别为8.7±1.8与6.3±1.6、8.8±1.7与6.5±1.9、8.9±1.9与5.8±1.6,差异均有统计学意义(P＜0.05),M受体拮抗剂组和PTNS组OABSS改善程度比较差异无统计学意义(P＞0.05),联合治疗组与M受体拮抗剂组和PTNS组比较差异均有统计学意义(P＜0.05).各组内治疗前后各单项量化指标(平均24 h排尿次数、平均夜尿次数、平均24 h尿失禁次数、平均24 h尿急次数、平均每次排尿量)比较差异均有统计学意义(P＜0.05).PTNS组失访和因故退出共8例,62例进行第2疗程治疗后,OABSS由6.5±1.9下降至6.1±[.9,差异有统计学意义(P＜0.05).PTNS组治疗2个疗程后临床有效的患者共43例,总有效率为69.4％(43/62);其中22例继续行第3疗程治疗,治疗24、48周时OABSS分别为6.4±2.1、6.5±2.2,与第1疗程结束时的6.4±1.6比较差异无统计学意义(P＞0.05). 结论 PTNS可显著改善女性OAB患者的排尿功能障碍,与托特罗定联合治疗可显著提高单种疗法的临床疗效.对PTNS初始治疗有效的患者,进行长期治疗可以获得较好的长期疗效.
목적 탐토경피경신경전자격(PTNS)치료녀성방광과도활동증(OAB)적료효.방법 전첨성선취2011년11월지2014년1월수치적212례녀성OAB환자,추첨법수궤분성3조,분별위M수체길항제조73례,구복주석산탁특라정2 mg,매일2차;PTNS조70례,채용PTNS치료,매주1차;연합치료조69례,량자연합치료.제1료정지속12주,관찰환자치료전후적OAB증상평분(OABSS)、배뇨차수、뇨실금차수등적변화정황.PTNS조계속진행제2료정치료(매주1차,공12주),기중림상유효환자진행제3료정치료(매주1차공24주,수후매2주1차공24주),관찰환자치료전후적OABSS、배뇨차수、뇨실금차수등적변화정황. 결과 제1료정결속시,M수체길항제조、PTNS조화연합치료조치료전후환자OABSS분별위8.7±1.8여6.3±1.6、8.8±1.7여6.5±1.9、8.9±1.9여5.8±1.6,차이균유통계학의의(P＜0.05),M수체길항제조화PTNS조OABSS개선정도비교차이무통계학의의(P＞0.05),연합치료조여M수체길항제조화PTNS조비교차이균유통계학의의(P＜0.05).각조내치료전후각단항양화지표(평균24 h배뇨차수、평균야뇨차수、평균24 h뇨실금차수、평균24 h뇨급차수、평균매차배뇨량)비교차이균유통계학의의(P＜0.05).PTNS조실방화인고퇴출공8례,62례진행제2료정치료후,OABSS유6.5±1.9하강지6.1±[.9,차이유통계학의의(P＜0.05).PTNS조치료2개료정후림상유효적환자공43례,총유효솔위69.4％(43/62);기중22례계속행제3료정치료,치료24、48주시OABSS분별위6.4±2.1、6.5±2.2,여제1료정결속시적6.4±1.6비교차이무통계학의의(P＞0.05). 결론 PTNS가현저개선녀성OAB환자적배뇨공능장애,여탁특라정연합치료가현저제고단충요법적림상료효.대PTNS초시치료유효적환자,진행장기치료가이획득교호적장기료효.
Objective To investigate the clinical efficacy of posterior tibial nerve stimulation (PT-NS) for female patients with overactive bladder.Methods From Nov 2011 to Jan 2014,212 female patients with overactive bladder (OAB) were enrolled in this study,prospectively.They were randomly divided into three groups.In the PTNS group (n =70),patients received posterior tibial nerve stimulation therapy once a week for 12 weeks.In the M receptor blockers group (n =73),patients received M receptor blockers (Tolterodine Tartrate Tablets 2mg 2 times per day) for 12 weeks.In the combined treatment group (n =69),patients received PTNS combined with M receptor blockers therapy mentioned above for 12 weeks.The patients underwent a physiotherapeutic evaluation before and after the treatment that included the overactive bladder symptom score (OABSS),mean daily voiding episodes,mean daily incontinence episodes,et al.The PTNS group received the second 12 weeks' PTNS treatment,and part of the patients with an initial positive response to 24 weekly PTNS treatments continued the third round of PTNS therapy (once a week for 24 weeks and Once every 2 weeks for the next 24 weeks).Results During the first 12 weeks' treatment,the OABSS scores declined significantly after the treatment,compared to those before treatment,in each group (The M receptor blockers group:6.3±1.6 vs.8.7±1.8; The PTNS group:6.5±1.9 vs.8,8±1.7; The combined treatment group:5.8± 1.6 vs.8.9± 1.9,P＜0.05).The mean daily voiding episodes,mean nocturia episodes,mean daily incontinence episodes,daily urgency episodes and mean vloume per voiding declined significantly after treatment in each group (P＜0.05).There was no significantly difference in OABSS scores between PTNS group and M receptor blockers group after the treatment (P＞0.05).All recorded items declined significantly in the combined treatment group compared with the other two groups (P＜0.05).In the PTNS group,the OABSS felt from 6.5±1.9 to 6.1±1.9 (P＜0.05) at the end of the second 12 weeks' PTNS treatment.4 patients lost to follow-up in the first 12 weeks' PTNS treatment,4 patients dropped out the the second 12 weeks' PTNS treatment.After the second round treatment,43 patients showed good response to the PTNS treatment.The overall response rate was 69.4％ (43/62).Among them,22 patients continued the third round of PTNS therapy (once a week for 24 weeks and once every 2 weeks for the next 24 weeks).The OABSS scores were 6.4±2.1,6.5±2.2 after 24 and 48 weeks,respectively.Those results were similar to those in the first round treatment (6.4± 1.6,P ＞ 0.05).Conclusions PTNS provides good therapeutic effect for female primary ovcractive bladder.And the combination therapy provided significantly better outcomes than mono therapy.To those patients with an initial positive response,long-term treatment by using this technique could sustain overactive bladder symptom improvement.