膀胱电刺激法结合膀胱功能训练在脊髓损伤后膀胱功能重建中的作用

胡益　俞建松　　刘莹莹

[摘要] 目的 探討膀胱电刺激法结合膀胱功能训练在脊髓损伤后膀胱功能重建中的作用。 方法 选取2017年1月至2019年12月我院康复治疗部治疗的脊髓损伤（SCI）后神经源性膀胱（NB）患者76例，随机分为两组，每组各38例。对照组予常规膀胱功能训练，观察组在对照组基础上加膀胱电刺激法，两组均治疗8周。评估两组治疗前后排尿情况及残余尿量情况，并比较膀胱功能恢复情况。 结果 治疗8周后，两组日均单次排尿量和日单次最大排尿量明显增加，日均排尿次数和残余尿量明显下降（P<0.05或P<0.01），且观察组变化幅度优于对照组（P<0.05）;同时观察组患者膀胱功能恢复总有效率高于对照组（χ2=4.150，P<0.05）。 结论 膀胱电刺激法结合膀胱功能训练在SCI后NB患者膀胱功能重建中的作用确切，能更明显改善排尿情况，减少残余尿量。

[关键词] 脊髓损伤;神经源性膀胱;膀胱功能训练;膀胱电刺激法;膀胱功能重建

[中图分类号] R694.5          [文献标识码] A          [文章编号] 1673-9701（2021）06-0010-03

The role of electrical bladder stimulation combined with bladder function training in bladder function reconstruction after spinal cord injury

HU Yi1， 2    YU  Jiansong1， 2     LIU Yingying1， 2

1.Department of Rehabilitation， Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University， Taizhou 317000， China; 2.Department of Rehabilitation， Luqiao Hospital，Taizhou Enze Medical Center（Group）， Taizhou 318050， China

[Abstract] Objective To explore the role of electrical bladder stimulation combined with bladder function training in bladder function reconstruction after spinal cord injury（SCI）. Methods A total of 76 patients with neurogenic bladder （NB） after SCI treated in Department of Rehabilitation Treatment of our hospital from January 2017 to December 2019 were selected and randomLy divided into two groups，with 38 patients in each group.The control group received conventional bladder function training， while the observation group also received electrical bladder stimulation on the basis of what the control group received. Both groups were treated for 8 weeks. The changes of micturition and volume of residual urine in the two groups before and after treatment were observed and compared， and the recovery of bladder function was evaluated. Results After 8 weeks of treatment， the average daily single micturition volume and the daily maximum single micturition volume of the two groups were significantly increased，while the average daily micturition frequency and volume of residual urine were significantly decreased（P<0.05 or P<0.01）， and the changes in the observation group were more significant than those in the control group（P<0.05）. Meanwhile，the recovery of bladder function in the observation group was significantly higher than that in the control group（χ2=4.150， P<0.05）. Conclusion Electrical bladder stimulation combined with bladder function training plays a definite role in bladder function reconstruction of the patients with NB after SCI. It can improve micturition more significantly and reduce the volume of residual urine.

[Key words] Spinal cord injury; Neurogenic bladder; Bladder function training; Electrical bladder stimulation; Bladder function reconstruction

脊髓損伤（Spinal cord injury，SCI）是一种常见且严重的中枢神经损伤性疾病，近年来，其发病率也呈逐年上升趋势[1-2]。神经源性膀胱（Neurogenic bladder，NB）是SCI后常见的主要并发症，主要表现为尿潴留或尿失禁，严重时并发尿路感染、肾积水及尿毒症等，严重时危及患者生命，需积极干预治疗。因此，对SCI后NB患者尽早重建膀胱功能，恢复正常排尿功能是治疗康复的关键[3-4]。膀胱功能训练法是一种锻炼膀胱功能常用的手段，用于SCI后NB患者效果较好，但部分病情顽固者效果仍并不够理想[5-6]。而近年来兴起的膀胱电刺激法是一种新型无创疗法，用于SCI后NB患者膀胱功能重建具有较好的疗效，但两者结合使用目前国内鲜有报道[7-8]。本研究探讨膀胱电刺激法结合膀胱功能训练在SCI后NB患者膀胱功能重建中的作用，现报道如下。……