盆底电生物反馈法治疗中老年颈部脊髓损伤患者术后排尿困难的疗效研究
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摘要
背景颈椎过伸性损伤是临床中老年患者常见疾病,排尿困难是主要并发症之一。近年来,盆底电生物反馈法被用于治疗排尿困难,且逐渐得到临床推广。但是,中老年患者仅用单一的物理或药物方法治疗排尿困难的效果常并不理想。目的探讨盆底电生物反馈法治疗中老年颈部脊髓损伤术后患者排尿困难的疗效。方法选取2012年5月—2015年5月温州医科大学附属第三医院收治的中老年颈部脊髓损伤术后排尿困难患者82例,采用随机数字表法分为对照组(42例)与治疗组(40例),其中对照组行膀胱训练法,治疗组在此基础上采用盆底电生物反馈法治疗。采用自主排尿试验测定留置导尿时间和自主排尿成功率。治疗前后进行尿流动力学检查,包括膀胱残余尿量、最大膀胱容量、最大尿流率、尿流率、充盈期末逼尿肌压力。结果 82例患者均获得随访,平均随访4.5个月。治疗组留置导尿时间为(24.5±3.9)d,短于对照组的(45.6±5.5)d(t=19.950,P<0.001)。治疗组37例(92.5%)患者恢复自主排尿;对照组28例(66.7%)患者恢复自主排尿,其中13例患者拔除导尿管后均出现不同程度的排尿困难症状。治疗组恢复自主排尿成功率高于对照组(χ2=8.329,P=0.004)。治疗后治疗组膀胱残余尿量、充盈期末逼尿肌压力小于对照组,最大膀胱容量、最大尿流率、尿流率大于对照组(P<0.05)。两组患者治疗后膀胱残余尿量、充盈期末逼尿肌压力小于治疗前,最大膀胱容量、最大尿流率、尿流率大于治疗前(P<0.05)。结论盆底电生物反馈法可有效改善中老年颈部脊髓损伤术后患者的排尿功能,缩短留置导尿时间,值得临床推广应用。
Background Cervical hyperextension injury is a common disease in middle-aged and elderly patients,and dysuria is one of the main complications. In recent years,pelvic floor electrobiofeedback method has been used to treat dysuria,and has been gradually promoted in clinical practice. However,the effect of using only a single physical or pharmaceutical method to treat dysuria in middle-aged and elderly patients is often unsatisfactory. Objective To evaluate the effect of pelvic floor biofeedback therapy(PFBT) on postoperative dysuresia in middle-aged and elderly people with cervical spinal cord injury(CSCI).Methods We enrolled 82 middle-aged and elderly patients with postoperative dysuresia following CSCI surgery from the Third Affiliated Hospital of Wenzhou Medical University from May 2012 to May 2015.We divided them into control group(n=42) and treatment group(n=40) by random number table,receiving bladder training,bladder training combined with PFBT,respectively.The treatment effect was evaluated by the duration of indwelling urethral catheter and the rate of successful spontaneous voiding measured during the active voiding trial,and urodynamic parameters(including the residual urine volume,maximum capacity of the bladder,maximum urinary flow rate,average urinary flow rate,detrusor pressure at the end of filling) measured after treatment.Results All patients were followed up for an average of 4.5 months.The average duration of indwelling urethral catheter in the treatment group was significant less than that of the control group〔(24.5±3.9) d vs(45.6±5.5) d,t=19.950,P<0.001〕.Spontaneous voiding recovery was achieved in 37(92.5%) in the treatment group,and 28(66.7%)in the control group including 13 demonstrated different degrees of dysuresia after the removal of the urethral catheter,indicating that the treatment group had a higher rate of successful spontaneous voiding(χ2=8.329,P=0.004).After treatment,the maximum capacity of the bladder,maximun arinary flow rate,and the average urinary flow rate significantly increased while the residual urine volume decreased,and the detrusor pressure at the end of filling dropped obviously in both groups compared to the baseline(P<0.05);the treatment group demonstrated substantially less residual urine volume and detrusor pressure at the end of filling and significantly increased maximum capacity of the bladder and average urinary flow rate compared with the control group(P<0.05).Conclusion PFBT can effectively improve the postoperative voiding function and shorten the duration of indwelling urethral catheter in middle-aged and elderly patients with CSCI,which is worthy of clinical application.
Background Cervical hyperextension injury is a common disease in middle-aged and elderly patients,and dysuria is one of the main complications. In recent years,pelvic floor electrobiofeedback method has been used to treat dysuria,and has been gradually promoted in clinical practice. However,the effect of using only a single physical or pharmaceutical method to treat dysuria in middle-aged and elderly patients is often unsatisfactory. Objective To evaluate the effect of pelvic floor biofeedback therapy(PFBT) on postoperative dysuresia in middle-aged and elderly people with cervical spinal cord injury(CSCI).Methods We enrolled 82 middle-aged and elderly patients with postoperative dysuresia following CSCI surgery from the Third Affiliated Hospital of Wenzhou Medical University from May 2012 to May 2015.We divided them into control group(n=42) and treatment group(n=40) by random number table,receiving bladder training,bladder training combined with PFBT,respectively.The treatment effect was evaluated by the duration of indwelling urethral catheter and the rate of successful spontaneous voiding measured during the active voiding trial,and urodynamic parameters(including the residual urine volume,maximum capacity of the bladder,maximum urinary flow rate,average urinary flow rate,detrusor pressure at the end of filling) measured after treatment.Results All patients were followed up for an average of 4.5 months.The average duration of indwelling urethral catheter in the treatment group was significant less than that of the control group〔(24.5±3.9) d vs(45.6±5.5) d,t=19.950,P<0.001〕.Spontaneous voiding recovery was achieved in 37(92.5%) in the treatment group,and 28(66.7%)in the control group including 13 demonstrated different degrees of dysuresia after the removal of the urethral catheter,indicating that the treatment group had a higher rate of successful spontaneous voiding(χ2=8.329,P=0.004).After treatment,the maximum capacity of the bladder,maximun arinary flow rate,and the average urinary flow rate significantly increased while the residual urine volume decreased,and the detrusor pressure at the end of filling dropped obviously in both groups compared to the baseline(P<0.05);the treatment group demonstrated substantially less residual urine volume and detrusor pressure at the end of filling and significantly increased maximum capacity of the bladder and average urinary flow rate compared with the control group(P<0.05).Conclusion PFBT can effectively improve the postoperative voiding function and shorten the duration of indwelling urethral catheter in middle-aged and elderly patients with CSCI,which is worthy of clinical application.
引文
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[4]杜小芳,王芳,王延荣,等.脊髓损伤患者间歇性导尿预防泌尿系统感染的效果分析[J].中华医院感染学杂志,2016,26(5):1108-1110.DOI:10.11816/cn.ni.2016-152741.DU X F,WANG F,WANG Y R,et al.Effect of intermittent catheterization for prevention of urinary tract infections in patients with spinal cord injury[J].Chinese Journal of Nosocomiology,2016,26(5):1108-1110.DOI:10.11816/cn.ni.2016-152741.
[5]刘洪举,李军.托特罗定配合间歇导尿治疗脊髓损伤后膀胱过度活动症[J].贵阳医学院学报,2014,39(1):125-126.LIU H J,LI J.Tolterodine combined with intermittent catheterization in the treatment of overactive bladder after spinal cord injury[J].Journal of Guiyang Medical College,2014,39(1):125-126.
[6]王晓红,周宁,王琴,等.针灸治疗脊髓损伤后不同类型神经源性膀胱疗效观察[J].中国康复,2014,29(5):362-364.DOI:10.3870/zgkf.2014.05.014.WANG X H,ZHOU N,WANG Q,et al.Clinical outcomes of acupuncture for different types of neuropathic bladders following spinal cord injuries[J].Chinese Journal of Rehabilitation,2014,29(5):362-364.DOI:10.3870/zgkf.2014.05.014.
[7]KRASMIK D,KREBS J,VAN OPHOVEN A,et al.Urodynamic results,clinical efficacy,and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury[J].Neurourol Urodyn,2014,33(8):1202-1206.DOI:10.1002/nau.22486.
[8]李鹏国,廖利民,鞠彦合,等.钬激光外括约肌切开术在神经源性膀胱男性患者中的应用及长期随访[J].中国康复理论与实践,2013,19(12):1108-1110.DOI:10.3969/j.issn.1006-9771.2013.12.003.LI P G,LIAO L M,JU Y H,et al.Transurethral sphincterotomy with holmium laser in male patients with neurogenic bladder and long term follow up[J].Chinese Journal of Rehabilitation Theory and Practice,2013,19(12):1108-1110.DOI:10.3969/j.issn.1006-9771.2013.12.003.
[9]陈亚平,杨延砚,周谋望,等.视觉反馈排尿训练在治疗脊髓损伤后神经源性膀胱中的应用[J].中国康复医学杂志,2008,23(2):117-119.DOI:10.3969/j.issn.1001-1242.2008.02.010.CHEN Y P,CHEN Y Y,ZHOU M W,et al.Effect of bladder training with visual biofeedback on neurogenic bladder following spinal cord injury[J].Chinese Journal of Rehabilitation Medicine,2008,23(2):117-119.DOI:10.3969/j.issn.1001-1242.2008.02.010.
[10]闫鹏,郑伟东,谭云冰,等.电刺激脊髓损伤模型兔肛周皮肤调控神经源性膀胱内压[J].中国组织工程研究,2015,19(49):7932-7937.DOI:10.3969/j.issn.2095-4344.2015.49.011.YAN P,ZHENG W D,TAN Y B,et al.Electrical stimulation of the perianal skin regulates neurogenic intravesical pressure in rabbit models of spinal cord injury[J].Journal of Clinical Rehabilitative Tissue Engineering Research,2015,19(49):7932-7937.DOI:10.3969/j.issn.2095-4344.2015.49.011.
[11]RADZISZEWSKI K.Outcomes of electrical stimulation of the neurogenic bladder:results of a two-year follow-up study[J].Neuro Rehabilitation,2013,32(4):867-873.DOI:10.3233/NRE-130911.
[12]CORREIA G N,PEREIRA V S,HIRAKAWA H S,et al.Effects of surface and intravaginal electrical stimulation in the treatment of women with stress urinary incontinence:randomized controlled trial[J].Eur J Obstet Gynecol Reprod Biol,2014,173:113-118.DOI:10.1016/j.ejogrb.2013.11.023.
[13]刘良乐,董伊隆,戴鸣海,等.盆底肌电生物反馈治疗脊髓损伤术后排尿功能障碍的疗效观察[J].中华物理医学与康复杂志,2015,37(3):209-211.DOI:10.3760/cma.j.issn.0254-1424.2015.03.015.LIU L L,DONG Y L,DAI M H,et al.Biofeedback with pelvic floor electromyography for urinary dysfunction following spinal cord injury surgery[J].Chinese Journal of Physical Medicine and Rehabilitation,2015,37(3):209-211.DOI:10.3760/cma.j.issn.0254-1424.2015.03.015.
[14]李英普,朱庆三,高忠礼,等.老年人颈椎过伸性颈髓损伤的特征[J].中国临床康复,2003,7(32):4370-4371.DOI:10.3321/j.issn:1673-8225.2003.32.016.LI Y P,ZHU Q S,GAO Z L,et al.Characteristic of extension injury of cervical spinal cord in the elderly[J].Chinese Journal of Clinical Rehabilitation,2003,7(32):4370-4371.DOI:10.3321/j.issn:1673-8225.2003.32.016.
[15]石秀秀,原艳丽,唐金树,等.膀胱水扩张结合视觉反馈排尿训练在治疗脊髓损伤患者神经源性膀胱中的意义[J].中国骨与关节损伤杂志,2014,3(9):675-679.DOI:10.3969/j.issn.2095-252X.2014.09.009.SHI X X,YUAN Y L,TANG J S,et al.Signiifcance of hyaluronate irrigation combined with visual feedback for neurogenic bladder in the patients with spinal cord injury[J].Chinese Journal of Bone and Joint,2014,3(9):675-679.DOI:10.3969/j.issn.2095-252X.2014.09.009.
[2]KIRSHBLUM S C,BURS S P,BIERING-SORENSEN F,et al.International standards for neurological classification of spinal cord injury(revise 2011)[J].J Spinal Cord Med,2011,34(6):535-546.DOI:10.1179/204577211X13207446293695.
[3]DAROUICHE R O,AL MOHAJER M,SIDDIQ D M,et al.Short versus long course of antibiotics for catheter-associated urinary tract infections in patients with spinal cord injury:a randomized controlled noninferiority trial[J].Arch Phys Med Rehabil,2014,95(2):290-296.DOI:10.1016/j.apmr.2013.09.003.
[4]杜小芳,王芳,王延荣,等.脊髓损伤患者间歇性导尿预防泌尿系统感染的效果分析[J].中华医院感染学杂志,2016,26(5):1108-1110.DOI:10.11816/cn.ni.2016-152741.DU X F,WANG F,WANG Y R,et al.Effect of intermittent catheterization for prevention of urinary tract infections in patients with spinal cord injury[J].Chinese Journal of Nosocomiology,2016,26(5):1108-1110.DOI:10.11816/cn.ni.2016-152741.
[5]刘洪举,李军.托特罗定配合间歇导尿治疗脊髓损伤后膀胱过度活动症[J].贵阳医学院学报,2014,39(1):125-126.LIU H J,LI J.Tolterodine combined with intermittent catheterization in the treatment of overactive bladder after spinal cord injury[J].Journal of Guiyang Medical College,2014,39(1):125-126.
[6]王晓红,周宁,王琴,等.针灸治疗脊髓损伤后不同类型神经源性膀胱疗效观察[J].中国康复,2014,29(5):362-364.DOI:10.3870/zgkf.2014.05.014.WANG X H,ZHOU N,WANG Q,et al.Clinical outcomes of acupuncture for different types of neuropathic bladders following spinal cord injuries[J].Chinese Journal of Rehabilitation,2014,29(5):362-364.DOI:10.3870/zgkf.2014.05.014.
[7]KRASMIK D,KREBS J,VAN OPHOVEN A,et al.Urodynamic results,clinical efficacy,and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury[J].Neurourol Urodyn,2014,33(8):1202-1206.DOI:10.1002/nau.22486.
[8]李鹏国,廖利民,鞠彦合,等.钬激光外括约肌切开术在神经源性膀胱男性患者中的应用及长期随访[J].中国康复理论与实践,2013,19(12):1108-1110.DOI:10.3969/j.issn.1006-9771.2013.12.003.LI P G,LIAO L M,JU Y H,et al.Transurethral sphincterotomy with holmium laser in male patients with neurogenic bladder and long term follow up[J].Chinese Journal of Rehabilitation Theory and Practice,2013,19(12):1108-1110.DOI:10.3969/j.issn.1006-9771.2013.12.003.
[9]陈亚平,杨延砚,周谋望,等.视觉反馈排尿训练在治疗脊髓损伤后神经源性膀胱中的应用[J].中国康复医学杂志,2008,23(2):117-119.DOI:10.3969/j.issn.1001-1242.2008.02.010.CHEN Y P,CHEN Y Y,ZHOU M W,et al.Effect of bladder training with visual biofeedback on neurogenic bladder following spinal cord injury[J].Chinese Journal of Rehabilitation Medicine,2008,23(2):117-119.DOI:10.3969/j.issn.1001-1242.2008.02.010.
[10]闫鹏,郑伟东,谭云冰,等.电刺激脊髓损伤模型兔肛周皮肤调控神经源性膀胱内压[J].中国组织工程研究,2015,19(49):7932-7937.DOI:10.3969/j.issn.2095-4344.2015.49.011.YAN P,ZHENG W D,TAN Y B,et al.Electrical stimulation of the perianal skin regulates neurogenic intravesical pressure in rabbit models of spinal cord injury[J].Journal of Clinical Rehabilitative Tissue Engineering Research,2015,19(49):7932-7937.DOI:10.3969/j.issn.2095-4344.2015.49.011.
[11]RADZISZEWSKI K.Outcomes of electrical stimulation of the neurogenic bladder:results of a two-year follow-up study[J].Neuro Rehabilitation,2013,32(4):867-873.DOI:10.3233/NRE-130911.
[12]CORREIA G N,PEREIRA V S,HIRAKAWA H S,et al.Effects of surface and intravaginal electrical stimulation in the treatment of women with stress urinary incontinence:randomized controlled trial[J].Eur J Obstet Gynecol Reprod Biol,2014,173:113-118.DOI:10.1016/j.ejogrb.2013.11.023.
[13]刘良乐,董伊隆,戴鸣海,等.盆底肌电生物反馈治疗脊髓损伤术后排尿功能障碍的疗效观察[J].中华物理医学与康复杂志,2015,37(3):209-211.DOI:10.3760/cma.j.issn.0254-1424.2015.03.015.LIU L L,DONG Y L,DAI M H,et al.Biofeedback with pelvic floor electromyography for urinary dysfunction following spinal cord injury surgery[J].Chinese Journal of Physical Medicine and Rehabilitation,2015,37(3):209-211.DOI:10.3760/cma.j.issn.0254-1424.2015.03.015.
[14]李英普,朱庆三,高忠礼,等.老年人颈椎过伸性颈髓损伤的特征[J].中国临床康复,2003,7(32):4370-4371.DOI:10.3321/j.issn:1673-8225.2003.32.016.LI Y P,ZHU Q S,GAO Z L,et al.Characteristic of extension injury of cervical spinal cord in the elderly[J].Chinese Journal of Clinical Rehabilitation,2003,7(32):4370-4371.DOI:10.3321/j.issn:1673-8225.2003.32.016.
[15]石秀秀,原艳丽,唐金树,等.膀胱水扩张结合视觉反馈排尿训练在治疗脊髓损伤患者神经源性膀胱中的意义[J].中国骨与关节损伤杂志,2014,3(9):675-679.DOI:10.3969/j.issn.2095-252X.2014.09.009.SHI X X,YUAN Y L,TANG J S,et al.Signiifcance of hyaluronate irrigation combined with visual feedback for neurogenic bladder in the patients with spinal cord injury[J].Chinese Journal of Bone and Joint,2014,3(9):675-679.DOI:10.3969/j.issn.2095-252X.2014.09.009.