体表神经电刺激治疗脊髓损伤后神经源性膀胱临床研究.doc

体表骶神经电刺激结合胫神经电刺激治疗脊髓损伤后神经源性膀胱30例临床观察 刘奕 漆伟 徐贞杰 潘科 石卫华 尚青龙 李伟 谭一 徐立新△ （重庆三峡中心医院康复科 重庆 万州 404000） 摘要：目的：观察体表骶神经电刺激结合胫神经电刺激对脊髓损伤后神经源性膀胱的疗效及其对尿流动力学指标的影响。方法:将脊髓损伤神经源性膀胱患者30例完全随机分为对照组和治疗组，对照组（n=15）予综合康复治疗和膀胱训练4周，治疗组（n=15）在综合康复治疗和膀胱训练4周的基础上，加用体表骶神经电刺激结合胫神经电刺激治疗。治疗前、后分别比较患者排尿日记、脊髓损伤神经学分类国际标准评分和尿流动力学检测结果。结果：经4周治疗后，两组患者24小时排尿次数无明显差异(P0.05)，但24小时尿失禁次数、每次排尿量及残余尿量比较，治疗组改善情况明显优于对照组(P0.05)；两组治疗后神经功能评分无明显差异(均P0.05)。治疗组治疗4周后尿流动力学检查结果显示，最大膀胱容积增加(P0．05)，充盈期逼尿肌压力下降(P0．05)，最大尿道压增加(P0．05)。结论：体表骶神经电刺激结合胫神经电刺激能优化综合康复治疗和膀胱训练等常规治疗对脊髓损伤后神经源性膀胱的治疗效果。 关键词：电刺激；脊髓损伤；神经源性膀胱；尿流动力学。 中图分类号：R493 Surface sacral nerve stimulation combined with electrical stimulation treatment on tibial of 30 cases of neurogenic bladder after spinal cord injury clinical observation Liu Yi,Qi Wei，Xu Zhenjie,Pan Ke,Shi Weihua,Shang Qinglong,Liwei，Tanyi，Xu Lixin （The Rehabilitation Division of Chongqing Three Gorges Central Hospital Wanzhou, Chongqing 404000） Abstract : Objective: To explore the clinical and urodynamic effects of sacral surface therapeutic electrical nerve stimulation(SS-TENS) and tibial nerve electrical stimulation(TNES) on neurogenic bladder after spinal cord injury(SCI). Methods: 30 patients with SCI were randomly divided into two groups: control group and treatment group, the control group (n=15）were given conventional rehabilitation therapy and bladder training for 4 weeks, the treatment group (n=15)were given conventional rehabilitation therapy and bladder traimng for 4 weeks, during this period they were treated with SS-TENS and TNES. The changes of the ASIA scores, urinate dairy and urodynamic investigation before and after treatment were record．Results: After treatment, the 24-hour voiding frequency was no significant difference (P 0.05), but the 24-hour urinary incontinence, each voided volume and residual urine comparison, the treatment group improved significantly better than the control group (P 0.05). There was no significant difference between the control group and the treatment g