火针治疗肾阳虚型卒中后神经源性膀胱的临床观察  

Clinical Observation of Heated Needling in the Treatment of Post-stroke Neurogenic Bladder with Kidney-yang Deficiency Syndrome

作　　者：陈琼君 梁家彬 蔡伟彬 刘通 陆彦青[2,3] 刘悦[2,3] CHEN Qiong-Jun;LIANG Jia-Bin;CAI Wei-Bin;LIU Tong;LU Yan-Qing;LIU Yue(Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;The Fifth Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510095 Guangdong,China;Guangdong Second Traditional Chinese Medicine Hospital,Guangzhou 510095 Guangdong,China)

机构地区：[1]广州中医药大学,广东广州510405 [2]广州中医药大学第五临床医学院,广东广州510095 [3]广东省第二中医院,广东广州510095

出　　处：《广州中医药大学学报》2022年第4期824-830,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广东省中医药局科研项目(编号:20203001)。

摘　　要：【目的】观察火针针刺“尿三针”治疗肾阳虚型卒中后神经源性膀胱(PSNB)的有效性和安全性。【方法】将90例肾阳虚型PSNB患者随机分为火针组、针刺组和常规组,每组各30例。常规组给予中西医常规治疗,针刺组在常规组的基础上给予普通毫针针刺“尿三针”治疗,火针组在常规组的基础上给予火针针刺“尿三针”治疗。2周为1个疗程,共治疗2个疗程。观察3组患者治疗前后每日排尿情况、尿动力学指标、日常生活能力改良Barthel指数(MBI)评分和焦虑自评量表(SAS)评分的变化情况,比较3组患者的尿潴留改善疗效、尿失禁改善疗效及不良反应发生情况。【结果】(1)疗效方面,治疗4周后,火针组患者的尿潴留改善疗效、尿失禁改善疗效的总有效率分别为84.6%(11/13)和88.2%(15/17),针刺组分别为70.6%(12/17)和69.2%(9/13),常规组分别为55.6%(10/18)和50.0%(6/12);组间比较,火针组的尿潴留改善疗效和尿失禁改善疗效均优于针刺组和常规组,针刺组的尿潴留改善疗效和尿失禁改善疗效又均优于常规组,差异均有统计学意义(P<0.05)。(2)每日排尿情况方面,治疗后,3组患者的日均排尿次数及日均尿失禁次数均显著下降,日均单次排尿量均显著上升,差异均有统计学意义(P<0.05);组间比较,火针组和针刺组在改善每日排尿情况的各项指标方面均明显优于常规组(P<0.05),而火针组在改善每日排尿情况的各项指标方面与针刺组比较,差异均无统计学意义(P>0.05)。(3)尿动力学指标方面,治疗后,3组患者膀胱最大容量均显著增加,膀胱残余尿量均显著减少,差异均有统计学意义(P<0.05);组间比较,火针组和针刺组在改善尿动力学指标方面均明显优于常规组(P<0.05),且火针组在提高膀胱最大容量方面明显优于针刺组,差异有统计学意义(P<0.05)。(4)日常生活能力方面,治疗后,火针组患者的MBI评分较治疗前明显提高(P<0.05Objective To observe the curative effect and safety of heated needling at urine three-needling points for the treatment of post-stroke neurogenic bladder(PSNB)with kidney yang deficiency syndrome.Methods Ninety patients with kidney-yang deficiency syndrome type of PSNB were randomly divided into heated needling group,acupuncture group and conventional group,with 30 cases in each group.The conventional group was treated with conventional traditional Chinese and western medicine,the acupuncture group was treated with ordinary filiform acupuncture at urine three-needle points on the basis of the conventional group,and the heated needling group was treated with heated needling at urine three-needle points on the basis of the conventional group.Two weeks constitute a course and the treatment lasted for 2 courses of treatment.The changes of daily urination,urodynamic indexes,modified Barthel index(MBI)scores and self-rated anxiety scale(SAS)scores of the patients in the3 groups were observed before and after treatment,and the urinary retention improvement efficacy,urinary incontinence improvement efficacy and the occurrence of adverse reactions in the 3 groups were compared.Results(1)In terms of efficacy:after 4 weeks of treatment,the total effective rates for improving urinary retention and incontinence were 84.6%(11/13)and 88.2%(15/17)in the heated needling group,were 70.6%(12/17)and69.2%(9/13)in the acupuncture group,and were 55.6%(10/18)and 50.0%(6/12)in the conventional group,respectively.The intergroup comparison showed that the urinary retention improvement efficacy and urinary incontinence improvement efficacy in the heated needling group were superior to those in the acupuncture group and the conventional group,and the effects in the acupuncture group were superior to those in the conventional group,the difference being statistically significant(P<0.05).(2)After treatment,the daily frequency of urination and urinary incontinence in the 3 groups were significantly decreased,and the daily volume of single urinat

关 键 词：卒中后神经源性膀胱 肾阳虚型 尿三针 火针 膀胱功能 焦虑情绪 生活质量 

分 类 号：R244.6[医药卫生—针灸推拿学]