火针联合膀胱功能训练治疗脊髓损伤所致神经源性膀胱:随机对照试验  

Fire needle therapy combined with bladder function training for neurogenic bladder caused by spinal cord injury:a randomized controlled trial

作　　者：董艳 刘震钢 刘媛 李花荣 于然 刘卫星 杨秀荣 王东昇 DONG Yan;LIU Zhengang;LIU Yuan;LI Huarong;YU Ran;LIU Weixing;YANG Xiurong;WANG Dongsheng(Inpatient Department of Acupuncture-Moxibustion and Tuina,Tangshan TCM Hospital,Tangshan 063000,Hebei Province,China;First Department of Radiology, Second Hospital of Tangshan City;Second Inpatient Department of Endocrinology,Tangshan TCM Hospital,Tangshan 063000,Hebei Province,China)

机构地区：[1]唐山市中医医院针灸推拿病区,河北唐山063000 [2]唐山市第二医院放射一科 [3]唐山市中医医院内分泌二病区,河北唐山063000

出　　处：《中国针灸》2024年第12期1395-1400,共6页Chinese Acupuncture & Moxibustion

基　　金：河北省中医药管理局科研计划项目:2020391。

摘　　要：目的:观察火针联合膀胱功能训练治疗脊髓损伤所致神经源性膀胱(NB)的临床疗效及安全性。方法:将60例脊髓损伤所致NB患者随机分为观察组和对照组,各30例。在常规西医治疗基础上,对照组采用膀胱功能训练治疗,每日1次,治疗4周;观察组在对照组治疗基础上,于双侧三阴交及关元、中极穴行火针治疗,隔日1次,治疗4周(共14次)。分别于治疗前及治疗2、4周后,记录两组排尿情况(日均排尿次数、日均漏尿次数、日均单次排尿量),检测两组患者尿流动力学参数[最大尿流率(Qmax)、最大尿流率时最大逼尿肌压力(Pdet Qmax)、膀胱残余尿量(RUA)、最大膀胱容量(MCC)、膀胱压力],观察两组患者神经源性膀胱症状评分(NBSS)、泌尿症状困扰评分(USDS)。观察两组患者治疗前后世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分。并评价两组患者疗效、尿路感染发生率及安全性。结果:两组患者治疗2、4周后日均排尿次数、日均漏尿次数、RUA及NBSS、USDS评分较治疗前降低(P<0.05),治疗4周后以上指标低于治疗2周后(P<0.05),且观察组治疗2、4周后以上指标低于对照组(P<0.05);两组患者治疗2、4周后日均单次排尿量、Qmax、Pdet Qmax、MCC、膀胱压力较治疗前升高(P<0.05),治疗4周后以上指标高于治疗2周后(P<0.05),且除治疗2周后膀胱压力外,观察组治疗2、4周后以上指标高于对照组(P<0.05)。治疗4周后,两组患者WHOQOL-BREF心理、生理、环境、社会关系各维度评分及总分较治疗前升高(P<0.05),观察组高于对照组(P<0.05)。观察组尿路感染发生率为0%(0/30),对照组为10.0%(3/30),差异无统计学意义(P>0.05);观察组总有效率为93.3%(28/30),高于对照组的73.3%(22/30,P<0.05)。观察组患者均未出现严重不良反应。结论:火针联合膀胱功能训练治疗可有效改善脊髓损伤所致NB患者的临床症状,改善患者排尿情况,恢复患者膀胱功能,提�Objective To observe the clinical effect and safety of fire needle therapy combined with bladder function training on neurogenic bladder(NB) caused by spinal cord injury.Methods A total of 60 patients with NB caused by spinal cord injury were randomly divided into an observation group and a control group,with 30 cases in each group.On the basis of conventional treatment with western medicine,the bladder function training was adopted in the control group,once a day and for 4 weeks.In the observation group,on the basis of the interventions as the control group,fire needling was operated at bilateral Sanyinjiao(SP 6) and Guanyuan(CV 4) and Zhongji(CV 3),once every two days and for 4 weeks(14 interventions in total).Separately,at the baseline and in 2 and 4 weeks of interventions,the urination conditions(average daily urination frequency,average daily leakage frequency,average daily single urination volume) were recorded in the two groups;the urodynamic parameters(maximum flow rate [Qmax],maximum detrusor pressure at maximum flow rate [PdetQmax],residual urine volume [RUA],maximum cystometric capacity [MCC],and bladder pressure) were detected;the neurogenic bladder symptom score(NBSS),urinary symptom distress score(USDS) were observed.Before and after treatment,the score of World Health Organization quality of life assessment scale-brief(WHOQOL-BREF) was observed in the two groups.The therapeutic effect,the incidence of urinary infection,and the safety were evaluated.Results In 2 and 4 weeks of interventions,the average daily urination frequency,the average daily leakage frequency,RUA,and the scores of NBSS and USDS decreased in the two groups when compared with the baseline(P<0.05).In 4 weeks of interventions,the above-mention outcomes were lower than those in 2 weeks of interventions(P<0.05);and the results in the observation group were lower in 2 and 4 weeks of interventions when compared with the control group(P<0.05).In 2 and 4 weeks of interventions,the average daily single urination volume,Qmax,PdetQmax,MCC,an

关 键 词：神经源性膀胱 脊髓损伤 火针疗法 膀胱功能训练 尿流动力学 尿路感染 随机对照试验 

分 类 号：R246.2[医药卫生—针灸推拿学]