经颅联合外周双向反馈磁刺激对脊髓损伤后神经源性膀胱患者膀胱及排尿功能的效果  

Effectiveness of bidirectional feedback magnetic stimulation on bladder and voiding function in patients with neurogenic bladder after spinal cord injury

作　　者：娄晓乐 宋佳苧 韩雪 刘换 江勇 LOU Xiaole;SONG Jianing;HAN Xue;LIU Huan;JIANG Yong(Department of Rehabilitation Medicine,the First Affiliated Hospital of Bengbu Medical University,Bengbu 233000,Anhui,China)

机构地区：[1]蚌埠医科大学第一附属医院康复医学科,安徽蚌埠233000

出　　处：《实用医学杂志》2025年第6期859-865,共7页The Journal of Practical Medicine

基　　金：安徽省教育厅高等学校质量工程项目(编号:[2023]56);蚌埠医科大学2023年度研究生科研创新计划立项项目(编号:Byycxz23071)。

摘　　要：目的探讨经颅联合外周磁刺激对脊髓损伤后神经源性膀胱(NB)患者膀胱及排尿功能的临床疗效。方法2023年9月至2024年10月,选取蚌埠医科大学第一附属医院康复医学科脊髓损伤后NB患者60例,随机分为对照组(n=15)、M1区刺激组(n=15)、骶神经根刺激组(n=15)和联合刺激组(n=15)。对照组行常规康复治疗,M1区刺激组在此基础上增加运动皮层M1区重复经颅磁刺激(rTMS),骶神经根刺激组在此基础上增加骶3神经根重复外周磁刺激(rPMS),联合刺激组在此基础上增加M1区rTMS和骶3神经根rPMS,共治疗4周。治疗前后评估4组患者尿动力学指标、排尿日记以及神经源性膀胱症状评分(NBSS)。结果治疗前,4组患者最大膀胱容量、初尿意时的膀胱容量、最大尿流率、残余尿量、日均排尿次数、日均排尿量以及NBSS评分进行比较,差异无统计学意义(P>0.05);治疗后,4组患者最大膀胱容量、初尿意时的膀胱容量、最大尿流率、残余尿量、日均排尿次数、日均排尿量以及NBSS评分均较治疗前改善(P<0.05);组间比较,治疗后,联合刺激组尿动力学指标、排尿日记以及NBSS评分均显著优于其他三组(P<0.05)。结论经颅联合外周双向反馈磁刺激治疗可改善脊髓损伤后NB患者的尿动力和排尿症状,促进患者膀胱及排尿功能恢复。Objective To explore the clinical efficacy of transcranial combined peripheral magnetic stimulation on bladder and voiding ability in patients with NB after spinal cord injury.Methods From September 2023 to October 2024,60 patients with NB after spinal cord injury were chosen from the Department of Rehabilitation Medicine of the First Affiliated Hospital of Bengbu Medical University,and were separated into the regular group(n=15),M1 area stimulation group(n=15),sacral nerve root stimulation group(n=15),and combined stimulation group(n=15).The control group underwent conventional rehabilitation treatment,the M1 area stimulation group added repetitive transcranial magnetic stimulation(rTMS)of the M1 area of the motor cortex,the sacral nerve root stimulation group added repetitive peripheral magnetic stimulation(rPMS)of the sacral 3 nerve roots,and the co-stimulation group added rTMS of the M1 area and rPMS of the sacral 3 nerve roots,and the treatment was carried out for 4 weeks in total.Urodynamic indices,voiding diaries,and neurogenic bladder symptom scores(NBSS)were assessed before and after therapy in the four groups.Results Before therapy,the differences in maximum bladder capacity,bladder capacity at the time of the first urge to urinate,maximum urine flow rate,residual urine volume,average number of urination per day,average daily urinary output,and NBSS scores of the four groups were not statistically significant when compared with those of the pre-treatment group(P<0.05);after treatment,the maximum bladder capacity,bladder capacity at the time of the first urge to urinate,maximum urine flow rate,residual urine volume,average number of urination per day,average daily urinary output,and NBSS scores were all improved compared with those before treatment(P<0.05);in comparison between the groups,after treatment,the Urodynamic indices,voiding diaries,and NBSS scores of the combined group were better than those of the other three groups(P<0.05).Conclusion Transcranial combined peripheral bidirectional feedback ma

关 键 词：脊髓损伤 膀胱 磁刺激 康复 尿动力 

分 类 号：R493[医药卫生—康复医学]