芒针对脊髓损伤后尿潴留患者的尿动力学影响
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摘要
目的:探索芒针在治疗脊髓损伤后尿潴留方面的临床意义。方法:2016年1月至2018年6月收治60例脊髓损伤后尿潴留的患者,分为芒针组和毫针组,每组30例,治疗穴位选取秩边和水道。芒针组男23例,女7例,年龄(52±9)岁,治疗予以芒针偶刺双侧穴位,并接电针仪30 min,频率3 Hz,治疗30 min;毫针组男24例,女6例,年龄(56±10)岁,治疗予毫针针刺双侧穴位后,留针30 min;两组的治疗频率都是隔日1次,在治疗2个月后通过分析两组患者达到平衡膀胱的时间、排尿日记、尿动力学指标和尿路感染情况等指标,发掘芒针在治疗该疾病的临床意义。结果:(1)平衡膀胱达到的时间:芒针组(39.5±1.2) d,毫针组(46.5±2.1) d;两组达到平衡膀胱的时间比较差异有统计学意义(P<0.05)。(2)两组患者的排尿日记比较,通过组内比较,两组患者治疗后的每日导尿次数、每次导尿量、每日排尿次数、每次排尿量优于治疗前(P<0.05);通过组间比较,在治疗后芒针组患者的每日导尿次数、每次导尿量、每日排尿次数、每次排尿量等指标的改善优于毫针组(P<0.05)。(3)两组患者的尿路感染改善情况比较:两组患者治疗后尿路感染情况均改善,芒针组的尿路感染改善率优于毫针组(P<0.05)。(4)两组患者尿动力学指标的比较:通过组内比较,两组患者治疗后的膀胱容量(VH2O),膀胱压力(pressure vesical,Pves),逼尿肌压力(pressure detrusor,Pdet),平均尿流速(Qave),最大尿流速(Qmax),膀胱顺应性(bladder compliance,BC)等优于治疗前(P<0.05);通过组间比较,在治疗后芒针组患者的VH_2O、Pves、Pdet、Qave、Qmax、BC等指标的改善优于毫针组(P<0.05)。结论:芒针在改善脊髓损伤后尿潴留患者的排尿状况、尿路感染和尿动力学方面要优于毫针针刺,对提高脊髓损伤后尿潴留患者生活质量具有积极意义,值得在临床上推广应用。
Objective:To explore the clinical significance of elongated needle in the treatment of urinary retention after spinal cord injury. Methods:From January 2016 to June 2018,60 patients with urinary retention after spinal cord injury were divided into elongated needle acupuncture group and needle acupuncture group,30 cases in each group. The Shuidao(ST28)and Zhibian(BL54) were selected as the treatment of acupoints. In the elongated needle group,there were 23 males and 7 females,with a mean age of(52±9) years old. The patients in this group were treated on both sides,and the electro acupuncture apparatus was used for 30 minutes at frequencies of 3 Hz for 30 minutes. In needle group,there were 24 males and 6 females,with a mean age of(56±10) years old. After treatment,the needles were retained for 30 minutes. The treatment frequencies of both groups were once every other day and passed for 2 months. After 2 months of treatment,the clinical significances of the treatment of the disease were explored by analyzing the time between the two groups of patients to reach the equilibrium bladder,diary urinary diary,urodynamics and urinary tract infection between the two groups. Results:(1)Time to reach the equilibrium bladder:(39.5±1.2) days in elongated needle group and(46.5±2.1) days in needle group; the time to reach the equilibrium bladder in the two groups was significantly different(P <0.05).(2)Comparison of urination diary between the two groups:the daily number of catheterization,the amount of each catheterization,the number of daily urination,and the amount of urine per urination after treatment were better than those before treatment by intra group comparison(P<0.05);the number of daily catheterization,the amount of daily catheterization,the number of daily urination,and the amount of urine output per patient in elongated needle group were better than those in needle group by comparison between two groups(P<0.05).(3)Comparison of improvement of urinary tract infection between the two groups :the urinary tract infection were better than that before treatmant in each group by intra group comparison;the improvement rate of urinary tract infection in awn needle group(1/3.3%) was higher than that in needle group(5/16.7%),with significantly differences.(4)Comparison of urodynamic index between two groups:by intra group comparison,the VH_2O,Pves,Pdet,Qave,Qmax,and BC of the two groups were better than those before treatment(P<0.05); By comparison between two groups,the improvement of VH2O,Pves,Pdet,Qave,Qmax and BC were better than those of the needle group(all P<0.05). Conclusion:The elongated needle is better than conventional needle in improving urinary retention,urinary tract infection and urodynamic index in patients with urinary retention after spinal cord injury. It has positive significance in improving patients' quality of life and is worth applying to clinical.
Objective:To explore the clinical significance of elongated needle in the treatment of urinary retention after spinal cord injury. Methods:From January 2016 to June 2018,60 patients with urinary retention after spinal cord injury were divided into elongated needle acupuncture group and needle acupuncture group,30 cases in each group. The Shuidao(ST28)and Zhibian(BL54) were selected as the treatment of acupoints. In the elongated needle group,there were 23 males and 7 females,with a mean age of(52±9) years old. The patients in this group were treated on both sides,and the electro acupuncture apparatus was used for 30 minutes at frequencies of 3 Hz for 30 minutes. In needle group,there were 24 males and 6 females,with a mean age of(56±10) years old. After treatment,the needles were retained for 30 minutes. The treatment frequencies of both groups were once every other day and passed for 2 months. After 2 months of treatment,the clinical significances of the treatment of the disease were explored by analyzing the time between the two groups of patients to reach the equilibrium bladder,diary urinary diary,urodynamics and urinary tract infection between the two groups. Results:(1)Time to reach the equilibrium bladder:(39.5±1.2) days in elongated needle group and(46.5±2.1) days in needle group; the time to reach the equilibrium bladder in the two groups was significantly different(P <0.05).(2)Comparison of urination diary between the two groups:the daily number of catheterization,the amount of each catheterization,the number of daily urination,and the amount of urine per urination after treatment were better than those before treatment by intra group comparison(P<0.05);the number of daily catheterization,the amount of daily catheterization,the number of daily urination,and the amount of urine output per patient in elongated needle group were better than those in needle group by comparison between two groups(P<0.05).(3)Comparison of improvement of urinary tract infection between the two groups :the urinary tract infection were better than that before treatmant in each group by intra group comparison;the improvement rate of urinary tract infection in awn needle group(1/3.3%) was higher than that in needle group(5/16.7%),with significantly differences.(4)Comparison of urodynamic index between two groups:by intra group comparison,the VH_2O,Pves,Pdet,Qave,Qmax,and BC of the two groups were better than those before treatment(P<0.05); By comparison between two groups,the improvement of VH2O,Pves,Pdet,Qave,Qmax and BC were better than those of the needle group(all P<0.05). Conclusion:The elongated needle is better than conventional needle in improving urinary retention,urinary tract infection and urodynamic index in patients with urinary retention after spinal cord injury. It has positive significance in improving patients' quality of life and is worth applying to clinical.
引文
[1]Estores IM.The consumer's perspective and the professional literature:what do persons with spinal cord injury want[J].J Rehabil Res Dev,2003,40(4 Suppl 1):93-98.
[2]侯春林.脊髓损伤后膀胱功能重建[J].解放军医学杂志,2003,28(8):663-665.HOU CL.Reconstruction of bladder function after spinal cord injury[J].Jie Fang Jun Yi Xue Za Zhi,2003,28(8):663-665.Chinese.
[3]王方永,李建军.脊髓损伤神经学分类国际标准(ASIA 2011版)最新修订及标准解读[J].中国康复理论与实践,2012,18(8):797-800.WANG YF,LI JJ.Modification and interpretation of ASIA 2011[J].Zhongguo Kang Fu Li Lun Yu Shi Jian,2012,18(8):797-800.Chinese.
[4]周凌云,李杰,李春梅,等.电针八、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.ZHOU LY,LI J,LI CM,et al.Observation on therapeutic effect of eIectroacupuncture at points Baliao and Huiyang(BL 35)on retention of urine induced by spinal cord injury[J].Zhongguo Zhen Jiu,2006,26(4):237-239.Chinese.
[5]杨玉霞,项蓉,刘艳艳,等.十二井穴接经针刺配合膀胱功能训练治疗中风后尿潴留临床研究[J].中国针灸,2017,37(10):1041-1044.YANG YX,XIANG R,LIU YY,et al.Clinical study on post stroke urinary retention treated with acupuncture at the twelve jing well points and bladder function training[J].Zhongguo Zhen Jiu,2017,37(10):1041-1044.Chinese.
[6]沈雅萍,金剑,王爱娟,等.个体化膀胱功能训练治疗脊髓损伤后神经源性膀胱患者的疗效观察[J].中华物理医学与康复杂志,2015,37(1):48-51.SHEN YP,JIN J,WANG AJ,et al.Effects of individualized bladder training therapy in neurogenie bladder patients after spinal cord injury[J].Zhonghua Wu Li Yi Xue Yu Kang Fu Za Zhi,2015,37(1):48-51.Chinese.
[7]Broeren MA,Bah觭eci S,Vader HL,et al.Screening for urinary tract infection with the Sysmex UF-1000i urine flow cytometer[J].J Clin Microbiol,2011,49(3):1025-1029.
[8]宋丰军,蒋松鹤,郑士立,等.电针治疗中风后尿失禁:多中心随机对照研究[J].中国针灸,2013,33(9):769-773.SONG FJ,JIANG SH,ZHENG SL,et al.Electroacupuncture for post stroke urinary incontinence:a multi center randomized controlled study[J].Zhongguo Zhen Jiu,2013,33(9):769-773.Chinese.
[9]时美芳,朱美红,沈雅萍,等.尿动力学分析结合膀胱再训练对脊髓损伤后神经源性膀胱功能的影响[J].中华物理医学与康复杂志,2017,39(10):756-760.SHI MF,ZHU MH,SHEN YP,et al.The effects of urodynamic analysis and individuaIized bladder training on bladder functiOn after spinal cord injury[J].Zhonghua Wu Li Yi Xue Yu Kang Fu Za Zhi,2017,39(10):756-760.Chinese.
[10]Bablumyan A,Kamalov A,Kirpatovski V,et al.Relationship of acute urinary retention,bladder ischemia and metabolic changes in bladder wall and urine during infravesical obstruction due to benign prostatic hyperplasia[J].Georgian Med News,2011,11(200):18-20.
[11]Torres B,Serakides R,Caldeira F,et al.The ameliorating effect of dantrolene on the morphology of urinary bladder in spinal cord injured rats[J].Pathol Res Pract,2011,207(12):775-779.
[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]Kruse M N,Bray L A,de Groat W C.Influence of spinal cord injury on the morphology of bladder afferent and efferent neurons[J].J Auton Nerv Syst,1995,54(3):215-224.
[14]Vizzard M A.Neurochemical plasticity and the role of neurotrophic factors in bladder reflex pathways after spinal cord injury[J].Prog Brain Res,2006,152(6):97-115.
[15]张大田,张春阳,司淑斌.大鼠脊髓损伤后尿动力学改变及P2X3表达的研究[J].中国医学工程,2010,18(4):31-32.ZHANG DT,ZHANG CY,SI SB.Study on urodynamics change and P2X3 expression of spinal cord injured rats[J].Zhongguo Yi Xue Gong Cheng,2010,18(4):31-32.Chinese.
[16]侯春林,张世民,衷鸿宾,等.脊髓损伤后的排尿功能重建[J].现代康复,2000,126(8):688-696.HOU CL,ZHANG SM,ZHONG HB,et al.Functional reconstruction of controlled micturition in spinal cord injury[J].Xian Dai Kang Fu,2000,126(8):688-696.Chinese.
[17]刘佳琪,刘志顺,于金娜,等.针灸治疗脊髓损伤后神经源性膀胱功能障碍的系统评价[J].河南中医,2018,38(3):467-472.LIU JQ,LIU ZS,YU JN,et al.Systematic evaluation of acupuncture for the treatment of neurogenic bladder dysfunction after spinal cord injury[J].He Nan Zhong Yi,2018,38(3):467-472.Chinese.
[18]全仁夫,胡华辉,黄小龙,等.电针秩边穴和水道穴对急性脊髓不完全损伤大鼠脑皮质代谢物的影响[J].中医正骨,2016,28(11):1-6.QUAN RF,HU HH,HUANG XL,et al.Effect of electroacupuncture at Point BL54(Zhibian)and Point ST28(Shuidao)on cerebral cortex metabolites in rats with acute incomplete spinal cord injuries[J].Zhong Yi Zheng Gu,2016,28(11):1-6.Chinese.
[19]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.QUAN RF,CHEN RL,XU SC,et al.Awn needle therapy on the impact of urinary retention after spinal cord injury[J].Zhongguo Gu Shang/China J Orthop Trauma,2013,26(1):54-58.Chinese with abstract in English.
[20]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.LIU BG,JI LX,HAO CY,et al.Anatomic basis of Zhibian through Shuidao method for treatment of chronic prostatitis[J].Zhongguo Zhen Jiu,2001,21(2):91-93.Chinese.
[2]侯春林.脊髓损伤后膀胱功能重建[J].解放军医学杂志,2003,28(8):663-665.HOU CL.Reconstruction of bladder function after spinal cord injury[J].Jie Fang Jun Yi Xue Za Zhi,2003,28(8):663-665.Chinese.
[3]王方永,李建军.脊髓损伤神经学分类国际标准(ASIA 2011版)最新修订及标准解读[J].中国康复理论与实践,2012,18(8):797-800.WANG YF,LI JJ.Modification and interpretation of ASIA 2011[J].Zhongguo Kang Fu Li Lun Yu Shi Jian,2012,18(8):797-800.Chinese.
[4]周凌云,李杰,李春梅,等.电针八、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.ZHOU LY,LI J,LI CM,et al.Observation on therapeutic effect of eIectroacupuncture at points Baliao and Huiyang(BL 35)on retention of urine induced by spinal cord injury[J].Zhongguo Zhen Jiu,2006,26(4):237-239.Chinese.
[5]杨玉霞,项蓉,刘艳艳,等.十二井穴接经针刺配合膀胱功能训练治疗中风后尿潴留临床研究[J].中国针灸,2017,37(10):1041-1044.YANG YX,XIANG R,LIU YY,et al.Clinical study on post stroke urinary retention treated with acupuncture at the twelve jing well points and bladder function training[J].Zhongguo Zhen Jiu,2017,37(10):1041-1044.Chinese.
[6]沈雅萍,金剑,王爱娟,等.个体化膀胱功能训练治疗脊髓损伤后神经源性膀胱患者的疗效观察[J].中华物理医学与康复杂志,2015,37(1):48-51.SHEN YP,JIN J,WANG AJ,et al.Effects of individualized bladder training therapy in neurogenie bladder patients after spinal cord injury[J].Zhonghua Wu Li Yi Xue Yu Kang Fu Za Zhi,2015,37(1):48-51.Chinese.
[7]Broeren MA,Bah觭eci S,Vader HL,et al.Screening for urinary tract infection with the Sysmex UF-1000i urine flow cytometer[J].J Clin Microbiol,2011,49(3):1025-1029.
[8]宋丰军,蒋松鹤,郑士立,等.电针治疗中风后尿失禁:多中心随机对照研究[J].中国针灸,2013,33(9):769-773.SONG FJ,JIANG SH,ZHENG SL,et al.Electroacupuncture for post stroke urinary incontinence:a multi center randomized controlled study[J].Zhongguo Zhen Jiu,2013,33(9):769-773.Chinese.
[9]时美芳,朱美红,沈雅萍,等.尿动力学分析结合膀胱再训练对脊髓损伤后神经源性膀胱功能的影响[J].中华物理医学与康复杂志,2017,39(10):756-760.SHI MF,ZHU MH,SHEN YP,et al.The effects of urodynamic analysis and individuaIized bladder training on bladder functiOn after spinal cord injury[J].Zhonghua Wu Li Yi Xue Yu Kang Fu Za Zhi,2017,39(10):756-760.Chinese.
[10]Bablumyan A,Kamalov A,Kirpatovski V,et al.Relationship of acute urinary retention,bladder ischemia and metabolic changes in bladder wall and urine during infravesical obstruction due to benign prostatic hyperplasia[J].Georgian Med News,2011,11(200):18-20.
[11]Torres B,Serakides R,Caldeira F,et al.The ameliorating effect of dantrolene on the morphology of urinary bladder in spinal cord injured rats[J].Pathol Res Pract,2011,207(12):775-779.
[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]Kruse M N,Bray L A,de Groat W C.Influence of spinal cord injury on the morphology of bladder afferent and efferent neurons[J].J Auton Nerv Syst,1995,54(3):215-224.
[14]Vizzard M A.Neurochemical plasticity and the role of neurotrophic factors in bladder reflex pathways after spinal cord injury[J].Prog Brain Res,2006,152(6):97-115.
[15]张大田,张春阳,司淑斌.大鼠脊髓损伤后尿动力学改变及P2X3表达的研究[J].中国医学工程,2010,18(4):31-32.ZHANG DT,ZHANG CY,SI SB.Study on urodynamics change and P2X3 expression of spinal cord injured rats[J].Zhongguo Yi Xue Gong Cheng,2010,18(4):31-32.Chinese.
[16]侯春林,张世民,衷鸿宾,等.脊髓损伤后的排尿功能重建[J].现代康复,2000,126(8):688-696.HOU CL,ZHANG SM,ZHONG HB,et al.Functional reconstruction of controlled micturition in spinal cord injury[J].Xian Dai Kang Fu,2000,126(8):688-696.Chinese.
[17]刘佳琪,刘志顺,于金娜,等.针灸治疗脊髓损伤后神经源性膀胱功能障碍的系统评价[J].河南中医,2018,38(3):467-472.LIU JQ,LIU ZS,YU JN,et al.Systematic evaluation of acupuncture for the treatment of neurogenic bladder dysfunction after spinal cord injury[J].He Nan Zhong Yi,2018,38(3):467-472.Chinese.
[18]全仁夫,胡华辉,黄小龙,等.电针秩边穴和水道穴对急性脊髓不完全损伤大鼠脑皮质代谢物的影响[J].中医正骨,2016,28(11):1-6.QUAN RF,HU HH,HUANG XL,et al.Effect of electroacupuncture at Point BL54(Zhibian)and Point ST28(Shuidao)on cerebral cortex metabolites in rats with acute incomplete spinal cord injuries[J].Zhong Yi Zheng Gu,2016,28(11):1-6.Chinese.
[19]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.QUAN RF,CHEN RL,XU SC,et al.Awn needle therapy on the impact of urinary retention after spinal cord injury[J].Zhongguo Gu Shang/China J Orthop Trauma,2013,26(1):54-58.Chinese with abstract in English.
[20]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.LIU BG,JI LX,HAO CY,et al.Anatomic basis of Zhibian through Shuidao method for treatment of chronic prostatitis[J].Zhongguo Zhen Jiu,2001,21(2):91-93.Chinese.