电针神经刺激疗法治疗间质性膀胱炎/膀胱疼痛综合征临床疗效分析
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摘要
目的:探讨电针神经刺激疗法治疗间质性膀胱炎/膀胱疼痛综合征(IC/PBS)的临床疗效。方法:将68例IC/PBS患者随机分为观察组和对照组,每组34例。观察组采用电针神经刺激疗法治疗,腹四穴、骶四穴左右两穴分别连接一对电极,腹四穴、骶四穴隔天交替治疗,每周治疗3次,每次治疗50 min,共治疗3个月;对照组采用肝素钠+利多卡因+碳酸氢钠+硫酸庆大霉素四联药物膀胱灌注治疗,每周灌注2次,灌注6～8周,之后每月2次,灌注3个月,灌注液保留1 h后排出。两组患者分别在治疗前、治疗1、3个月及治疗后6个月记录O’Leary-Sant评分[间质性膀胱炎症状指数(ICSI)、间质性膀胱炎问题指数(ICPI)评分]、24h排尿次数、视觉模拟量表(VAS)评分及最大膀胱容量,并观察治疗期间不良反应。结果:两组患者治疗1、3个月及治疗后6个月时O’Leary-Sant(ICSI、ICPI)评分、24 h排尿次数、VAS评分及最大膀胱容量,与治疗前相比均有所改善(均P<0.05);观察组ICSI评分、ICPI评分、VAS评分、24 h排尿次数与对照组比较均明显降低,差异均有统计学意义(P<0.05);观察组最大膀胱容量与对照组比较均明显增加(P<0.05)。治疗后6个月随访,观察组总有效率为87.5%(28/32),高于对照组的69.7%(23/33,P<0.01)。所有患者在治疗期间均未发生明显的不良事件。结论:电针神经刺激疗法能有效缓解间质性膀胱炎/膀胱疼痛综合征患者的临床症状,其远期疗效有待进一步观察。
Objective To explore the clinical efficacy of electroacupuncture nerve stimulation therapy(ENST) for interstitial cystitis/painful bladder syndrome(IC/PBS). Methods A total of 68 patients with IC/PBS were randomly divided into an observation group and a control group, 34 cases in each one. The patients in the observation group were treated with ENST; abdominal four acupoints and sacral four acupoints were connected with a pair of electrodes and treated alternately every other day. The ENST was given 50 min per times, three times a week for 3 months. The patients in the control group were treated with perfusion therapy of four-medication combination(heparin sodinm, lidocaine,sodium bicarbonate, gentamicin sulfate), twice a week for the first 6-8 weeks, followed by twice per month for 3 months. The infusion fluid remained for 1 h before discharging. The O' Leary-Sant score, including interstitial cystitis symptom index(ICSI) and interstitial cystitis problem index(ICPI), 24 h urination frequency, visual analogue scale(VAS) and maximum bladder volume were observed before treatment and treatment of 1 month, 3 months and 6 months after treatment respectively; the adverse events during the treatment were also recorded. Results Compared before treatment, the O'Leary-Sant score(ICSI, ICPI), 24 h urination frequency, VAS and maximum bladder volume in the two groups were improved after 1, 3 months treatment and 6 months after treatment(all P<0.05). The scores of ICSI, ICPI, VAS and 24 h urination frequency in the observation group were significantly lower than those in the control group(P<0.05). The maximum bladder volume in the observation group was significantly higher than that in the control group(P<0.05). Six months after treatment, the total effective rate in the observation group was 87.5%(28/32), which was higher than 69.7%(23/33) in the control group(P<0.01). No significant adverse events occurred during the treatment. Conclusion ENST could effectively relieve the clinical symptoms of IC/PBS, but its long-term efficacy needs further observation.
Objective To explore the clinical efficacy of electroacupuncture nerve stimulation therapy(ENST) for interstitial cystitis/painful bladder syndrome(IC/PBS). Methods A total of 68 patients with IC/PBS were randomly divided into an observation group and a control group, 34 cases in each one. The patients in the observation group were treated with ENST; abdominal four acupoints and sacral four acupoints were connected with a pair of electrodes and treated alternately every other day. The ENST was given 50 min per times, three times a week for 3 months. The patients in the control group were treated with perfusion therapy of four-medication combination(heparin sodinm, lidocaine,sodium bicarbonate, gentamicin sulfate), twice a week for the first 6-8 weeks, followed by twice per month for 3 months. The infusion fluid remained for 1 h before discharging. The O' Leary-Sant score, including interstitial cystitis symptom index(ICSI) and interstitial cystitis problem index(ICPI), 24 h urination frequency, visual analogue scale(VAS) and maximum bladder volume were observed before treatment and treatment of 1 month, 3 months and 6 months after treatment respectively; the adverse events during the treatment were also recorded. Results Compared before treatment, the O'Leary-Sant score(ICSI, ICPI), 24 h urination frequency, VAS and maximum bladder volume in the two groups were improved after 1, 3 months treatment and 6 months after treatment(all P<0.05). The scores of ICSI, ICPI, VAS and 24 h urination frequency in the observation group were significantly lower than those in the control group(P<0.05). The maximum bladder volume in the observation group was significantly higher than that in the control group(P<0.05). Six months after treatment, the total effective rate in the observation group was 87.5%(28/32), which was higher than 69.7%(23/33) in the control group(P<0.01). No significant adverse events occurred during the treatment. Conclusion ENST could effectively relieve the clinical symptoms of IC/PBS, but its long-term efficacy needs further observation.
引文
[1]Hanno PM,Erickson D,Moldwin R,et al.Diagnosis and treatment of interstitial cystitis/bladder pain syndrome:AUAguideline amendment[J].J Urol,2015,193(5):1545-1553.
[2]Gillenwater JY,Wein AJ.Summary of the national institute of arthritis,diabetes,digestive and kidney diseases workshop on interstitial cystitis,national institutes of health,Bethesda,Maryland,August 28-29,1987[J].J Urol,1988,140(1):203-206.
[3]van de Merwe JP,Nordling J,Bouchelouche P,et al.Diagnostic criteria,classification,and nomenclature for painful bladder syndrome/interstitial cystitis:an ESSIC proposal[J].Eur Urol,2008,53(1):60-67.
[4]Wang SY,Feng JW,Lv XM.Efficacy of Electrical Pudendal Nerve Stimulation versus Transvaginal Electrical Stimulation in Treating Female Idiopathic Urgency Urinary Incontinence[J].JUrol,2017,197(6):1496-1501.
[5]O’Leary MP,Sant GR,Fowler FJ Jr,et al.The interstitial cystitis symptom index and problem index[J].Urology,1997,49(5A Suppl):58-63.
[6]Shao Y,Shen ZJ,Rui WB,et a1.Intravesical instillation of hyaluronic acid prolonged the effect of bladder hydrodistention in patients with severe interstitial cystitis[J].Urology,2010,75(3):547-550.
[7]Theoharides TC1,Whitmore K,Stanford E,et al.Interstitial cystitis:bladder pain and beyond[J].Expert Opin Pharmacother2008,9(17):2979-2994.
[8]李杰荣,刘国庆,王剑锋,等.A型肉毒毒素注射治疗女性间质性膀胱炎/膀胱疼痛综合征的效果[J].广东医学,2015,36(24):3853-3856.
[9]方志伟,张晓鹏,胡浩,等.四联药物与透明质酸钠膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征的疗效比较[J].中华泌尿外科杂志,2015,36(4):280-284.
[10]田钰,廖利民.间质性膀胱炎治疗的研究进展[J].中国康复理论与实践,2013,19(9):856-859.
[11]Dawson TE,Jamison J.Intravesical treatments for painful bladder syndrome/interstitial cystitis[J/CD].Cochrane Database Syst Rev,2007,17(4):CD006113.
[12]吕坚伟,薛蔚,冷静,等.碱化利多卡因联合肝素膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎215例报告[J].中华泌尿外科杂志,2008,29(1):54-56.
[13]Wein AJ.Re:Long-Term Outcomes of Intravesical Dimethyl Sulfoxide/Heparin/Hydrocortisone Therapy for Interstitial Cystitis/Bladder Pain Syndrome[J].J Urol,2018,199(4):897-898.
[14]Nickel JC1,Moldwin R,Lee S,et al.Intravesical alkalinized lidocaine(PSD597)offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome[J].BJU Int,2009,103(7):910-918.
[15]Wang J,Chen Y,Chen J,et al.Sacral Neuromodulation for Refractory Bladder Pain Syndrome/Interstitial Cystitis:a Global Systematic Review and Meta-analysis[J].Sci Rep,2017,7(1):11031.
[16]张耀光,王建业,张大磊,等.骶神经调节治疗膀胱疼痛综合征间质性膀胱炎患者的初步临床结果[J].中华泌尿外科杂志,2015,36(2):91-94.
[17]伊庆同,吕坚伟,王咏蕾,等.经皮穿刺腹下交感神经阻滞治疗难治性间质性膀胱炎/膀胱疼痛综合征[J].上海交通大学学报(医学版),2016,36(3):380-384.
[18]Wang SY,Zhang SJ,Zhao L.Long-term efficacy of electrical pudendal nerve stimulation for urgency-frequency syndrome in women[J].Int Urogynecol J,2014,25(3):397-402.
[19]吴定宗,杨立平,邓春雷.针刺对下丘脑后部与延髓排尿中枢及膀胱机能的影响[J].中国针灸,1982,2(5):15.
[20]汪司右,张淑静.电针阴部神经刺激疗法治疗女性压力性尿失禁的临床疗效和作用机制[J].中华泌尿外科杂志,2013,34(8):575-578.
[21]Wang SY,Lv JW,Feng XM,et al.Efficacy of Electrical Pudendal Nerve Stimulation versus Transvaginal Electrical Stimulation in Treating Female Idiopathic Urgency Urinary Incontinence[J].J Urol,2017,197(6):1496-1501.
[22]孟鹏.电针神经刺激疗法与舍尼亭治疗女性尿频尿急综合征的临床比较研究[D].上海:上海中医药大学,2014.
[2]Gillenwater JY,Wein AJ.Summary of the national institute of arthritis,diabetes,digestive and kidney diseases workshop on interstitial cystitis,national institutes of health,Bethesda,Maryland,August 28-29,1987[J].J Urol,1988,140(1):203-206.
[3]van de Merwe JP,Nordling J,Bouchelouche P,et al.Diagnostic criteria,classification,and nomenclature for painful bladder syndrome/interstitial cystitis:an ESSIC proposal[J].Eur Urol,2008,53(1):60-67.
[4]Wang SY,Feng JW,Lv XM.Efficacy of Electrical Pudendal Nerve Stimulation versus Transvaginal Electrical Stimulation in Treating Female Idiopathic Urgency Urinary Incontinence[J].JUrol,2017,197(6):1496-1501.
[5]O’Leary MP,Sant GR,Fowler FJ Jr,et al.The interstitial cystitis symptom index and problem index[J].Urology,1997,49(5A Suppl):58-63.
[6]Shao Y,Shen ZJ,Rui WB,et a1.Intravesical instillation of hyaluronic acid prolonged the effect of bladder hydrodistention in patients with severe interstitial cystitis[J].Urology,2010,75(3):547-550.
[7]Theoharides TC1,Whitmore K,Stanford E,et al.Interstitial cystitis:bladder pain and beyond[J].Expert Opin Pharmacother2008,9(17):2979-2994.
[8]李杰荣,刘国庆,王剑锋,等.A型肉毒毒素注射治疗女性间质性膀胱炎/膀胱疼痛综合征的效果[J].广东医学,2015,36(24):3853-3856.
[9]方志伟,张晓鹏,胡浩,等.四联药物与透明质酸钠膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征的疗效比较[J].中华泌尿外科杂志,2015,36(4):280-284.
[10]田钰,廖利民.间质性膀胱炎治疗的研究进展[J].中国康复理论与实践,2013,19(9):856-859.
[11]Dawson TE,Jamison J.Intravesical treatments for painful bladder syndrome/interstitial cystitis[J/CD].Cochrane Database Syst Rev,2007,17(4):CD006113.
[12]吕坚伟,薛蔚,冷静,等.碱化利多卡因联合肝素膀胱灌注治疗膀胱疼痛综合征/间质性膀胱炎215例报告[J].中华泌尿外科杂志,2008,29(1):54-56.
[13]Wein AJ.Re:Long-Term Outcomes of Intravesical Dimethyl Sulfoxide/Heparin/Hydrocortisone Therapy for Interstitial Cystitis/Bladder Pain Syndrome[J].J Urol,2018,199(4):897-898.
[14]Nickel JC1,Moldwin R,Lee S,et al.Intravesical alkalinized lidocaine(PSD597)offers sustained relief from symptoms of interstitial cystitis and painful bladder syndrome[J].BJU Int,2009,103(7):910-918.
[15]Wang J,Chen Y,Chen J,et al.Sacral Neuromodulation for Refractory Bladder Pain Syndrome/Interstitial Cystitis:a Global Systematic Review and Meta-analysis[J].Sci Rep,2017,7(1):11031.
[16]张耀光,王建业,张大磊,等.骶神经调节治疗膀胱疼痛综合征间质性膀胱炎患者的初步临床结果[J].中华泌尿外科杂志,2015,36(2):91-94.
[17]伊庆同,吕坚伟,王咏蕾,等.经皮穿刺腹下交感神经阻滞治疗难治性间质性膀胱炎/膀胱疼痛综合征[J].上海交通大学学报(医学版),2016,36(3):380-384.
[18]Wang SY,Zhang SJ,Zhao L.Long-term efficacy of electrical pudendal nerve stimulation for urgency-frequency syndrome in women[J].Int Urogynecol J,2014,25(3):397-402.
[19]吴定宗,杨立平,邓春雷.针刺对下丘脑后部与延髓排尿中枢及膀胱机能的影响[J].中国针灸,1982,2(5):15.
[20]汪司右,张淑静.电针阴部神经刺激疗法治疗女性压力性尿失禁的临床疗效和作用机制[J].中华泌尿外科杂志,2013,34(8):575-578.
[21]Wang SY,Lv JW,Feng XM,et al.Efficacy of Electrical Pudendal Nerve Stimulation versus Transvaginal Electrical Stimulation in Treating Female Idiopathic Urgency Urinary Incontinence[J].J Urol,2017,197(6):1496-1501.
[22]孟鹏.电针神经刺激疗法与舍尼亭治疗女性尿频尿急综合征的临床比较研究[D].上海:上海中医药大学,2014.