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[不同阶段针刺干预对脊髓损伤后神经源性膀胱尿功能重建的影响]

[Effects of acupuncture intervention at different stages on urinary function reconstruction of neurogenic bladder after spinal cord injury].

作者信息

Qin Jiang, Zhao Yajie, Shi Xiuxiu, Hu Yuan, Tang Jiaguang, Ren Dongfeng, Cao Zheng, Tang Jinshu

出版信息

Zhongguo Zhen Jiu. 2015 Feb;35(2):132-6.

Abstract

OBJECTIVE

To explore the effects of early intervention of acupuncture on urinary function reconstruction of neurogenic bladder after spinal cord injury, so as to find the optimal treatment timing of acupuncture.

METHODS

Fifty-three patients of neurogenic bladder after spinal cord injury were randomly divided into a prior-to-catheter group (25 cases) and a posterior-to-catheter group (28 cases). For the prior-to-catheter group, one week before the removal of catheter, acupoints on the abdomen and back such as Guanyuan (CV 4), Zhongji (CV 3), Baliao (Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33), Xialiao (BL 34), Jiaji (EX-B 2) and acupoints at distal end such as Zusanli (ST 36) and Sanyinjiao (SP 6) were selected; after the catheter removal, simple method. of water column was used to measure bladder capacity pressure to classify the type of bladder, and then different acupuncture manipulations were given; intermittent catheterization was performed if condition was allowed. The posterior-to-catheter group applied identical treatment after removal of catheter as the prior-to-catheter group. The treatment was given 5 times per week; after one-month treatment, five aspects including the time of first effective urination, time of establishing reflex urination, average residual volume of urine, time of residual urine less than 100 mL and quality of life (QOL) were evaluated.

RESULTS

After treatment, the time of first effective urination, time of establishing reflex urination, average residual volume of urine and time of residual urineless than 100 mL in the prior-to-catheter group were all superior to those in the posterior-to-catheter group (all P<0. 05) ; the score of QOL was improved in two groups after treatment (both P<0. 01), but the difference between two groups was not statistically significant (P>0. 05); each index of urination function was not significant among patients with different injured segments of spinal cord (all P>0. 05).

CONCLUSION

The early intervention of acupuncture (prior to catheter) has obvious improving function on establishing balanced bladder in patients with neurogenic bladder after spinal cord injury, which is superior to acupuncture intervention after removal of catheter, however, the effects of different injured segments on establishing balanced bladder are not different.

摘要

目的

探讨针刺早期干预对脊髓损伤后神经源性膀胱排尿功能重建的影响,以寻找针刺的最佳治疗时机。

方法

将53例脊髓损伤后神经源性膀胱患者随机分为导尿管拔除前组(25例)和导尿管拔除后组(28例)。导尿管拔除前组在拔除导尿管前1周,选取腹部和背部穴位如关元(CV4)、中极(CV3)、八髎(上髎(BL31)、次髎(BL32)、中髎(BL33)、下髎(BL34)、夹脊(EX - B2)以及远端穴位如足三里(ST36)、三阴交(SP6);拔除导尿管后,采用简易水柱法测量膀胱容量压力以判断膀胱类型,然后给予不同针刺手法;若条件允许则行间歇性导尿。导尿管拔除后组在拔除导尿管后采用与导尿管拔除前组相同的治疗。每周治疗5次;治疗1个月后,评估首次有效排尿时间、建立反射性排尿时间、平均残余尿量、残余尿量小于100 mL的时间以及生活质量(QOL)5个方面。

结果

治疗后,导尿管拔除前组的首次有效排尿时间、建立反射性排尿时间、平均残余尿量及残余尿量小于100 mL的时间均优于导尿管拔除后组(均P<0.05);两组治疗后QOL评分均提高(均P<0.01),但两组间差异无统计学意义(P>0.05);不同脊髓损伤节段患者的排尿功能各指标差异均无统计学意义(均P>0.05)。

结论

针刺早期干预(导尿管拔除前)对脊髓损伤后神经源性膀胱患者建立平衡膀胱有明显改善作用,优于导尿管拔除后针刺干预,然而不同损伤节段对建立平衡膀胱的影响无差异。

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