Wang Fang, Mi Shu-Bin, Guo Hua-Ping
Department of Rehabilitation, The Affiliated Hospital of Chengde Medical College, Chengde, China.
Department of Preventive Medicine, Chengde Medical College, Chengde, China.
World Neurosurg. 2023 Sep;177:e440-e445. doi: 10.1016/j.wneu.2023.06.072. Epub 2023 Jun 24.
To observe the therapeutic effect of bladder function training combined with repetitive sacral root magnetic stimulation (rSMS) on neurogenic bladder in patients with spinal cord injury.
From January 2019 to May 2021, we selected 68 patients with neurogenic bladder and spinal cord injury who were hospitalized in the rehabilitation department of our hospital. Patients were divided into the rSMS group (36 cases) and control group (32 cases) according to a random number table. The rSMS group was treated with bladder functional training combined with rSMS, while the control group was treated only with bladder functional training. The training lasted for 40 days. Finally, we compared the therapeutic effects in the 2 groups.
There was no significant difference in sex, age, course of disease, site, and grade of spinal cord injury between the 2 groups. There was no statistically significant difference in urodynamics between the 2 groups before treatment. After treatment, the residual urine volume of the rSMS group was 82.7 ± 34.6 mL, maximum urine flow rate was 15.7 ± 4.8 mL/second, bladder volume was 388.6 ± 51.3 mL, and bladder pressure was 36.3 ± 6.3 cm HO. After treatment, the residual urine volume in the rSMS group was significantly less than that in the control group (P < 0.05). The maximum urine flow, bladder volume, and bladder pressure in the rSMS group were higher than those in the control group, and the differences were statistically significant (P < 0.05). After treatment and after 40 days of follow-up, the Barthel index scores of the patients in the rSMS group were 69.5 ± 9.3 and 73.5 ± 8.2, respectively, which were significantly higher than those of the patients in the control group (P < 0.05). The effective rates were 94.4% in the rSMS group and 81.3% in the control group, and the difference was statistically significant (P < 0.05).
Compared with bladder function training alone, bladder function training combined with rSMS was more effective in the treatment of neurogenic bladder, particularly for detrusor hyporeflexia/areflexia; it significantly improved patients' ability to urinate autonomously, reduced the residual urine volume of the bladder, and improved patients' quality of life.
观察膀胱功能训练联合重复骶神经根磁刺激(rSMS)对脊髓损伤患者神经源性膀胱的治疗效果。
选取2019年1月至2021年5月在我院康复科住院的68例脊髓损伤合并神经源性膀胱患者。根据随机数字表将患者分为rSMS组(36例)和对照组(32例)。rSMS组采用膀胱功能训练联合rSMS治疗,对照组仅采用膀胱功能训练。训练持续40天。最后比较两组的治疗效果。
两组患者在性别、年龄、病程、脊髓损伤部位及程度方面差异无统计学意义。治疗前两组尿动力学指标差异无统计学意义。治疗后,rSMS组残余尿量为82.7±34.6 mL,最大尿流率为15.7±4.8 mL/秒,膀胱容量为388.6±51.3 mL,膀胱压力为36.3±6.3 cmH₂O。治疗后,rSMS组残余尿量明显少于对照组(P<0.05)。rSMS组最大尿流率、膀胱容量及膀胱压力均高于对照组,差异有统计学意义(P<0.05)。治疗后及随访40天后,rSMS组患者的Barthel指数评分分别为69.5±9.3和73.5±8.2,明显高于对照组患者(P<0.05)。rSMS组有效率为94.4%,对照组为81.3%,差异有统计学意义(P<0.05)。
与单纯膀胱功能训练相比,膀胱功能训练联合rSMS治疗神经源性膀胱效果更佳,尤其对于逼尿肌反射减退/无反射;能显著提高患者自主排尿能力,减少膀胱残余尿量,改善患者生活质量。