间歇导尿结合生物反馈电刺激治疗脑梗死后早期潴留的应用探讨

目的 观察脑梗死后尿潴留患者尿流动力学相关指标的变化,探讨间歇导尿结合生物反馈电刺激治 疗的有效性和作用机制。 方法 入选2014年1月-2016年1月急性脑梗死后尿潴留患者98例,对所有患者进行一般情况检查, 根据患者和（或）家属意愿分为治疗组48例和对照组50例,对照组采用无菌间歇导尿结合膀胱功能 训练治疗,治疗组在对照组基础上采用生物反馈电刺激治疗仪。分别于治疗前和治疗后1周测定两组 情况,包括生活质量精简问卷评分（Subjective Quality of Life Profile,SQLP）和尿流动力学指标。 结果 两组的尿潴留情况均逐渐好转,治疗组经治疗7次后,恢复自主排尿时间早于对照组（P ＜0.01）,治疗组的膀胱容量、残余尿量和最大尿流率改善优于对照组（P＜0.01）。 结论 间歇导尿结合生物反馈电刺激治疗改善脑梗死后早期尿潴留状况效果更好。     

骶神经刺激结合膀胱功能训练治疗脑卒中后神经源性膀胱的效果

目的探究骶神经刺激结合膀胱功能训练治疗脑卒中后神经源性膀胱患者的临床效果。方法选择郑州大学第二附属医院2016-07-2018-03接诊的的脑卒中后神经源性膀胱患者109例进行研究,按照患者入院ID号随机分为观察组(51例)和对照组(58例)。对照组采用膀胱功能训练,观察组在对照组基础上结合骶神经刺激。观察治疗效果并比较2组治疗前后尿动力学指标特征,2 d排尿日记(每日排尿次数、单次尿量及最大排尿量)及视觉模拟评分(VAS)。结果治疗后观察组总有效率明显高于对照组(86.3%vs 65.5%,P0.05)。2组平均残余尿量、平均膀胱压力、平均最大尿道闭合压均明显降低,平均膀胱容量及平均最大尿流率明显升高(P0.05),观察组改善状况显著优于对照组(P0.05)。2组排尿次数、尿失禁发作次数、单次尿量、最大排尿量均显著改善(P0.05),观察各指标均显著优于对照组(P0.05)。2组VAS评分均显著降低,观察组明显低于对照组(P0.05)。结论骶神经刺激配合膀胱功能训练能效改善脑卒中后神经源性膀胱患者患者排尿功能障碍,且效果优于单纯使用膀胱功能训练。     

综合性治疗脊髓损伤后神经源性膀胱的临床观察

目的观察综合性治疗脊髓损伤(SCI)后神经源性膀胱的临床疗效。方法采用药物治疗、导尿术、膀胱功能训练、生物反馈进行综合治疗SCI神经源性膀胱患者28例,通过排尿次数、膀胱容量、最大排尿量、残余尿量及国际LUTS症状指标观察治疗疗效。结果 28例脊髓损伤后神经源性膀胱患者在接受综合治疗后排尿次数、残余尿量显著减少,而膀胱容量增加,排尿症状、国际LUTS症状评分显著改善,差异均具有统计学意义(P0.05)。结论脊髓损伤后神经源性膀胱患者采用综合性治疗方法能够改善排尿功能,达到提高生存质量的目的。     

心理护理在产后压力性尿失禁80例患者中的应用效果分析

目的研究并探讨心理护理在产后压力性尿失禁中的应用效果。方法将2014年1月～2016年10月期间我院妇产科收治的160例产后压力性尿失禁患者列为研究对象,采取计算机单盲随机分组法将患者随机分为两组,每组80例,对照组采取常规护理措施,观察组采取心理护理措施,比较两组患者的总症状积分(total symptom score,TSS)、尿垫试验评分、泌尿生殖评分、心理状态、护理满意度。结果干预后,观察组的TSS症状积分、泌尿生殖评分、焦虑评分、抑郁评分相较于干预前均明显降低(P0.05),其尿垫试验评分明显增高(P0.05),且其TSS症状积分、尿垫试验评分、泌尿生殖评分、焦虑评分、抑郁评分均明显优于对照组干预后(P0.05);相比于对照组,观察组的护理满意度明显更高(P0.05)。结论采取心理护理措施对产后压力性尿失禁患者进行干预,可有效缓解患者的尿失禁症状,促进其泌尿生殖健康,还可有效改善患者的心理状态,提高患者对护理服务的评价。     

膀胱功能训练在脊柱损伤后神经源性膀胱中的应用

目的观察膀胱功能训练在脊柱损伤后神经源性膀胱中的应用效果。方法采用膀胱功能训练治疗脊柱损伤后神经源性膀胱排尿功能障碍患者110例,采用平均膀胱容量﹑日排尿次数﹑残余尿量﹑最大排尿量、因排尿功能障碍导致的生存质量评分和国际下尿路功能(LUTS)症状评分进行疗效评价。结果 110例患者接受膀胱功能训练后,平均膀胱容量增加﹑排尿次数减少﹑残余尿量减少情况与治疗前相比,差异有统计学意义(P0.01);生存质量评分、国际LUTS症状评分较治疗前明显升高,差异有统计学意义(P0.01)。结论膀胱功能训练可有效改善脊柱损伤后神经源性膀胱患者的排尿功能。     

心理护理对急性缺血性脑卒中患者神经功能的影响

目的探讨心理护理干预在急性缺血性脑卒中患者临床护理中的效果。方法选取我院神经科收治的100例急性缺血性脑卒中患者为观察对象,随机分为对照组与观察组各50例,对照组采取常规护理模式,观察组在常规护理模式的基础上联合心理护理干预,对比2组护理前、护理1周后与护理4周后神经功能缺损评分(NIHSS评分)情况,并观察2组的治疗效果。结果 (1)护理1周后与护理4周后,观察组NIHSS评分均明显低于对照组,差异有统计学意义(P0.05)。(2)观察组总有效率为94%,明显高于对照组的70%,差异有统计学意义(P0.05)。结论心理护理干预能够增强急性缺血性脑卒中患者的神经功能,改善其临床症状,有助于提高临床治疗效果。     

功能性电刺激结合重复经颅磁刺激用于缺血性脑卒中偏瘫患者步行障碍恢复的临床观察

目的 观察功能性电刺激结合重复经颅磁刺激用于缺血性脑卒中偏瘫患者步行障碍恢复的临床疗效。方法 将53例缺血性脑卒中偏瘫患者随机分为对照组、治疗组、假治疗组3组,在均接受常规康复训练的基础上对照组接受功能性电刺激治疗,治疗组接受功能性电刺激及重复经颅磁刺激治疗,假治疗组接受功能性电刺激及假重复经颅磁刺激治疗; 治疗前及治疗8周后采用步态运动学参数、时间参数、距离参数及Amer-Lindholm分级对3组患者的下肢综合运动功能进行评定。结果 治疗前3组患者步态运动学参数、时间参数、距离参数及Amer-Lindholm分级评分均无显著差异(P>0.05),治疗8周后3组患者上述指标明显改善且治疗组改善幅度明显优于其余2组(P<0.05)。结论 功能性电刺激联合重复经颅磁刺激治疗有利于改善缺血性脑卒中偏瘫患者的步行运动功能。     

生物反馈治疗及相关护理对焦虑症患者的疗效分析

目的分析生物反馈治疗及其相关护理对焦虑症患者的临床症状,日常生活能力及生活质量的影响。方法将2012年1月~2016年12月来我院接受治疗的80例焦虑症患者纳入研究,随机分为两组,各40例;常规治疗组予以舍曲林治疗和常规护理,生物反馈组则在常规治疗组基础上进行生物反馈治疗以及相关的护理。比较两组焦虑症治疗总有效率,及干预前后汉密尔顿焦虑量表(HAMA)、焦虑自评量表(SAS)、日常生活能力评定量表(ADL)、生活质量量表(SF-36)评分差异。结果干预后生物反馈组临床总有效率高于常规治疗组(P0.05);干预前两组患者的HAMA,SAS,ADL和SF-36评分组间无明显差异(P0.05);干预后两组患者的HAMA,SAS评分较干预前均降低,ADL和SF-36评分较干预前均升高,且生物反馈组上述量表的改善程度均优于于常规治疗组(P0.05)。结论在常规药物治疗基础上,合并生物反馈治疗及相关护理可更好地改善患者焦虑症状,促进患者日常生活能力、生活质量的提高,提高临床疗效。     

生物反馈电刺激仪治疗腹腔镜前列腺癌根治术后尿失禁☆

目的：应用生物反馈电刺激仪可以指导患者进行正确自主的盆底肌肉训练，观察其对腹腔镜前列腺癌根治术后控尿功能恢复的作用。 方法：选择2005-07/2007-06中山大学附属第三医院泌尿外科收治腹腔镜前列腺癌根治术后尿失禁患者41例，轻度12例，中度23例，重度6例。采用加拿大Laborie 公司生产的UROSTIM型盆腔生物反馈电刺激治疗仪电刺激联合盆底肌肉训练，生物反馈电刺激每日1次，5次为1个疗程，根据患者尿失禁程度分别治疗一两个疗程。疗效判定标准：治愈，自觉尿失禁症状消失、小便能自控，排尿正常，尿垫试验阴性；有效，自觉尿失禁次数明显减少、尿垫试验连续3次以上阴性；无效，尿失禁症状无明显改善，尿垫试验阳性。治疗结束后4周评价其治疗效果，追踪观察随访3~12个月。 结果：41例术后不同程度尿失禁患者，治愈23例(56.1%) ，有效11例(26.9%) ，无效7例(17.0%) ，总有效率为83%。轻度尿失禁患者，治愈11例，有效1例；中度尿失禁患者，治愈11例，有效8例，无效3例；重度尿失禁患者，治愈1例，有效2例，无效3例。 结论：应用生物反馈电刺激仪可促进前列腺癌根治术后患者控尿功能的恢复。     

吞咽功能训练联合低频电刺激术治疗缺血性卒中吞咽障碍的疗效观察

目的探讨吞咽功能训练联合低频电刺激术对缺血性卒中患者吞咽障碍的疗效。方法共68例缺血性卒中合并吞咽障碍患者,分别予常规吞咽功能训练(包括吞咽训练和进食策略训练,对照组)及常规吞咽功能训练联合低频电刺激术(联合治疗组),于治疗前和治疗后15 d,采用视频透视吞咽检查(VFSS)和标准吞咽功能评价量表(SSA)评价患者吞咽功能。结果 34例予以常规吞咽功能训练,英国牛津郡社区脑卒中项目(OCSP)分型完全前循环梗死型(TACI型)12例、部分前循环梗死型(PACI型)8例、后循环梗死型(POCI型)10例、腔隙性梗死型(LACI型)4例;34例予以常规吞咽功能训练联合低频电刺激术,OCSP分型TACI型10例、PACI型7例、POCI型11例、LACI型6例。与治疗前相比,两组患者治疗后VFSS评分增加(P=0.003,0.000)、SSA评分减少(P=0.003,0.000);与对照组相比,联合治疗组患者VFSS评分增加(P=0.004)、SSA评分减少(P=0.020)。结论吞咽功能训练联合低频电刺激术对急性缺血性卒中患者吞咽障碍具有较好疗效,优于单纯吞咽功能训练。     

Prevalence of urinary incontinence and other pelvic floor disorders in women with myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is a neuromuscular disease that can affect the pelvic floor muscles but few studies have investigated pelvic floor disorders, including urinary incontinence. The main purpose of this study was to document the prevalence, characteristics, and impacts of urinary incontinence and other pelvic floor disorders in women with DM1. Associations between pelvic floor disorders and phenotypes, considering age and parity, were explored. Eighty adult women aged 47,1±13,7 years old participated in a cross-sectional study using validated questionnaires, including the International Consultation Incontinence Questionnaire – Urinary Incontinence short form (ICIQ-UI-SF)), the Pelvic Floor Disorder Inventory (PFDI), and the Pelvic Floor Impact Questionnaire short form (PFIQ-SF). The mean score for the ICIQ-UI-SF was 4.3. The mean scores for the subscales of the PFDI were 36.8 for the urinary distress inventory, 74.1 for the colorectal-anal distress inventory, and 43.8 for the pelvic organ prolapse distress inventory. A total of 60% of women reported urinary incontinence and 56.3% anal incontinence. Pelvic prolapse symptoms (>1 symptom) were reported by 25% of women. Findings reveal high prevalence and significant related impacts of these disorders. This provides evidence regarding the importance of screening for these disorders in a clinical setting and the need to explore treatment approaches.     

电刺激联合神经节苷脂治疗男性脊髓损伤后排尿障碍

目的探讨经皮穴位电刺激联合神经节苷脂穴位注射治疗男性脊髓损伤后排尿障碍的疗效。方法对48例脊髓损伤后出现功能性排尿障碍的男性患者,应用经皮穴位电刺激联合神经节苷脂穴位注射,并配合Crede手法挤压腹部下方促进排出尿液或间歇导尿,运用测定残留尿方法、膀胱容量的改变、肾功能的改变以及相关B超等指标评估治疗效果。结果 48例患者经治疗后,自行或配合Crede手法后,均能顺利排出尿液,尿残留量出现明显下降的趋势。经最长24个月的随访,48例患者均未出现尿路感染症状且肾功能均正常。结论经皮穴位电刺激+神经节苷脂穴位注射治疗男性脊髓损伤后神经源性功能性膀胱排尿障碍的疗效肯定,患者生活质量明显提高。     

The effect of pelvic floor muscle training on sexual function in men with lower urinary tract symptoms after stroke

Abstract

Background:

Erectile dysfunction and lower urinary tract symptoms (LUTS) are common sequelae in men after stroke.

Objective:

The objective of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on measured erectile function as an indicator of sexuality in men with LUTS after stroke.

Method:

A sample of 516 men with stroke was invited to participate in this single-blinded, randomized controlled trial according to in- and exclusion criteria. This resulted in 31 participants who were randomized to either a Treatment Group (n?=?16) or a Control Group (n?=?15). The intervention included 12?weeks of PFMT.

The effect was measured on the International Index of Erectile Function (IIEF-5) questionnaire.

Results:

Thirty participants (median age: 68 years; interquartile range: 60–74 years) completed the study, 15 in each group. The results of the IIEF-5 sum score showed a significant improvement (P?<?0.04) from pre-test to post-test in the Treatment Group, but not in the Control Group. Within pre-test and 6-month follow-up, the median sum score decreased in both groups, worsened in the Control Group [Treatment Group, 3 (17%) versus Control Group, 5 (31%)]. There were differences between the groups at post-test and at follow-up, but they were not statistically significant.

Conclusion:

The results showed that, as measured by erectile function in men with LUTS after stroke, PFMT may have short-term and long-term effect, although no statistically significant effect was demonstrated between the groups.     

A Novel Externally Applied Neuromuscular Stimulator for the Treatment of Stress Urinary Incontinence in Women—A Pilot Study

Objectives: Neuromuscular electrical stimulation (NMES) is commonly used to treat lower urinary tract dysfunctions. This study evaluated the efficacy of a novel externally applied stimulator in the treatment of stress urinary incontinence (SUI). Materials and Methods: Nine women were included in this study. Provocative tests included a cough and jumping jack test assessed via pad weight. Ultrasound (US) imaging assessed pelvic floor muscle (PFM) contraction. A bladder filling protocol allowed for delineation of the bladder from the pelvic floor and standardized volume. External electrodes were used during 30 min, at least four times per week treatment protocol at home for eight weeks. Participants were blinded to US and were not instructed regarding pelvic floor contractions. Results: At week 1, participants could perform PFM contractions verified with US. More importantly, an 87.43% decrease in leakage was noted. At week 8, participants reported a 97.71% decrease in leakage (p= 0.0001). Changes noted in Incontinence Impact Questionnaire and Modified Oxford scores were significant (p= 0.0001 and p= 0.0001). Conclusions: NMES is frequently used to promote muscle strength and coordination. Studies have shown NMES to be effective in decreasing symptoms associated with SUI; however, few, if any, have used it as a primary treatment modality. The novel device in this study was shown to be effective in improving muscle strength, reducing or ablating the symptoms associated with SUI, and in eliciting PFM contractions. The device is noninvasive and can be used as a home treatment.     

Pelvic floor rehabilitation in multiple sclerosis

Although primarily used for treatment of stress incontinence, pelvic floor rehabilitation has been reported to have some value in the treatment of detrusor instability and urgency. In neurogenic bladder dysfunction due to Multiple Sclerosis, many authors have suggested the possible use of pelvic floor rehabilitation as a treatment modality. Therefore, we designed an open prospective trial to look at the possible role of pelvic floor rehabilitation in voiding dysfunction due to MS, concentrating upon the clinical and neurological parameters in relation to the outcome. A new scoring system for pelvic floor dysfunction is introduced. Thirty female patients were evaluated. In 25, the strength of the pelvic floor was significantly improved after one month (p < 0.001). In all patients but one the endurance score improved significantly (p < 0.001) as did the exhaustibility score (p = 0.01). The relaxation score on the other hand did not show any significant evolution despite intensive training. Cystometric findings after one month did not significantly differ from the initial cystometric findings. There was a significant increase in the mean functional bladder capacity as read from the voiding charts from 173.8 cc +/- 53.9 cc to 208.5 cc +/- 57.6 cc (p = 0.005). Also the mean urinary frequency decreased significantly from 12.7 +/- 3.6 to 9.1 +/- 2.6 (p < 0.01) as did the mean number of daily incontinent episodes from 2.8 +/- 1.3 to 1.5 +/- 1.5 (p < 0.01). Pelvic floor rehabiltation has a place in the treatment of MS patients with a low Kurtzke score and without pelvic floor spasticity.     

Sacral Nerve Stimulation for Treatment of Intractable Pain Associated with Cauda Equina Syndrome

Sacral nerve stimulation (SNS) is an effective treatment for bladder and bowel dysfunction, and also has a role in the treatment of chronic pelvic pain. We report two cases of intractable pain associated with cauda equina syndrome (CES) that were treated successfully by SNS. The first patient suffered from intractable pelvic pain with urinary incontinence and fecal incontinence after surgery for a herniated lumbar disc. The second patient underwent surgery for treatment of a burst fracture and developed intractable pelvic area pain, right leg pain, excessive urinary frequency, urinary incontinence, voiding difficulty and constipation one year after surgery. A SNS trial was performed on both patients. Both patients'' pain was significantly improved and urinary symptoms were much relieved. Neuromodulation of the sacral nerves is an effective treatment for idiopathic urinary frequency, urgency, and urge incontinence. Sacral neuromodulation has also been used to control various forms of pelvic pain. Although the mechanism of action of neuromodulation remains unexplained, numerous clinical success reports suggest that it is a therapy with efficacy and durability. From the results of our research, we believe that SNS can be a safe and effective option for the treatment of intractable pelvic pain with incomplete CES.