重复经颅磁刺激技术和托特罗定治疗脊髓损伤后逼尿肌反射亢进的疗效观察  

Effecs of repetitive transcranial magnetic stimulation and tolterodine in the treatment of detrusor hyperreflexia after spinal cord injury

作　　者：林心心 邹恩苗 李婵 林海燕[1] LIN Xinxin;ZOU Enmiao;LI Chan;LIN Haiyan(Department of Rehabilitation Medicine,the Second Affiliated Hospital of Wenzhou Medical University,Zhejiang,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第二医院康复医学科,浙江温州325000

出　　处：《中国现代医生》2022年第30期61-65,共5页China Modern Doctor

基　　金：温州市科技局资助项目(Y20180627)。

摘　　要：目的观察重复经颅磁刺激技术(repetitive transcranial magnetic stimulation,rTMS)和托特罗定治疗脊髓损伤后逼尿肌反射亢进的临床疗效。方法收集2019年1月至12月在温州医科大学附属第二医院脊柱外科和康复医学科住院的符合要求的脊髓损伤后逼尿肌反射亢进患者共40例,采用随机数字表法分为A、B两组,每组各20例,A组患者行rTMS治疗8周,B组患者行托特罗定治疗8周,治疗前、治疗8周后、停止治疗1个月后采用排尿日记、尿动力学指标、生存质量评分和国际下尿路症状评分进行疗效评估。结果两组患者治疗前的日均单次排尿量、日单次最大排尿量、日均排尿次数、日均残余尿量比较,差异均无统计学意义(P>0.05);两组患者治疗8周后日均单次排尿量、日单次最大排尿量、日均排尿次数、日均残余尿量分别较治疗前均有所改善(P<0.05);但经A组患者停止治疗1个月后的日均单次排尿量、日单次最大排尿量、日均排尿次数、日均残余尿量较治疗前均有所改善(P<0.05),而经B组患者停止治疗1个月后的日均单次排尿量、日单次最大排尿量、日均排尿次数、日均残余尿量与治疗前比较,差异均无统计学意义(P>0.05)。两组患者治疗前的膀胱容量、膀胱顺应性、膀胱开口压力、最大膀胱压力、最大逼尿肌压力比较,差异均无统计学意义(P>0.05);A组患者治疗8周后及停止治疗1个月后的膀胱容量、膀胱顺应性、膀胱开口压力、最大膀胱压力、最大逼尿肌压力均较治疗前明显改善(P<0.05);B组患者治疗8周后膀胱容量、膀胱开口压力、最大膀胱压力、最大逼尿肌压力较治疗前有所好转(P<0.05),但停止治疗1个月后,仅膀胱开口压力和最大逼尿肌压力较治疗前有所改善(P<0.05);两组患者治疗前的生存质量评分和国际下尿路症状评分比较,差异均无统计学意义(P>0.05),治疗8周后及停止治疗1个月后两组患者�Objective To observe the clinical efficacy of repetitive transcranial magnetic stimulation(rTMS)and tolterodine in the treatment of detrusor hyperreflexia after spinal cord injury.Methods A total of 40 patients with detrusor hyperreflexia after spinal cord injury were collected from January to December 2019 in Department of Spinal Surgery and Rehabilitation medicine of the Second Affiliated Hospital of Wenzhou Medical University,and 40 patients were randomly divided into group A(n=20)and group B(n=20).The group A underwent rTMS treatment while the group B accepted to lterodine treatment each for 8 weeks.The voiding dairy,urine dynamics testing,quality of life scores and the international lower urinary tract symptoms scores were recorded during before treatment,after 8 weeks of treatment and after stopping treatment for 1 month.Results There were no significant differences between the two groups in the daily average single micturition volume,daily maximum single micturition volume,daily average micturition times and daily average residual urine volume before treatment(P>0.05).After 8 weeks of treatment,the daily average single micturition volume,daily maximum single micturition volume,daily average micturition times and daily average residual urine volume of the two groups were improved respectively(P<0.05).However,after stopping treatment for 1 month,the daily average single micturition volume,daily maximum single micturition volume,daily average micturition times and daily average residual urine volume in group A were improved compared with those before treatment(P<0.05),while the daily average single micturition volume,daily maximum single micturition volume,daily average micturition times and daily average residual urine volume in group B were not significantly different compared with those before treatment(P>0.05).There were no significant differences between the two groups in the bladder volume,bladder compliance,bladder opening pressure,maximum bladder pressure and maximum detrusor pressure before treatment

关 键 词：重复经颅磁刺激技术 托特罗定 脊髓损伤 逼尿肌反射亢进 

分 类 号：R651.2[医药卫生—外科学]