温针灸联合尿路综合管超早期康复模式对急性脑卒中后尿失禁的影响

目的:观察温针灸联合尿路综合管理的超早期康复模式对急性脑卒中后尿失禁的影响。方法:选取2015年1月至2016年12月武汉大学附属同仁医院急性脑卒中后尿失禁患者69例,随机分为观察组(n=35)与对照组(n=34),2组均在神经内科常规药物治疗基础上,给予温针灸联合尿路综合管理康复模式,观察组在发病24 h内开启此康复模式,而对照组在发病满2周时开启,疗程1个月,比较2组尿失禁严重程度积分与相关尿动力学指标。结果:治疗后,2组尿失禁严重程度积分较治疗前均明显降低(P 0. 05),观察组优于对照组(P 0. 05);治疗1个月后,2组最大尿流率和最大膀胱容量较治疗前均显著提高(P 0. 05),观察组优于对照组(P 0. 05);治疗后观察组的膀胱残余尿量较对照组减少(P 0. 05);最大逼尿肌压,观察组治疗后较治疗前显著下降(P 0. 05),而对照组在治疗前后比较,差异无统计学意义(P0. 05),观察组优于对照组(P 0. 05);结论:温针灸结合尿路综合管理的超早期康复模式,较之早期康复模式,可以更有效地改善急性脑卒中后尿失禁症状与程度,改善膀胱功能,提高生命质量。

Effect of Ultra-rehabilitation Mode of Warm Needling Moxibustion Combined with Urinary Tract Integrated Management on Patients With Urinary Incontinence after Stroke in Acute-phase

To observe the effect of ultra-rehabilitation mode which combined warm needling moxibustion with urinary tract integrated management on patients with urinary incontinence after acute stroke. Methods:A total of 69 cases of patients with urinary incontinence after acute stroke in our hospital from January 2015 to December 2016 were randomly divided into experimental group (35 cases) and control group (34 cases). Two groups all received the same routine medical treatment of neurology and the rehabilitation mode of warm needling moxibustion combined with urinary tract integrated management. The experimental group started this rehabilitation medicine model within 24 hours of onset, while the control group started this at 2 weeks of onset. Urine incontinence severity score and correlated urodynamic index of two groups were compared after a month''s rehabilitation treatment. Results:In both the experimental and control group, the urinary incontinence severity scores were dramatically decreased after a month''s treating than that before treating (P<0.01), while the former was better than the latter (P<0.01). In the aspect of urodynamic index, in the two groups, maximum urine flow rate and maximum bladder capacity were both dramatically increased after treating than before treating (P<0.01), while the experimental group was better than the control group (P<0.01). The residual urine volume in the experimental group was dramatically lower than that in the control group (P<0.01). In the experimental group, the maximum detrusor pressure was evidently lower than that before treating (P<0.01). There was no significant change in the maximum pressure of detrusor before and after treatment in the control group (P>0.05), while the experimental group was better than the control group (P<0.01). Conclusion:The ultra-rehabilitation mode of warm needling moxibustion combined with urinary tract integrated management can be more effective in improving the symptom and degree of urinary incontinence after acute stroke, the bladder function and the quality of life.