骶神经电针刺激对马尾神经损伤患者神经源性膀胱排尿功能重建的意义  

Significance of sacral nerve electro-acupuncture stimulation on the urinary function reconstruction of neurogenic bladder in the patients with cauda equina injury

作　　者：秦江[1] 赵亚杰[2] 任能[1] 唐家广[1] 任东风[1] 石秀秀[1] 曹峥[1] 于宁[1] 唐金树[1] 

机构地区：[1]解放军总医院第一附属医院骨科,全军骨科研究所,北京100048 [2]解放军总医院麻醉手术中心,北京100853

出　　处：《中国骨与关节杂志》2014年第9期665-669,共5页Chinese Journal of Bone and Joint

摘　　要：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 treat

关 键 词：电刺激疗法 膀胱 神经原性 排尿障碍 脊髓损伤 康复 骶尾部 

分 类 号：R651.3[医药卫生—外科学]