八正散配合推拿手法治疗脊髓损伤后尿潴留的机制研究
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摘要
目的:探讨八正散配合推拿手法治疗脊髓损伤后尿潴留的疗效,及对血清中P物质(SP)和降钙素基因相关肽(CGRP)水平及抗氧化作用的影响。方法:选择脊髓损伤后尿潴留患者104例作为研究对象,按数字表法随机分为观察组和对照组各52例。所有患者予常规治疗。对照组给予膀胱功能训练及常规尿潴留治疗。观察组在对照组治疗的基础上采用八正散配合推拿手法治疗。两组患者连续治疗4周。比较两组患者治疗后单次尿量和尿管留置时间、尿动力学参数、中医主要症状评分及临床疗效。检测两组患者血清中SP和CGRP及黄嘌呤氧化还原酶(XOD),丙二醛(MDA),超氧化物歧化酶(SOD)水平。结果:治疗后观察组的单次尿量、最大尿流量、最大尿流率时逼尿肌压及最大尿意膀胱容量明显高于对照组,尿管留置时间明显少于对照组(P <0. 01);与对照组相比较观察组治疗后排尿无力、小腹坠胀、怠倦乏力评价均有降低(P <0. 01);观察组总有效率为90. 2%,显著高于对照组的72%(P <0. 05);观察组治疗后血清中SP和CGRP水平均显著高于对照组(P <0. 01);与对照组相比,观察组治疗后血清中XOD,MDA水平降低更明显,而SOD升高更显著(P <0. 01)。结论:八正散配合推拿手法治疗脊髓损伤后尿潴留取得了一定疗效,其上调体内SP和CGRP水平及增强抗氧化作用可能与上述治疗作用有关。
Objective:To explore the effect of Bazheng Powder combined with massage on the retention of urine after spinal cord injury,and the effect on the serum levels of substance P( SP) and calcitonin gene related peptide( CGRP) and antioxidation in serum. Methods:Totally 104 patients with urinary retention after spinal cord injury were selected as the research subjects. They were randomly divided into the observation group and the control group,52 cases in each group. All patients were treated with routine treatment. The control group was given bladder function training and routine urinary retention. The observation group was treated with Bazheng Powder combined with massage manipulation on the basis of the control group's treatment. Two groups were treated for 4 weeks. We compared catheter retention time,urodynamic parameters,TCM main symptom score and clinical efficacy. Serum levels of SP and CGRP,xanthine oxidoreductase( XOD),malondialdehyde( MDA) and superoxide dismutase( SOD) in two groups of patients were detected. Results:After treatment,the single urine volume,maximum urine flow,maximum urine flow rate and maximum urinary bladder capacity in the observation group were significantly higher than those in the control group. The retention time of urethral catheter was significantly less than that of the control group( P < 0. 01),and the evaluation of urination weakness,small abdominal distention and fatigue fatigue after treatment was lower than that of the control group( P < 0. 01). The total effective rate of the observation group was 90. 2%,significantly higher than that of the control group(72%) P < 0. 05). The serum levels of SP and CGRP in the observation group were significantly higher than those of the control group( P < 0. 01). Compared with the control group,the levels of XOD,MDA in the serum of the observation group were more obvious,and the SOD increased significantly( P < 0. 01). Conclusion:The treatment of urinary retention after spinal cord injury by Bazheng Powder combined with massage has a certain effect on the retention of urinary retention after spinal cord injury. The up regulation of SP and CGRP levels in the body and the enhancement of antioxidant effect may be related to the effect of the above treatment.
Objective:To explore the effect of Bazheng Powder combined with massage on the retention of urine after spinal cord injury,and the effect on the serum levels of substance P( SP) and calcitonin gene related peptide( CGRP) and antioxidation in serum. Methods:Totally 104 patients with urinary retention after spinal cord injury were selected as the research subjects. They were randomly divided into the observation group and the control group,52 cases in each group. All patients were treated with routine treatment. The control group was given bladder function training and routine urinary retention. The observation group was treated with Bazheng Powder combined with massage manipulation on the basis of the control group's treatment. Two groups were treated for 4 weeks. We compared catheter retention time,urodynamic parameters,TCM main symptom score and clinical efficacy. Serum levels of SP and CGRP,xanthine oxidoreductase( XOD),malondialdehyde( MDA) and superoxide dismutase( SOD) in two groups of patients were detected. Results:After treatment,the single urine volume,maximum urine flow,maximum urine flow rate and maximum urinary bladder capacity in the observation group were significantly higher than those in the control group. The retention time of urethral catheter was significantly less than that of the control group( P < 0. 01),and the evaluation of urination weakness,small abdominal distention and fatigue fatigue after treatment was lower than that of the control group( P < 0. 01). The total effective rate of the observation group was 90. 2%,significantly higher than that of the control group(72%) P < 0. 05). The serum levels of SP and CGRP in the observation group were significantly higher than those of the control group( P < 0. 01). Compared with the control group,the levels of XOD,MDA in the serum of the observation group were more obvious,and the SOD increased significantly( P < 0. 01). Conclusion:The treatment of urinary retention after spinal cord injury by Bazheng Powder combined with massage has a certain effect on the retention of urinary retention after spinal cord injury. The up regulation of SP and CGRP levels in the body and the enhancement of antioxidant effect may be related to the effect of the above treatment.
引文
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[5]李文刚,方强,卢根生,等.急性尿潴留大鼠膀胱组织黄嘌呤氧化还原酶活性变化及其意义[J].第三军医大学学报,2006,28(9):973-975.
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[8]吴忠禹,林麟.电针、推拿治疗骨折术后非阻塞性尿潴留10例的报告[J].贵阳中医学院学报,2012,34(5):203-204.
[9]王强强,潘华山,张晓,等.温和灸治疗中风后尿潴留的临床疗效观察[J].广州中医药大学学报,2014,31(2):212-215
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[11]孙卫兵,杨帆,齐清会.电针次髎穴对慢性膀胱过度活动症模型大鼠尿动力学及脊髓背角SP和CGRP影响[J].大连医科大学学报,2012,34(3):220-224.
[12]刘海,王忠诚,崔勇,等.高压氧对大鼠脊髓损伤后内源性神经干细胞的诱导作用[J].中国康复理论与实践,2006,12(5):369-371.
[13] Drake MJ,HEDlUND P,Mills IW,et al. Structural and functional denervation of human detrusor after spinal cord injury[J]. Lab Invest,2000,80(10):1491-1499.
[14] Munoz-Torres M,Alonso G,Raya MP. Calcitonin therapy in osteoporosis[J]. Treat Endocrinol,2004,3(2):117-132.
[15]林传友,HOBISHI A L Ahmad Saleh,等.辣椒素对大鼠膀胱内压及CGRP,NPY免疫反应性神经的影响[J].中国神经科学杂志,2001,17(4):317-320.
[16]郑鑫. NGF与膀胱逼尿肌功能研究进展[J].国际泌尿系统杂志,2011,31(2):187.
[17]李文刚,方强,杨景,等.活性氧在急性尿潴留大鼠膀胱功能损害中的作用研究[J].第三军医大学学报,2005,27(4):331-333.
[18] BOBAN M,KOCIC G,RADENKOVIC S,et al. Circu1ating purine compounds, uric acid, and xanthine oxidase/dehydrogenase re1ationship in essential hypertension and end stage renal disease[J]. Ren Fail,2014,36(4):613-618.
[19] Nakamura M,Houghtling RA,Mac Arthur L,et al. Differences in cytokine gene expression profile between acute and secondary injury in adult rat spinal cord[J]. Exp Neurol,2003,184(1):313-325
[20] LIN X,WU S,WANG Q,et al. Saikosaponin-D reduces H2O2-induced PC12 cell apoptosis by removing ROS and blocking MAPKdependent oxidative damage[J]. Cell Mol Neurobiol,2016,36(8):1365-1375.
[2]安彩萍,常翠芳,赵文洁,等.妇科术后尿潴留的病因及针灸治疗进展[J].中国针灸,2013,33(11):1052-1056.
[3]贾志龙,代二庆,李西忠.基于宫颈癌根治术后的尿潴留针灸与西药疗效对照研究[J].中华中医药学刊,2012,30(10):2249-2250.
[4]李正飞.腹部推拿治疗非阻塞性尿潴留的探讨[J].河北中医,2015,37(12):1856-1857.
[5]李文刚,方强,卢根生,等.急性尿潴留大鼠膀胱组织黄嘌呤氧化还原酶活性变化及其意义[J].第三军医大学学报,2006,28(9):973-975.
[6]宋宏扬,高淑红.综合疗法治疗中风后尿潴留22例临床观察[J].湖南中医杂志,2017,41(7):92-94.
[7]高强强.针刺配合推拿治疗肛肠术后尿潴留58例[J].陕西中医学院学报,2014,37(3):52-53.
[8]吴忠禹,林麟.电针、推拿治疗骨折术后非阻塞性尿潴留10例的报告[J].贵阳中医学院学报,2012,34(5):203-204.
[9]王强强,潘华山,张晓,等.温和灸治疗中风后尿潴留的临床疗效观察[J].广州中医药大学学报,2014,31(2):212-215
[10]周奎龙,马勇.脊髓损伤后神经源性膀胱的中西医治疗[J].中国中医骨伤科杂志,2008,16(9):64-66
[11]孙卫兵,杨帆,齐清会.电针次髎穴对慢性膀胱过度活动症模型大鼠尿动力学及脊髓背角SP和CGRP影响[J].大连医科大学学报,2012,34(3):220-224.
[12]刘海,王忠诚,崔勇,等.高压氧对大鼠脊髓损伤后内源性神经干细胞的诱导作用[J].中国康复理论与实践,2006,12(5):369-371.
[13] Drake MJ,HEDlUND P,Mills IW,et al. Structural and functional denervation of human detrusor after spinal cord injury[J]. Lab Invest,2000,80(10):1491-1499.
[14] Munoz-Torres M,Alonso G,Raya MP. Calcitonin therapy in osteoporosis[J]. Treat Endocrinol,2004,3(2):117-132.
[15]林传友,HOBISHI A L Ahmad Saleh,等.辣椒素对大鼠膀胱内压及CGRP,NPY免疫反应性神经的影响[J].中国神经科学杂志,2001,17(4):317-320.
[16]郑鑫. NGF与膀胱逼尿肌功能研究进展[J].国际泌尿系统杂志,2011,31(2):187.
[17]李文刚,方强,杨景,等.活性氧在急性尿潴留大鼠膀胱功能损害中的作用研究[J].第三军医大学学报,2005,27(4):331-333.
[18] BOBAN M,KOCIC G,RADENKOVIC S,et al. Circu1ating purine compounds, uric acid, and xanthine oxidase/dehydrogenase re1ationship in essential hypertension and end stage renal disease[J]. Ren Fail,2014,36(4):613-618.
[19] Nakamura M,Houghtling RA,Mac Arthur L,et al. Differences in cytokine gene expression profile between acute and secondary injury in adult rat spinal cord[J]. Exp Neurol,2003,184(1):313-325
[20] LIN X,WU S,WANG Q,et al. Saikosaponin-D reduces H2O2-induced PC12 cell apoptosis by removing ROS and blocking MAPKdependent oxidative damage[J]. Cell Mol Neurobiol,2016,36(8):1365-1375.