电针结合经会阴BTX-A注射治疗脊髓损伤后神经源性膀胱的临床研究  

Clinical research of electroacupuncture combined with transperineal injection of BTX-A for neurogenic bladder after spinal cord injury

作　　者：孟兆祥[1] 王彤[2] 尹正录[3] 王继兵[3] 

机构地区：[1]南京医科大学,江苏南京210029 [2]南京医科大学第一附属医院康复医学科,江苏南京210029 [3]江苏省苏北人民医院康复医学科

出　　处：《中国针灸》2015年第1期17-20,共4页Chinese Acupuncture & Moxibustion

摘　　要：目的:评价电针结合经会阴注射A型肉毒杆菌毒素(BTX-A)治疗脊髓神经损伤所致神经源性膀胱的临床疗效。方法:将脊髓损伤后合并神经源性膀胱患者35例于术后第1天随机分为BTX-A+电针组(20例)和BTX-A组(15例)。两组均在常规膀胱功能康复训练的基础上,行经会阴尿道外括约肌注射BTX-A 200IU(4mL),BTX-A+电针组辅以电针治疗,穴取中极、关元、肾俞、会阳、八!,每日1次,每次40min,每周治疗6天,治疗4周。观察两组治疗前后排尿状况,并于治疗前后分别行尿动力学检查,检测尿道压变化。结果:治疗4周后,两组患者平均尿失禁次数、平均导尿量及尿失禁量均较治疗前改善(均P<0.05),BTX-A+电针组优于BTX-A组(均P<0.05)。两组治疗后残余尿量、膀胱压力、最大膀胱容积、最大尿道闭合压及最大尿流率均较治疗前改善(均P<0.01);BTX-A+电针组对残余尿量、最大膀胱容积、最大尿道闭合压的改善较BTX-A组显著(均P<0.05)。结论:电针结合经会阴注射BTX-A治疗可以有效改善脊髓损伤所致神经源性膀胱的排尿障碍。Objective To evaluate the clinical efficacy of electroacupuncture （EA） combined with transperineal injection of botulinum toxin-A （BTX-A） on neurogenic bladder caused by spinal cord injury. Methods One day after surgery, 35 cases of spinal cord injury accompanied with neurogenic bladder were randomly divided into a BTX-A plus EA group （20 cases, group A） and a BTX-A group （15 cases, group B）. The two groups were both treated with regular rehabilitation training of bladder function and injection of 200 IU （4 mL） BTX-A through perineum external urethral sphincter ;the group A was additionally treated with EA at Zhongji （CV 3）, Guanyuan （CV 4）, Shenshu （BL 23）, Huiyang （BL 35） and Baliao （Shangliao （BL 31）, Ciliao （BL 32）, Zhongliao （BL 33）, Xialiao （BL 34））, once a day, 40 min per treatment. The treatment was given 6 times per week for 4 weeks. The urina- tion status in two groups before and after treatment was observed, and urodynamics examination and urethral pres- sure test were also made. Results After 4-week treatment, mean times of urinary incontinence, mean urethral catheter output, pressure of bladder and volume of urinary incontinence were all improved in two groups （all P〈 0.05）, which were more significant in the group A （all P〈0. 05）. The residual urine, maximum bladder capacity, maximum urethral closure pressure and maximum urine flow rate were all improved in two groups after treatment （all P〈0.01） ; the improvement of residual urine, maximum bladder capacity, maximum urethral closure pressure in the group A was more significant than that in the group B （all P〈0.05）. Conclusion Electroacupuncture com- bined with transperineal injection of BTX-A could effectively improve the urination dysfunction in patients with neurogenic bladder after spinal cord injury.

关 键 词：脊髓损伤 神经源性膀胱 电针 A型肉毒杆菌毒素 

分 类 号：R246.2[医药卫生—针灸推拿学]