基于俞募配穴的平补平泻法双向调节卒中后神经源性膀胱的临床研究

Clinical study on the bidirectional regulation of neurogenic bladder after stroke by the Pingbu Pingxie method based on the matching of shumu points

关键词:  俞募配穴  平补平泻  双向调节  卒中后神经源性膀胱

Key words:  matching of shuumu points  Pingbu Pingxie method  bidirectional regulation  neurogenic bladder after stroke

摘要:

[目的] 观察基于俞募配穴的平补平泻法双向调节卒中后神经源性膀胱的治疗效果。[方法] 选取120例卒中后神经源性膀胱患者，根据排尿情况分为尿失禁组、尿潴留组各60例，其中每组再按照随机数字表法分为治疗组和对照组各30例。治疗组（尿失禁组和尿潴留组）采用同一种俞募配穴针刺推拿平补平泻手法治疗，对照组采用常规护理。比较患者治疗前后临床症状指标、功能性检查指标、临床疗效及尿路感染发生情况。[结果] 治疗后尿失禁组尿失禁程度量表（UISS）评分和尿潴留组神经源性膀胱症状评分表（NBDS）评分均较治疗前降低，且治疗组评分低于对照组，差异有统计学意义（P<0.05）；尿失禁组治疗后膀胱最大容量较治疗前增加，且治疗组容量高于对照组，差异有统计学意义（P<0.05）；尿潴留组治疗后残余尿量较治疗前降低，且治疗组尿量低于对照组，差异有统计学意义（P<0.05）；尿失禁和尿潴留治疗组总有效率高于对照组，且尿路感染发生率低于对照组，差异有统计学意义（P<0.05）；尿失禁组感染率差异未见统计学意义（P＞0.05），但治疗组展现出显著的临床保护趋势（RR=0.167，OR=0.138），提示该方案具有重要感染预防价值。[结论] 基于俞募配穴的平补平泻法可同时有效治疗卒中后神经源性膀胱出现的尿潴留和尿失禁，改善临床症状，增加膀胱容量，减少残余尿，且尿路感染发生少，可实现双向调节膀胱功能，提高生活质量。

Abstract:

[Objective] To observe the therapeutic effect of the clinical study on the bidirectional regulation of neurogenic bladder after stroke by the Pingbu Pingxie method based on the matching of shumu points. [Methods] The 120 patients with neurogenic bladder after stroke were selected and divided into an urinary incontinence group and an urinary retention group according to their urination status，with 60 patients in each group. Each group was further divided into a treatment group and a control group of 30 patients each according to the random number table method. The treatment groups（both the urinary incontinence group and the urinary retention group） were treated with the same acupuncture and massage Pingbu Pingxie manipulation based on the matching of shumu points，while the control groups received routine nursing care. The clinical symptom indexes，functional examination indexes，clinical efficacy，and the incidence of urinary tract infection were compared before and after treatment. [Results] After treatment，the UISS score of the urinary incontinence group and the NBDS score of the urinary retention group were both lower than those before treatment，and the scores of the treatment groups were lower than those of the control groups，with statistically significant differences（P<0.05）. In the urinary incontinence group，the maximum bladder capacity after treatment was increased compared with that before treatment，and the capacity of the treatment group was higher than that of the control group，with a statistically significant difference（P<0.05）. In the urinary retention group，the residual urine volume after treatment was decreased compared with that before treatment，and the urine volume of the treatment group was lower than that of the control group，with a statistically significant difference（P<0.05）. The total effective rate of the treatment groups for both urinary incontinence and urinary retention was higher than that of the control groups，and the incidence of urinary tract infection was lower than that of the control groups，with statistically significant differences（P<0.05）. The difference in infection rates between groups did not reach statistical significance in the urinary incontinence subgroup（P＞0.05），but the treatment group demonstrated a clinically meaningful protective trend（RR=0.167，OR=0.138），suggesting significant infection prevention value of this regimen. [Conclusion] The Pingbu Pingxie method based on the matching of shumu points can effectively treat both urinary retention and urinary incontinence in patients with neurogenic bladder after stroke，improve clinical symptoms，increase bladder capacity，reduce residual urine，and has a low incidence of urinary tract infection，achieving a bidirectional regulatory function and improving the quality of life of patients.