芒针针刺秩边、水道对脊髓损伤患者尿潴留的影响
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摘要
目的:比较芒针与毫针治疗脊髓损伤后尿潴留的临床疗效。方法:将66例脊髓损伤后尿潴留患者随机分为芒针组(34例)和毫针组(32例)。两组患者均采用骨科常规治疗和膀胱功能训练,芒针组采用芒针针刺秩边、水道穴,毫针组采用毫针针刺秩边和水道穴,两组针刺均隔日1次,共治疗2个月。分别于治疗前、治疗1个月和2个月后观察两组患者的残余尿量、尿动力学指标(膀胱容量、最大尿流速、膀胱压力)和安全性指标,并比较两组临床疗效。结果:与治疗前比较,两组在治疗1个月和2个月后,膀胱残余尿量明显减少(均P<0.01),膀胱容量、最大尿流速、膀胱压力明显改善(均P<0.01);在治疗1个月和2个月时,芒针组患者的残余尿量均低于毫针组(均P<0.01),芒针组患者膀胱容量、最大尿流速、膀胱压力的改善均优于毫针组(均P<0.01)。芒针组总有效率为94.1%(32/34),高于毫针组的71.9%(23/32,P<0.01)。两组患者在治疗中均未出现肾功能损害,无晕针或断针现象出现。结论:芒针在治疗脊髓损伤后尿潴留方面疗效优于毫针针刺,且具有安全性。
Objective To explore the clinical effects of acupuncture with elongated needle on urinary retention after spinal cord injury. Methods A total of 66 patients with urinary retention after spinal cord injury were randomized into an elongated needle group(34 cases) and a filiform needle group(32 cases). In both of the groups, the routine orthopedic treatment and the bladder function training were adopted. Additionally, in the elongated needle group, the acupuncture at Zhibian(BL 54) and Shuidao(ST 28) was used with the elongated needle. In the filiform needle group, the acupuncture with filiform needle was used at Zhibian(BL 54) and Shuidao(ST 28). In both of the groups, acupuncture treatment was provided once every two days, for 2 months consecutively. Separately, before treatment and after 1, 2 month treatment, the residual urine volume, urodynamic parameters(bladder capacity, peak urinary flow rate and bladder pressure) and safety indicators were observed in the patients of the two groups. The clinical therapeutic effects were compared between the two groups.Results As compared with the results before treatment, the residual urine volume was reduced obviously(all P<0.01),bladder capacity, peak urinary flow rate and bladder pressure were improved obviously(all P<0.01) after 1, 2 month treatment in the two groups. After 1, 2 month treatment, the residual urine volume in the elongated needle group was lower than the filiform needle group(both P<0.01). The improvements in bladder capacity, peak urinary flow rate and bladder pressure in the elongated needle group were superior to the filiform needle(all P<0.01). The total effective rate was 94.1%(32/34) in the elongated needle group, higher than 71.9%(23/32) in the filiform needle group(P<0.01). During treatment,there was no damage of kidney function, no fainting or broken needle happened in the two groups. Conclusion Acupuncture with elongated needle achieves the significant effects on urinary retention after spinal cord injury. This therapy is better than acupuncture with filiform needle and safe in operation.
Objective To explore the clinical effects of acupuncture with elongated needle on urinary retention after spinal cord injury. Methods A total of 66 patients with urinary retention after spinal cord injury were randomized into an elongated needle group(34 cases) and a filiform needle group(32 cases). In both of the groups, the routine orthopedic treatment and the bladder function training were adopted. Additionally, in the elongated needle group, the acupuncture at Zhibian(BL 54) and Shuidao(ST 28) was used with the elongated needle. In the filiform needle group, the acupuncture with filiform needle was used at Zhibian(BL 54) and Shuidao(ST 28). In both of the groups, acupuncture treatment was provided once every two days, for 2 months consecutively. Separately, before treatment and after 1, 2 month treatment, the residual urine volume, urodynamic parameters(bladder capacity, peak urinary flow rate and bladder pressure) and safety indicators were observed in the patients of the two groups. The clinical therapeutic effects were compared between the two groups.Results As compared with the results before treatment, the residual urine volume was reduced obviously(all P<0.01),bladder capacity, peak urinary flow rate and bladder pressure were improved obviously(all P<0.01) after 1, 2 month treatment in the two groups. After 1, 2 month treatment, the residual urine volume in the elongated needle group was lower than the filiform needle group(both P<0.01). The improvements in bladder capacity, peak urinary flow rate and bladder pressure in the elongated needle group were superior to the filiform needle(all P<0.01). The total effective rate was 94.1%(32/34) in the elongated needle group, higher than 71.9%(23/32) in the filiform needle group(P<0.01). During treatment,there was no damage of kidney function, no fainting or broken needle happened in the two groups. Conclusion Acupuncture with elongated needle achieves the significant effects on urinary retention after spinal cord injury. This therapy is better than acupuncture with filiform needle and safe in operation.
引文
[1]Piatt JA,Nagata S,Zahl M,et al.Problematic secondary health conditions among adults with spinal cord injury and its impact on social participation and daily life[J].J Spinal Cord Med,2016,39(6):693-698.
[2]王佳琪,刘志顺.针灸治疗脊髓损伤神经原性膀胱功能障碍概况[J].中国针灸,2008,28(10):779-782.
[3]全仁夫,陈荣良,许世超,等.芒针透刺秩边-水道穴对脊髓损伤后尿潴留膀胱尿动力学的影响[J].中国骨伤,2013,26(1):54-58.
[4]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
[5]孟祥霞,李丽,冷军,等.膀胱尿压测评在脊髓损伤后神经源性膀胱尿潴留的规范化应用[J].康复学报,2017,27(3):47-50.
[6]缪鸿石.康复医学理论与实践[M].上海:上海科学技术出版社,2001.
[7]储开博,杨李旺,何丽清.“秩边透水道”穴周解剖关系及其治疗术后尿潴留机理探讨[J].中国中医药信息杂志,2009,16(4):98-99.
[8]李维国,王向东.新版《临床疾病诊断依据治愈好转标准》简介[J].解放军医院管理杂志,1998(3):299.
[9]Hu HZ,Granger N,Jeffery ND.Pathophysiology,clinical importance,and management of neurogenic lower urinary tract dysfunction caused by suprasacral spinal cord injury[J].J Vet Intern Med,2016,30(5):1575-1588.
[10]Herrity AN,Petruska JC,Stirling DP,et al.The effect of spinal cord injury on the neurochemical properties of vagal sensory neurons[J].Am J Physiol Regul Integr Comp Physiol,2015,308(12):R1021.
[11]Johnston L,Cunningham RMJ,Young JS,et al.Altered distribution of interstitial cells and innervation in the rat urinary bladder following spinal cord injury[J].J Cell Mol Med,2012,16(7):1533-1543.
[12]Wognum S,Lagoa CE,Nagatomi J,et al.An exploratory pathways analysis of temporal changes induced by spinal cord injury in the rat bladder wall:insights on remodeling and inflammation[J].PLoS One,2009,4(6):e5852.
[13]郑红云,赵超男,夏艳萍,等.脊髓损伤后导尿管留置时间对膀胱功能的影响[J].中国脊柱脊髓杂志,2006,16(6):433-434.
[14]Salameh A,Mohajer MA,Daroucihe RO.Prevention of urinary tract infections in patients with spinal cord injury[J].CMAJ,2015,187(11):807-811.
[15]Ho CH,Sung KC,Lim SW,et al.Chronic indwelling urinary catheter increase the risk of bladder cancer,even in patients without spinal cord injury[J].Medicine,2015,94(43):e1736.
[16]李佳音.针刺治疗脊髓损伤后排尿障碍41例[J].针灸临床杂志,2009,25(11):9-10.
[17]周凌云,李杰,李春梅,等.电针八髎、会阳治疗脊髓损伤性尿潴留疗效观察[J].中国针灸,2006,26(4):237-239.
[18]王再岭,马金娜,宁丽娜.芒针弯刺天突穴治疗脑梗死后吞咽障碍临床疗效观察[J].中国针灸,2016,36(10):1019-1022.
[19]刘宝贵,冀来喜,郝重耀,等.秩边透水道针法治疗慢性前列腺炎的解剖学基础[J].中国针灸,2001,21(2):91-93.
[20]全仁夫,李长明,谢尚举,等.芒针治疗对脊髓损伤大鼠TNF-α、IL-6β、IL-1β、NF-Kβ表达的影响[J].中医临床研究,2015,7(28):5-8.
[21]全仁夫,陈荣良,许世超,等.芒针透刺对脊髓损伤后脊髓诱发电位影响的实验研究[J].中医正骨,2012,24(11):3-6.
[2]王佳琪,刘志顺.针灸治疗脊髓损伤神经原性膀胱功能障碍概况[J].中国针灸,2008,28(10):779-782.
[3]全仁夫,陈荣良,许世超,等.芒针透刺秩边-水道穴对脊髓损伤后尿潴留膀胱尿动力学的影响[J].中国骨伤,2013,26(1):54-58.
[4]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
[5]孟祥霞,李丽,冷军,等.膀胱尿压测评在脊髓损伤后神经源性膀胱尿潴留的规范化应用[J].康复学报,2017,27(3):47-50.
[6]缪鸿石.康复医学理论与实践[M].上海:上海科学技术出版社,2001.
[7]储开博,杨李旺,何丽清.“秩边透水道”穴周解剖关系及其治疗术后尿潴留机理探讨[J].中国中医药信息杂志,2009,16(4):98-99.
[8]李维国,王向东.新版《临床疾病诊断依据治愈好转标准》简介[J].解放军医院管理杂志,1998(3):299.
[9]Hu HZ,Granger N,Jeffery ND.Pathophysiology,clinical importance,and management of neurogenic lower urinary tract dysfunction caused by suprasacral spinal cord injury[J].J Vet Intern Med,2016,30(5):1575-1588.
[10]Herrity AN,Petruska JC,Stirling DP,et al.The effect of spinal cord injury on the neurochemical properties of vagal sensory neurons[J].Am J Physiol Regul Integr Comp Physiol,2015,308(12):R1021.
[11]Johnston L,Cunningham RMJ,Young JS,et al.Altered distribution of interstitial cells and innervation in the rat urinary bladder following spinal cord injury[J].J Cell Mol Med,2012,16(7):1533-1543.
[12]Wognum S,Lagoa CE,Nagatomi J,et al.An exploratory pathways analysis of temporal changes induced by spinal cord injury in the rat bladder wall:insights on remodeling and inflammation[J].PLoS One,2009,4(6):e5852.
[13]郑红云,赵超男,夏艳萍,等.脊髓损伤后导尿管留置时间对膀胱功能的影响[J].中国脊柱脊髓杂志,2006,16(6):433-434.
[14]Salameh A,Mohajer MA,Daroucihe RO.Prevention of urinary tract infections in patients with spinal cord injury[J].CMAJ,2015,187(11):807-811.
[15]Ho CH,Sung KC,Lim SW,et al.Chronic indwelling urinary catheter increase the risk of bladder cancer,even in patients without spinal cord injury[J].Medicine,2015,94(43):e1736.
[16]李佳音.针刺治疗脊髓损伤后排尿障碍41例[J].针灸临床杂志,2009,25(11):9-10.
[17]周凌云,李杰,李春梅,等.电针八髎、会阳治疗脊髓损伤性尿潴留疗效观察[J].中国针灸,2006,26(4):237-239.
[18]王再岭,马金娜,宁丽娜.芒针弯刺天突穴治疗脑梗死后吞咽障碍临床疗效观察[J].中国针灸,2016,36(10):1019-1022.
[19]刘宝贵,冀来喜,郝重耀,等.秩边透水道针法治疗慢性前列腺炎的解剖学基础[J].中国针灸,2001,21(2):91-93.
[20]全仁夫,李长明,谢尚举,等.芒针治疗对脊髓损伤大鼠TNF-α、IL-6β、IL-1β、NF-Kβ表达的影响[J].中医临床研究,2015,7(28):5-8.
[21]全仁夫,陈荣良,许世超,等.芒针透刺对脊髓损伤后脊髓诱发电位影响的实验研究[J].中医正骨,2012,24(11):3-6.