摘要
目的:观察电针双侧次髎、中髎、会阳治疗脊髓源性逼尿肌活动过度尿失禁的临床疗效。
方法:将本人导师刘志顺主任诊治的脊髓源性逼尿肌活动过度尿失禁符合纳入标准的20例患者全部纳入本研究研究。其中男45%(9例),女55%(11例)。年龄范围为5岁至83岁,病程范围为2.5个月至40年,病程小于或等于1年者8例,病程大于1年者12例。观察20例患者的脊髓损伤包括物理损伤(如,外伤、手术伤、放疗伤、压迫等)14例,以及病理损伤(如,急性脊髓炎,脱髓鞘型脊髓炎,多系统萎缩等)6例。电针双侧中髎、次髎、会阳穴,每周治疗5次,周六、周日休息,连续治疗4周。疗效评价基于患者排尿日记及患者对治疗的自我评价。
结果:
①主要疗效指标:治疗4周后20例患者每周尿失禁实际次数较治疗前显著减少(P<0.05),每天排尿急迫次数较治疗前显著减少(P<0.05)。排尿急迫程度治疗后较治疗前显著减轻(P<0.05)。
②次要疗效指标:治疗4周后20例患者24h排尿次数较治疗前明显减少(P<0.05),每天夜尿次数较治疗前明显减少(P<0.05),每周使用尿垫个数较治疗前明显减少(P<0.05)。
患者对电针治疗的自我评价,20例患者中认为4周治疗非常有效的为8例(40%),认为治疗有效的为6例(30%),认为治疗无效的为6例(30%)。
③不同损伤类型尿失禁的疗效差别:本组观察两种不同类型脊髓损伤在电针治疗4周后每周尿失禁次数、每天排尿急迫次数以及24h排尿次数无显著差异(P>0.05),治疗4周后每天夜尿次数及每周尿垫使用个数无显著差异(P>0.05)。
结论:
①电针次髎、中髎、会阳治疗脊髓源性逼尿肌活动过度尿失禁4周,可显著减少每周尿失禁实际次数,同时显著减少排尿急迫次数及急迫程度。
②在本次观察的20例脊髓源性逼尿肌活动过度尿失禁患者中,电针治疗对物理损伤(如,外伤、手术伤、放疗伤、压迫等)的效果与对病理损伤(如,急性脊髓炎,脱髓鞘型脊髓炎,多系统萎缩等)的治疗效果无明显差异。
③电针可操作性强,费用低廉,是一种安全的、有良好耐受性的治疗方法,适合临床推广应用。
Object: To observe the clinical effects of using electrical acupuncture on BL-32 (Ciliao), BL-33 (Zhongliao), BL-35 (Huiyang) to treat urinary incontinence patients of detrusor hyperreflexia caused by spinal injury.
Method: The study type of this research is series study. Twenty patients who reach the including criteria of urinary incontinence of detrusor hyperreflexia caused by spinal injury were enrolled out of the 98 urinary incontinence cases from Dem. 1st , 2007 to Mar. 31st, 2008. Among them, there are 9 male cases (45%) and 11 female cases (55%). The age ranger is from 5 to 83. The disease duration is from 2.5 months to 40 years. There are 8 cases whose disease duration is less than one year. And the case of more than one year is 12. The spinal injury contains 14 cases of physical injury (eg, trauma, surgery, radiation, pressing), and 6 cases of pathological change (eg, acute myelitis, demyelination, multiple system atrophy). The electric acupuncture treatment is to stimulate BL-32 (Ciliao), BL-33 (Zhongliao), BL-35 (Huiyang) on both sides. Patient receives treatment five times a week and takes a rest on Saturday and Sunday. The treatment continues for four weeks. And the clinical effect is evaluated by the patients’voiding diary and their self-evaluation of the treatment.
Result:①Primary outcome measurement: After 4 week treatment, the urinary incontinence times per week, the urgency times, and the pad used per week decrease obviously compared to pre-treatment (P<0.05).
In the self-evaluation to the treatment, eight patients (40%) think the treatment is very effective. Seven of them (87.5%) are physical injury, and one of them (12.5%) is pathological injury. Six patients (30%) think the treatment is effective. Among them, two (33.3%) are physical injury cases. And four of them (66.7%) are pathological changes. Six of them (30%) view the treatment is ineffective. Among them, four (66.7%) are physical injury cases. And two (33.3%) are pathological changes.
②Secondary outcome measurement: After four week treatment, the 24 hour voiding times, night urinary times, and the pad used per week decrease obviously (P In the patient’s self-evaluation to the treatment, eight of them (40%) think the treatment is very effective; six of them (30%) think is effect; and six of them (30%) think it’s ineffective.
③There is no obvious difference between the physical injury case and the pathological case on the aspect of urinary incontinence time per week, urgency time per day, night urine time, the 24 hour voiding time, and pad used per week (P>0.05).
Conclusion:①Electric acupuncture can decrease urinary incontinence per week, and urgency time per day and the urgency level obviously.②There is no obvious difference between physical injury and pathological injury.③Electric acupuncture is easy to be practiced and cheap. It is a safe therapy with good tolerance. It is suitable to practice in the clinic.
引文
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