中医综合康复对脊髓损伤后膀胱功能障碍患者自主排尿功能及生活质量的影响
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摘要
目的观察中医综合康复方案对脊髓损伤(SCI)后神经源性膀胱(NGB)尿潴留患者的自主排尿功能及生活质量的影响。方法采用区组随机方法,将确诊为SCI后NGB尿潴留的患者随机分为治疗组和对照组,对照组采用间歇性导尿方法治疗,治疗组在间歇性导尿治疗基础上加用针刺、推拿方法。观察两组患者自主排尿功能及生活质量指数(QOL评分)情况。结果治疗后,治疗组有73例恢复自主排尿功能,对照组有49例恢复自主排尿功能,两组比较差异具有统计学意义(P <0. 05)。两组患者治疗后QOL评分均较治疗前显著改善,组内比较差异有统计学意义(P <0. 05);且治疗组患者治疗后QOL评分与对照组比较,差异具有统计学意义(P <0. 05)。结论中医综合康复方案治疗SCI后NGB尿潴留在恢复患者自主排尿及提高患者生活质量等方面具有一定优势,可以为临床应用和推广提供参考和借鉴。
Objective To observe the impacts of the comprehensive rehabilitation therapy of TCM on automatic micturition and the quality of life in the patients with neurogenic bladder( NGB) after spinal cord injury( SCI). Methods The randomized block design was adopted. The eligible patients with NGB were randomized into a treatment group and a control group. In the control group,the intermittent catheterization was applied. In the treatment group,on the base of the treatment as the control group,acupuncture and Chinese massage were supplemented. The automatic micturition function and the index of quality of life( QOL score) were observed in the two groups. Results After treatment,the automatic micturition was recovered in 73 cases of the treatment group and recovered in 49 cases of the control group,indicating the significant difference in comparison between the two groups( P < 0. 05). After treatment,QOL scores were obviously improved as compared with the scores before treatment in the two groups. The difference was significant in the intra-group comparison( P< 0. 05). After treatment,QOL score in the treatment group was different significantly as compared with the control group ( P < 0. 05). Conclusion The comprehensive rehabilitation regimen of TCM is advantageous in the recovery of automatic micturiation and the improvement of quality of life in the patients with NGB after SCI. This therapy provides the references to clinical practice and promotion.
Objective To observe the impacts of the comprehensive rehabilitation therapy of TCM on automatic micturition and the quality of life in the patients with neurogenic bladder( NGB) after spinal cord injury( SCI). Methods The randomized block design was adopted. The eligible patients with NGB were randomized into a treatment group and a control group. In the control group,the intermittent catheterization was applied. In the treatment group,on the base of the treatment as the control group,acupuncture and Chinese massage were supplemented. The automatic micturition function and the index of quality of life( QOL score) were observed in the two groups. Results After treatment,the automatic micturition was recovered in 73 cases of the treatment group and recovered in 49 cases of the control group,indicating the significant difference in comparison between the two groups( P < 0. 05). After treatment,QOL scores were obviously improved as compared with the scores before treatment in the two groups. The difference was significant in the intra-group comparison( P< 0. 05). After treatment,QOL score in the treatment group was different significantly as compared with the control group ( P < 0. 05). Conclusion The comprehensive rehabilitation regimen of TCM is advantageous in the recovery of automatic micturiation and the improvement of quality of life in the patients with NGB after SCI. This therapy provides the references to clinical practice and promotion.
引文
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[13]程瑞动,朱根应,叶祥明,等.不同时期针刺对不完全性脊髓损伤患者盆底肌及排尿功能的影响[J].中国康复理论与实践,2016,22(12):1438-1441.
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[15]朱毅,李凝,励建安,等.脊髓损伤后神经源性膀胱尿潴留的针刺康复临床研究[J].中华全科医学,2010,8(12):1495-1497.
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[17]Coco CT,Meenakshi-Sundaram B,Eldefrawy A,et al. A cross sec-tional single institution study of quality of life in adult patients withspina bifida[J]. Neurourol Urodyn,2018,37(5):1757-1763.
[2]于潮将,冯虎,高啸,等.脊髓损伤后尿路感染的研究进展[J].中国脊柱脊髓杂志,2016,26(11):1042-1046.
[3]Jaggi A,Fatoye F. Real world treatment patterns in the neurogenicbladder population:a systematic literature review[J]. Transl AndrolUrol,2017,6(6):1175-1183.
[4]汪玲,孙咏梅,彭丽娟,等.电针与低频脉冲电穴位刺激对新西兰兔尿潴留模型排尿效果影响的比较[J].中国脊柱脊髓杂志,2017,27(12):1114-1118.
[5]刘承梅,高玲莉,冯晓东.益元灸治疗不完全性脊髓损伤后膀胱功能障碍的临床研究[J].中国康复医学杂志,2017,32(10):1148-1151.
[6]王彦彬,徐智慧,诸靖宇,等.骶3神经电针治疗脊髓损伤后逼尿肌反射亢进的临床效果[J].中国康复理论与实践,2014,20(3):224-225.
[7]American Spinal Injury Association,International Spinal Cord Socie-ty.脊髓损伤神经学分类国际标准(2011年修订)[J].李建军,王方永,译.中国康复理论与实践,2011,17(10):963-972.
[8]国家中医药管理局.中医病症诊断疗效标准(ZY/T001. 1~001. 9-94)[S].南京:南京大学出版社,1994:27-28.
[9]蔡文智,陈思婧.神经源性膀胱护理指南(2011年版)(二)[J].中华护理杂志,2011,46(2):210-216.
[10]国家技术监督局.经穴部位(GB12346-90)[M].北京:中国标准出版社,2009,8:20-21.
[11]王之虹.推拿学[M].北京:高等教育出版社,2007:75-81.
[12]李强.盐酸坦索罗辛治疗首次尿潴留的BPH患者疗效观察[J].临床泌尿外科杂志,2010,25(11):879-880.
[13]程瑞动,朱根应,叶祥明,等.不同时期针刺对不完全性脊髓损伤患者盆底肌及排尿功能的影响[J].中国康复理论与实践,2016,22(12):1438-1441.
[14]李华南,张海明,顾兵,等.针刺促进脊髓损伤后神经功能恢复的机制及相关信号通路的作用[J].中国康复理论与实践,2017,23(6):641-644.
[15]朱毅,李凝,励建安,等.脊髓损伤后神经源性膀胱尿潴留的针刺康复临床研究[J].中华全科医学,2010,8(12):1495-1497.
[16]唐卫东.综合性传统康复疗法对脊髓损伤后神经源性膀胱的疗效分析[J].中医临床研究,2012,4(3):32-33.
[17]Coco CT,Meenakshi-Sundaram B,Eldefrawy A,et al. A cross sec-tional single institution study of quality of life in adult patients withspina bifida[J]. Neurourol Urodyn,2018,37(5):1757-1763.