第九十一期:电刺激治疗神经源性膀胱感觉功能障碍的疗效观察
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电刺激治疗神经源性膀胱感觉功能障碍的疗效观察
作者:吴娟 廖利民 万里 付 光等
临床单位:中国康复研究中心北京博爱医院泌尿科

摘要
目的:
观察电刺激治疗神经源性膀胱感觉功能障碍的疗效。

方法:在2009年3月~2010年10月收治的神经源性膀胱患者中,选取以膀胱感觉功能障碍为主诉、经查体和尿动力学检查证实存在膀胱感觉功能障碍的患者38例,其中18例接受电刺激治疗(治疗组),男 11例,女7例,年龄23~50岁,平均31.4 岁,完全性脊髓损伤患者10例,不完全性脊髓损伤患者8例,病程1~32个月,平均7.2个月;其余 20例不接受电刺激治疗,为对照组,男15例,女5例,年龄21~48岁,平均28.6岁,完全性脊髓损伤患者13例,不完全性脊髓损伤患者7例,病程1~27个月,平均6.9个月。尿动力学检查:治疗组中10例膀胱感觉消失,8例膀胱感觉减弱;对照组中11例膀胱感觉消失,9 例膀胱感觉减弱。两组年龄、性别、膀胱感觉障碍类型相匹配。治疗组除常规训练外,每天先后进行膀胱腔内电刺激和经皮膀胱电刺激各1次;对照组只进行常规膀胱训练,不行电刺激治疗,1个月后比较两组患者膀胱感觉变化情况。

结果:治疗组11例膀胱感觉获得不同程度改善,7例膀胱感觉无变化;8例膀胱感觉减弱患者平均初始尿意膀胱容量和强烈尿意膀胱容量治疗前分别为414±46ml、540±42ml,治疗后分别为255±41ml、420±82ml,治疗前后比较有显著性差异(P<0.05)。对照组治疗前后膀胱感觉无明显变化,平均初始尿意膀胱容量和强烈尿意膀胱容量治疗前分别为466±37ml、562±45ml,治疗后分别为421±21ml、598±47ml,治疗前后比较无显著性差异(P>0.05)。治疗前平均初始尿意膀胱容量和强烈尿意膀胱容量两组间比较无显著性差异(P>0.05),治疗后平均初始尿意膀胱容量和强烈尿意膀胱容量两组间比较有显著性差异(P<0.05)。 

结论:综合电刺激治疗能改善部分神经源性膀胱患者的膀胱感觉功能。

Electric stimulation for neurogenic bladder sensory dysfunction
WU Juan, LIAO Li-min, WAN Li, et al.
Chinese Journal of Spine and Spinal Cord.

Abstract
Objectives:
To observe the effects of electric stimulation on neurogenic bladder sensation.

Methods: 38 cases complained of bladder sensory dysfunction and  diagnosed as neurogenic bladder by clinincal and urodynamic method from March 2009 to October 2010 were reviewed retrospectively. In the treatment  group, 18 patients(11 males and 7 females ) with a mean age of 31.4 years(23-50 years) received electric stimulation therapy, of them, 10 cases suffered from complete spinal cord injury and 8 cases suffered from incomplete spinal cord injury, the average duration was 7.2 months(range, 1-32 months); while the remaining 20 cases(15 males and 5 females)  with a mean age of 28.6 years(21-48 years) receiving no electric stimulation were referred as the control group, of them 13 cases suffered from complete  spinal  cord injury and 7 cases suffered from incomplete spinal cord injury, the average duration was 6.9 months(range, 1-27 months). Urodynamic test in the treatment group showed bladder sensation disappeared in 10 cases and bladder sensation weakened in 8 cases, while bladder sensation  disappeared in 11 cases and bladder sensation weakened in 9 cases in the control group. The age, gender, type of bladder sensation disorders matched in two groups. The treatment group received daily intravesical electric stimulation and percutaneous electric stimulation of bladder. While the control group received only conventional bladder training. Improvement of the bladder sensation between two groups was compared 1 month later.

Results: 11 of 18 cases in the treatment group had varied degrees of improvement of bladder sensation while 7 cases remained no change. Before and after treatment, the average first sensation capacity and strong desire capacity in 8 cases with bladder hypoesthesia was 414±46ml, 540±42ml and 255±41ml, 420±82ml respectively, which showed significant difference (P<0.05). Bladder sensation showed no significant change in the control group before and after treatment, the  average first sensation capacity and strong desire capacity was 466±37ml, 562±45ml and 421±21ml, 598±47ml respectively, which showed no significant difference before and after treatment(P>0.05). The average first sensation capacity and strong desire capacity improved significantly between the treatment group and the control group(P<0.05).

Conclusions: The comprehensive electric stimulation therapy can improve bladder sensory function to some degrees in neurogenic bladder patient.

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