电针和艾灸治疗脊髓损伤后神经源性膀胱疗效差异：随机对照试验

韦慧麟; 任亚锋; 张芝兰; 黄晓萌; 李冰

doi:10.13703/j.0255-2930.20221027-k0005

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电针和艾灸治疗脊髓损伤后神经源性膀胱疗效差异：随机对照试验

临床研究2 | 更新时间：2024-06-03

- 电针和艾灸治疗脊髓损伤后神经源性膀胱疗效差异：随机对照试验
- Efficacy differences between electroacupuncture and moxibustion for neurogenic bladder after spinal cord injury: a randomized controlled trial
- 中国针灸 2023年43卷第9期页码：1036-1041
- 作者机构：
  
  1.河南中医药大学，郑州450046
  2.河南中医药大学第一附属医院，郑州450099
- 作者简介：
  
  任亚锋，主任医师。E-mail：253453490@qq.com
- 基金信息：
  
  河南省中医药科学研究专项课题项目(2022JDZX015);2021JDZY022、2018JDZX010
- DOI：10.13703/j.0255-2930.20221027-k0005
  中图分类号： R 246.6
- 收稿：2022-10-27，
  
  网络首发：2023-05-09，
  
  纸质出版：2023-09-12
- 稿件说明：
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韦慧麟,任亚锋,张芝兰等.电针和艾灸治疗脊髓损伤后神经源性膀胱疗效差异：随机对照试验[J].中国针灸,2023,43(09):1036-1041.

WEI Hui-lin,REN Ya-feng,ZHANG Zhi-lan,et al.Efficacy differences between electroacupuncture and moxibustion for neurogenic bladder after spinal cord injury: a randomized controlled trial[J].Chinese Acupuncture & Moxibustion,2023,43(09):1036-1041.
韦慧麟,任亚锋,张芝兰等.电针和艾灸治疗脊髓损伤后神经源性膀胱疗效差异：随机对照试验[J].中国针灸,2023,43(09):1036-1041. DOI： 10.13703/j.0255-2930.20221027-k0005.

WEI Hui-lin,REN Ya-feng,ZHANG Zhi-lan,et al.Efficacy differences between electroacupuncture and moxibustion for neurogenic bladder after spinal cord injury: a randomized controlled trial[J].Chinese Acupuncture & Moxibustion,2023,43(09):1036-1041. DOI： 10.13703/j.0255-2930.20221027-k0005.

摘要

目的

比较电针和艾灸治疗脊髓损伤（SCI）后神经源性膀胱（NB）的临床疗效。

方法

将120例SCI后NB患者随机分为电针组、艾灸组和间歇导尿组，每组40例。间歇导尿组给予常规治疗及间歇导尿，电针组和艾灸组在间歇导尿组基础上分别给予电针（断续波，频率1.3~1.6 Hz，强度以患者能耐受为度）和艾灸治疗，均穴取中极、关元，双侧足三里、阴陵泉、八髎穴，每次30 min，每日1次，每周6次，共治疗6周。比较治疗前后各组患者最大膀胱容积（MBC）、残余尿量（RUV）、充盈期逼尿肌压力（Pdet）、膀胱顺应性（BC）、双肾最大肾盂分离宽度、尿白细胞数、中医证候积分、世界卫生组织生存质量测定量表简表（WHOQOL-BREF）评分，记录治疗后各组达到膀胱功能平衡状态患者例数，评定各组临床疗效。

结果

治疗后，电针组和艾灸组MBC、Pdet、BC、WHOQOL-BREF评分较治疗前增加（

0.05），RUV、双肾最大肾盂分离宽度、尿白细胞数、中医证候积分较治疗前减少（

0.05，

0.01）；间歇导尿组MBC、RUV、双肾最大肾盂分离宽度、尿白细胞数较治疗前减少（

0.05），BC、WHOQOL-BREF评分较治疗前增加（

0.05）。治疗后，电针组和艾灸组MBC、Pdet、BC、WHOQOL-BREF评分高于间歇导尿组（

0.05），RUV、中医证候积分低于间歇导尿组（

0.05）；艾灸组MBC、Pdet高于电针组（

0.05），电针组RUV、双肾最大肾盂分离宽度、中医证候积分低于艾灸组（

0.05）。电针组和艾灸组治疗后达到膀胱功能平衡状态患者例数多于间歇导尿组（

0.05）。电针组愈显率为85.0%（34/40），艾灸组愈显率为82.5%（33/40），均高于间歇导尿组的65.0%（26/40，

0.05），电针组和艾灸组比较差异无统计学意义（

0.05）。

结论

电针、艾灸均能有效改善SCI后NB患者膀胱功能状态，电针在减少残余尿量、减轻尿道括约肌过度活动、缓解中医证候方面疗效更佳，艾灸则在增加充盈期逼尿肌压力、建立逼尿肌反射方面疗效更佳。

Abstract

Objective

To compare the clinical efficacy between electroacupuncture(EA) and moxibustion for neurogenic bladder (NB) after spinal cord injury (SCI).

Methods

One hundred and twenty patients with NB after SCI were randomly divided into an EA group

a moxibustion group

and an intermittent catheterization group

with 40 patients in each group. The patients in the intermittent catheterization group were treated with routine treatment and intermittent catheterization

while the patients in the EA group and the moxibustion group were treated with additional treatments of EA (discontinuous wave

with a frequency of 1.3-1.6 Hz

and intensity based on patient tolerance) and moxibustion

respectively. The acupoints used in both groups were Zhongji (CV 3) and Guanyuan (CV 4)

bilateral Zusanli (ST 36)

Yinlingquan (SP 9)

and

Baliao

points. Each session lasted for 30 min

once daily

six times a week

for a total of six weeks.The maximum bladder capacity (MBC)

residual urine vdume (RUV)

detrusor pressure (Pdet) during the filling phase

bladder compliance (BC)

maximum renal pelvis separation width of both kidneys

urine white blood cell count

TCM syndrome score

and World Health Organization quality of life assessment-BREF (WHOQOL-BREF) score were compared before and after treatment in the 3 groups. The number of patients in each group who achieved bladder functional balance was recorded

and the clinical efficacy was assessed after treatment.

Results

After treatment

the MBC

Pdet

and WHOQOL-BREF scores in the EA group and the moxibustion group were increased (

0.05)

while the RUV

maximum renal pelvis separation width of both kidneys

urine white blood cell count

and TCM syndrome scores were decreased

(

0.05

0.01). In the intermittent catheterization group

MBC

RUV

maximum renal pelvis separation width of both kidneys

and urine white blood cell count were decreased (

0.05)

while BC and WHOQOL-BREF score were increased (

0.05) after treatment. After treatment

the MBC

Pdet

and WHOQOL-BREF scores in the EA group and the moxibustion group were higher than those in the intermittent catheterization group (

0.05)

while the RUV and TCM syndrome scores were lower than those in the intermittent catheterization group (

0.05). Moreover

after treatment

the MBC and Pdet in the moxibustion group were higher than those in the EA group (

0.05)

while the RUV

maximum renal pelvis separation width of both kidneys

and TCM syndrome score in the EA group were lower than those in the moxibustion group (

0.05). The number of patients who achieved bladder functional balance after treatment in the EA group and the moxibustion group was higher than that in the intermittent catheterization group (

0.05). The cured and effective rate was 85.0% (34/40) in the EA group and 82.5% (33/40) in the moxibustion group

which were both higher than 65.0% (26/40) in the intermittent catheterization group (

0.05)

there was no significant difference between the EA group and the moxibustion group (

0.05).

Conclusion

EA and moxibustion could effectively improve the functional state of bladder in patients with NB after SCI. EA is more effective in reducing residual urine volume and excessive activity of the urethral sphincter

and relieving TCM syndromes

while moxibustion is more effective in increasing the pressure of the detrusor during the filling period and establishing the detrusor reflex.

关键词

Keywords

references

曹烈虎 , 牛丰 , 张文财 , 等 . 创伤性脊柱脊髓损伤康复治疗专家共识(2020版) [J ] . 中华创伤杂志 , 2020 , 36 ( 5 ): 385 - 392 .

Hamid R , Averbeck MA , Chiang H , et al . Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury [J ] . World J Urol , 2018 , 36 ( 10 ): 1517 - 1527 .

Lee JK . Neurogenic bladder management [J ] . Radiol Technol , 2021 , 92 ( 3 ): 281 - 295 .

Welk B . Quality of life in neurourology patients [J ] . Eur Urol Focus , 2020 , 6 ( 3 ): 531 - 533 .

Panicker JN . Neurogenic bladder: epidemiology, diagnosis, and management [J ] . Semin Neurol , 2020 , 40 ( 5 ): 569 - 579 .

郭宁 , 秦合伟 , 李彦杰 , 等 . 近5年电针治疗脊髓损伤后神经源性膀胱机制研究进展 [J ] . 中国中医药信息杂志 , 2022 , 29 ( 9 ): 153 - 156 .

牛秋妍 , 任亚锋 , 白俊敏 , 等 . 灸法治疗脊髓损伤后神经源性膀胱的研究进展 [J ] . 护理研究 , 2021 , 35 ( 14 ): 2523 - 2527 .

ASIA and ISCoS International Standards Committee . The 2019 revision of the international standards for neurological classification of spinal cord injury (ISNCSCI)-what's new? [J ] . Spinal Cord , 2019 , 57 ( 10 ): 815 - 817 .

陈忠 , 崔喆 , 双卫兵 . 神经源性膀胱 [M ] . 北京 : 人民卫生出版社 , 2009 : 219 - 220 .

刘宏炜 . 创伤性脊柱脊髓损伤诊断与治疗专家共识(2022版) [J ] . 中国老年保健医学 , 2022 , 20 ( 4 ): 6 - 9 .

武晓冬 , 黄龙祥 , 赵京生 . 《经穴名称与定位》(GB/T 12346-2021)标准解读 [J ] . 中国针灸 , 2022 , 42 ( 5 ): 579 - 582,584 .

任亚锋 . 艾灸治疗脊髓损伤后膀胱功能障碍的临床研究 [D ] . 郑州 : 郑州大学 , 2015 .

张玉海 . 膀胱排尿功能障碍 [M ] . 北京 : 人民卫生出版社 , 2000 : 142 - 145 .

郑筱萸 . 中药新药临床研究指导原则(试行) [M ] . 北京 : 中国医药科技出版社 , 2002 : 29 - 31 .

Skevington SM , Lotfy M , O'Connell KA , et al . The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group [J ] . Qual Life Res , 2004 , 13 ( 2 ): 299 - 310 .

于慧金 , 张艳 , 张秀功 , 等 . 中医疗法在脊髓损伤后神经源性膀胱排尿障碍患者中的运用 [J ] . 中医研究 , 2020 , 33 ( 2 ): 74 - 77 .

Liu XM , Xu M , Zhang H , et al . Effects of electroacupuncture on urodynamics, intramedullary apoptosis and bidirectional regulation of neurotrophic factors in neurogenic bladder rats after supersacral spinal cord injury [J ] . World J Acupunct-Moxibust , 2021 , 31 ( 2 ): 121 - 128 .

任亚锋 , 张博爱 , 冯晓东 , 等 . 艾灸治疗脊髓损伤后膀胱功能障碍的临床研究 [J ] . 中国中医基础医学杂志 , 2013 , 19 ( 10 ): 1178 - 1180,1183 .

柳珺桐 , 丁天红 , 张润宁 , 等 . 电针八髎穴联合穴位注射治疗神经源性膀胱功能障碍及对患者排尿功能重建的影响 [J ] . 陕西中医 , 2022 , 43 ( 5 ): 653 - 657 .

Romo PGB , Smith CP , Cox A , et al . Non-surgical urologic management of neurogenic bladder after spinal cord injury [J ] . World J Urol , 2018 , 36 ( 10 ): 1555 - 1568 .

Rosier PFWM , Schaefer W , Lose G , et al . International Continence Society Good Urodynamic Practices and Terms 2016: urodynamics, uroflowmetry, cystometry, and pressure-flow study [J ] . Neurourol Urodyn , 2017 , 36 ( 5 ): 1243 - 1260 .

廖利民 , 吴娟 , 鞠彦合 , 等 . 脊髓损伤患者泌尿系管理与临床康复指南 [J ] . 中国康复理论与实践 , 2013 , 19 ( 4 ): 301 - 317 .

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