基于超声引导技术的电针对不完全脊髓损伤患者膀胱尿动力学的影响  

The urodynamic effect of ultrasound-guided electroacupuncture on the bladder in patients with incomplete spinal cord injury

作　　者：卢君艳[1] 林乐[1] 程博[1] LU Junyan;LIN Le;CHENG Bo(Center of Physical Medicine and Rehabilitation,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院康复医学中心,浙江温州325027

出　　处：《温州医科大学学报》2023年第5期359-363,369,共6页Journal of Wenzhou Medical University

基　　金：温州市基础性科研项目(Y20210240);浙江省中医药科技计划项目(2013ZB087)。

摘　　要：目的:探讨基于超声引导技术的电针关元等穴对不完全脊髓损伤后神经源性膀胱(逼尿肌无反射型)的作用。方法:将符合标准的32例脊髓损伤患者随机分成超声电针组16例和常规电针组16例,先做尿动力检查,然后使膀胱容量维持在400 mL左右,选取关元、中极和归来穴,采用超声引导法和徒手法两种方法进行针刺,电针频率选40 Hz,即时观察尿动力参数、排尿感以及膀胱收缩情况等指标。结果:基于超声引导下的针刺能精准、安全地将针尖刺到膀胱逼尿肌层。超声电针组电针时患者出现排尿感,11例患者出现膀胱轻度收缩,16例患者肛周出现与电针频率一致的电信号,与常规电针组比较差异有统计学意义(P<0.05)。两种方法电针时Pdetmax及Qmax无明显改变,两组比较差异无统计学意义(P>0.05)。结论:超声引导下电针治疗不完全性脊髓损伤后神经源性膀胱(逼尿肌无反射型)患者的排尿障碍是有效且安全的。Objective:To investigate the effect of electroacupuncture at Guanyuan and other acupoints on neurogenic bladder(detrusor areflexia type)after spinal cord injury based on ultrasonic guidance technology.Methods:32 patients with SCI who met the standard were randomly divided into ultrasonic electroacupuncture group(16 cases)and conventional electroacupuncture group(16 cases).The urodynamic tests were performed first,and then the bladder volume was maintained at about 400 mL.CV4,CV3 and bilateral ST29 points were selected for acupuncture with ultrasonic guidance and manual manipulation,respectively.The frequency of electroacupuncture was 40 Hz,the waveform was continuous wave,and the pulse width was 200μs,and urodynamic parameters,micturition sensation,and contractions of the bladder were observed in real time.Results:Acupuncture guided by ultrasound can accurately and safely locate the needle tip to the bladder muscle layer.In the ultrasonic electroacupuncture group,there was a significant sense of urination during electroacupuncture,11 patients had slight bladder contraction,and all patients had significant electrical stimulation signals around the anus.There was a significant difference compared with the conventional electroacupuncture group(P<0.05).Pdetmax and Qmax did not change significantly in the two groups before and after electroacupuncture,and there was no significant difference between the two groups(P>0.05).Conclusion:Ultrasound guided electroacupuncture can safely and effectively improve bladder micturition function of patients with detrusor areflexia bladder after incomplete SCI.

关 键 词：超声引导 脊髓损伤 电针 神经源性膀胱 尿动力学 

分 类 号：R744[医药卫生—神经病学与精神病学]