间歇导尿联合神经电刺激治疗脊髓损伤后神经源性膀胱的疗效  

Intermittent catheterization joint nerve electrical stimulation treatment the curative effect of neurogenic bladder after spinal cord injury

作　　者：刘奕 漆伟 徐贞杰 潘科 尚青龙 向连 徐立新 

机构地区：[1]三峡市中心医院康复科,重庆万州404000

出　　处：《国际泌尿系统杂志》2015年第5期641-643,共3页International Journal of Urology and Nephrology

基　　金：重庆市万州区科学技术项目（编号：201203008）;重庆市重点学科基金资助项目（编号：2008-47）

摘　　要：目的 探讨脊髓损伤后神经源性膀胱患者采用间歇性寻尿术联合体表骶神经和胫神经电刺激治疗的疗效及对患者尿动力学指标的影响.方法 将神经源性膀胱患者30例完全随机分为对照组（15例）和治疗组（15例）,对照组予综合康复治疗和膀胱训练4周,治疗组在对照组治疗方案的基础上加用体表骶神经和胫神经电刺激治疗.对比治疗后两组患者脊髓损伤神经学分类国际标准评分、排尿日记和尿动力学检测结果.结果 经4周治疗后,两组治疗后神经功能评分、24h排尿次数间无明显差异（P＞0.05）,但治疗组患者的每次排尿量显著升高,而24h尿失禁次数及残余尿量显著降低（P＜0.05）.尿流动力学检查显示,治疗组治疗4周后的最大膀胱容积、最大尿道压增加,充盈期逼尿肌压力下降,差异有统计学意义（P＜0.05）.结论 在综合康复治疗和膀胱训练的基础上,加用体表骶神经和胫神经电刺激可有效改善脊髓损伤后神经源性膀胱患者的膀胱功能,提高治疗效果,值得在临床推广应用。Objectives To explore in patients with neurogenic bladder after spinal cord injury using urethral catheterization for intermittent joint surface sacral nerve and tibial nerve electrical stimulation treatment curative effect,analyzes its effects on patients with urinary dynamics index.Methods Choose 30 patients with neurogenic bladder,by using the method will be completely randomized into control group（15 cases） and treatment group（15 cases） and control group in the comprehensive rehabilitation treatment and bladder training 4 weeks,the treatment group in the control group used on the basis of the surface treatment of sacral and tibial nerve electrical stimulation therapy.Compared the two groups after treatment in patients with spinal cord injury international standards for neurological classification score,voiding diary and urine dynamics test results.Results There was no significant difference between the control group and the treatment group on the ASIA scores and the 24-hour voiding frequency after treatment（P 〉 0.05）,but the 24-hour urinary incontinence,each voided volume and residual urine comparison of the treatment group improved significantly better than the control group（P 〈 0.05）.The results of urodynamic investigation in treatment group showed that maximum cystometric capacity and max urethal pressure were significantly increased（P 〈0.05）,and detrusor pressure at retention was significantly decreased（P 〈 0.05）.Conclusions On the basis of comprehensive rehabilitation treatment and bladder training,combined with surface sacral nerve and tibial nerve electrical stimulation can effectively improve the neurogenic bladder after spinal cord injury patients with bladder function,improve the treatment effect,is worth popularizing in clinical application.

关 键 词：膀胱疾病 电刺激 脊髓损伤 

分 类 号：R694[医药卫生—泌尿科学]