中医针刺联合疗法对脊髓损伤后神经源性膀胱的疗效及尿流动力学的影响

Efficacy of acupuncture and traditional Chinese medicine combined therapy on neurogenic bladder and influence on urodynamics after spinal cord injury

关键词:  温肾通督方  脊髓损伤  神经源性膀胱  针刺  尿流动力学

Key words:  Wenshen Tongdu Decoction  spinal cord injury  neurogenic bladder  acupuncture  urodynamics

摘要:

[目的] 分析温肾通督方联合针刺对脊髓损伤（SCI）后神经源性膀胱（NB）的疗效及对尿流动力学的影响。[方法] 回顾性选取2021年1月—2023年11月在四川省康复医院脊髓损伤康复科收治的95例不完全性脊髓损伤（ISCI）后NB患者作为研究对象，根据治疗方案分为对照组（n=45）和针药组（n=50）。对照组给予常规的西医对症支持治疗，针药组在对照组的基础上使用温肾通督方联合针刺进行治疗。对比两组患者的尿流动力学指标、中医证候积分、排尿情况、膀胱功能积分、临床疗效和生活质量。[结果] 针药组治疗12周的总有效率（92.00 %）显著高于对照组的总有效率（75.56 %）（P<0.05）。两组膀胱顺应性（BC）、最大尿流速率（Qmax）、最大尿流速率时逼尿肌压力（Pdet Qmax）在不同时间点之间存在差异（F_时间=505.288、54.107、221.903，P_时间<0.001），在不同组别之间存在差异（F_组间=47.726、12.082、40.533，P_组间<0.001），变化趋势存在差异（F_交互=27.398、3.644、13.266，P_交互<0.05）。中医证候积分在不同时间点之间存在差异（F_时间=326.605，P_时间<0.001），在不同组别之间存在差异（F_组间=59.029，P_组间<0.001），变化趋势存在差异（F_交互=17.842，P_交互<0.001）。两组日均单次排尿量、日均排尿次数、日均导尿次数在不同时间点之间存在差异（F_时间=376.083、1 619.355、215.564，P_时间<0.001），在不同组别之间存在差异（F_组间=52.573、252.387、51.996，P_组间<0.001），变化趋势存在差异（F_交互=81.412、137.974、24.434，P_交互<0.001）。两组膀胱功能积分、I-QOL评分在不同时间点之间存在差异（F_时间=2 672.823、202.110，均P_时间<0.001），在不同组别之间存在差异（F_组间=141.178、22.778，P_组间<0.001），变化趋势存在差异（F_交互=46.809、6.840，P_交互<0.001）。[结论] 温肾通督方联合针刺辅助治疗ISCI后NB患者具有良好的临床疗效，增强膀胱的顺应性，改善排尿功能，提高预后生活质量水平。

Abstract:

[Objective] To analyze the efficacy of Wenshen Tongdu Decoction combined with acupuncture on neurogenic bladder（NB） after spinal cord injury（SCI） and the effect on urodynamics. [Methods] Ninety-five patients with NB after incomplete spinal cord injury（ISCI） admitted to the Department of Spinal Cord Injury Rehabilitation of the Rehabilitation Hospital from January 2021 to November 2023 were retrospectively selected as the study subjects，and they were divided into a control group（45 cases） and acupuncture and traditional Chinese medicine combined therapy group（50 cases） according to the treatment protocol. The control group was given conventional Western medicine symptomatic supportive treatment，and the acupuncture and traditional Chinese medicine combined therapy groups was treated with Wenshen Tongdu Decoction combined with acupuncture on the basis of the control group. The urodynamic indexes，traditional Chinese medicine syndrome score，urination，bladder function points，clinical efficacy and quality of life of the two groups were compared. [Results] The total effective rate of the acupuncture group（92.00 %） was significantly higher than that of the control group（75.56 %） after 12 weeks of treatment（P<0.05）. Bladder compliance（BC），maximal urinary flow rate（Qmax），and pressure of the forced urethra muscle at maximal urinary flow rate（Pdet Qmax） differed between the two groups at different time points（F_time=505.288，54.107，and 221.903，P_time<0.001），and differed between the groups（F_{between groups}=47.726，12.082，40.533，P_intergroup<0.001），and there were differences in the trend of change（F_interaction=27.398，3.644，13.266，P_interaction<0.05）. The traditional Chinese medicine syndrome score differed between time points（F_time=326.605，P_time<0.001），between groups（F_{between groups}=59.029，P _{between groups}<0.001），and the trend of change differed（F_interaction=17.842，P_interaction<0.001）. There was a difference between the two groups in the average daily single voiding volume， the average daily number of micturitions，and the average daily number of catheterizations between time points（F_time=376.083，1 619.355， 215.564，P_time<0.001），between groups（F_intergroups=52.573，252.387，51.996，P_intergroups<0.001） and there was a difference in the trend（F_interaction=81.412，137.974，24.434，P_interaction<0.001）. The bladder function scores and I-QOL scores of the two groups differed between time points（F_time=2 672.823，202.110，P_time<0.001），between groups（F_intergroup=141.178， 22.778，P_intergroup<0.001），and the trend of change differed（F_interaction=46.809，6.840，P_interaction <0.001）. [Conclusion] Wenshen Tongdu Decoction combined with acupuncture-assisted treatment for NB patients after ISCI has good clinical efficacy，enhances bladder compliance，improves voiding function，and improves prognostic quality of life level.