间歇导尿联合膀胱干扰电治疗脑卒中患者神经源性膀胱的疗效观察  

Efficacy of intermittent catheterization combined with interferential electrical therapy on neurogenic bladder in patients with stroke

作　　者：王立童[1] 靳丹 代永利 WANG Litong;JIN Dan;DAI Yongli(Department of Rehabilitation Medicine,The Second Affiliated Hospital of Dalian Medical University,Dalian 116031,China;Department of Rehabilitation Medicine,Dalian Lvshunkou Hospital of Traditional Chinese Medicine)

机构地区：[1]大连医科大学附属第二医院康复医学科,辽宁大连116031 [2]旅顺口区中医院康复医学科

出　　处：《沈阳医学院学报》2022年第3期276-280,共5页Journal of Shenyang Medical College

摘　　要：目的:探讨间歇导尿联合膀胱干扰电治疗脑卒中患者神经源性膀胱的临床疗效。方法:采用随机对照单盲法将符合纳入标准的受试者46例分为间歇导尿联合膀胱干扰电治疗组(观察组)、留置导尿联合膀胱干扰电治疗组(对照组),观察治疗前后患者膀胱功能、尿动力学指标如膀胱容量(VH_(2)O)、膀胱的顺应性(BC)、膀胱压力(Pves)、逼尿肌压力(Pdet),连接肌电图测定肛门外括约肌功能,生活自理能力(ADL)评分等。结果:对照组治疗后VH_(2)O显著高于同组治疗前;BC、Pves、Pdet、残余尿量与同组治疗前比较差异无统计学意义(P>0.05)。观察组治疗后VH_(2)O、BC均较治疗前显著升高,Pves、Pdet、残余尿量均较治疗前显著降低;观察组治疗后膀胱功能评分下降,ADL评分、排尿次数提高,差异均有统计学意义(P<0.05);观察组治疗后括约肌扩张、收缩波幅均高于治疗前(P<0.05);2组上述指标除Pdet和排尿次数外,差异均有统计学意义。2组患者均未见泌尿系感染、肾积水、肾盂肾炎等情况发生。分别对患者治疗后4、8周进行随访复查,观察组停止间歇导尿后均可自行排尿且残余尿量均小于50 ml;对照组疗程结束后仍留置导尿者共7例,其中2例出现导尿管相关性尿路感染。结论:间歇导尿联合膀胱干扰电治疗可提高脑卒中后神经源性膀胱患者的膀胱功能,增加逼尿肌兴奋性,提高肛门括约肌舒缩功能,促进尿流动力学改善,改善日常生活自理能力,缩短留管时间,由此减少尿路感染等其他并发症的发生。Objective:To investigate the clinical efficacy of intermittent catheterization combined with interferential electrical therapy for neurogenic bladder in patients with stroke.Methods:A total of 46 patients with urination dysfunction after stroke were selected as subjects and were prospectively divided into two groups by randomized controlled single-blind method.The observation group(n=24)was treated with the intermittent catheterization combined with interferential electrical therapy,and the control group(n=22)was treated with indwelling catheterization combined with interferential electrical therapy.Bladder function and urodynamic indicators such as bladder volume(VH_(2)O),bladder compliance(BC),bladder pressure(Pves)and detrusor pressure(Pdet)were observed before and after treatment.External anal sphincter function was determined by electromyography,and activity of daily living(ADL)score was evaluated by Modified Barthel Index(MBI).Results:VH_(2)O in the control group after treatment was significantly higher than that before treatment.There were no significant differences in BC,Pves,Pdet and residual urine volume in the control group after treatment compared with those before treatment(P>0.05).In the observation group,VH_(2)O and BC significantly increased,and Pves,Pdet and residual urine volume significantly decreased after treatment(P<0.05).After treatment,the bladder function score in the observation group significantly decreased,and ADL score and urination frequency significantly increased(P<0.05).The amplitude of sphincter relaxation and contraction increased(P<0.05).There was significant difference in the above indicators between the 2 groups except Pdet and urination freguency(P<0.05).No urinary tract infection,hydronephrosis and pyelonephritis occurred in the 2 groups during the treatment period.At 4 and 8 weeks after treatment,after stopping intermittent catheterization,all patients in the observation group could urinate spontaneously and residual urine volume was less than 50 ml.In the control group,th

关 键 词：脑卒中 神经源性膀胱 间歇导尿 干扰电 尿流动力学 

分 类 号：R246.6[医药卫生—针灸推拿学]