间歇清洁导尿联合神经肌肉电刺激治疗神经源性膀胱的疗效观察

目的探讨间歇清洁导尿联合神经肌肉电刺激对脊髓损伤后神经源性膀胱的治疗效果。方法将2015年3月～2018年9月我院康复科收治的脊髓损伤伴有神经源性膀胱的68例患者随机分为对照组(34例)和观察组(34例),其中对照组34例患者在间歇开放导尿(保留导尿管)的基础上进行神经肌肉电刺激、盆底肌训练及行为疗法,观察组改用间歇清洁导尿,余同对照组。1个月后观察并比较两组患者残余尿量、自主排尿量、膀胱容量、膀胱顺应性及并发尿路感染情况,并根据排尿功能评定疗效。结果治疗后两组患者残余尿量、自主排尿量、膀胱容量、膀胱顺应性均优于治疗前;其中对照组患者与治疗前比较,残余尿量有所减少,自主排尿量、膀胱容量较前增加(P0.05),而膀胱顺应性较前稍有改善,差异无统计学意义;观察组上述各项指标与治疗前相比,均具有统计学意义(P0.05);且治疗后上述各项指标均优于对照组(P0.05);经治疗后根据排尿功能评定疗效,对照组显效5例,有效7例,无效22例;观察组显效8例,有效12例,无效14例,两组疗效比较,差异有统计学意义(P0.05);另观察组的尿路感染发生率明显低于对照组(P0.05)。结论采用间歇清洁导尿、神经肌肉电刺激,辅以盆底肌训练及行为疗法等综合疗法治疗神经源性膀胱疗效确切,值得临床推广、使用。

Observation on the therapeutic effect of clean intermittent catheterization combined with neuromuscular electrical stimulation in the treatment of neurogenic bladder

Objective To investigate the therapeutic effect of clean intermittent catheterization combined with neuromuscular electrical stimulation in the treatment of neurogenic bladder after spinal cord injury.Methods 68 patients with spinal cord injury complicated with neurogenic bladder who were admitted to the department of rehabilitation in our hospital from March 2015 to September 2018 were randomly divided into control group(34 cases)and observation group(34 cases).Among them,34 patients in the control group were given neuromuscular electrical stimulation,pelvic floor muscle training and behavioral therapy on the basis of intermittent open catheterization(retaining catheter).The observation group,instead,was given clean intermittent catheterization,and the rest were the same with the control group.After one month,the residual urine volume,autonomous urine volume,bladder capacity,bladder compliance and concurrent urinary tract infection were observed and compared between the two groups,and the efficacy was evaluated according to the urination function.Results After treatment,the residual urine volume,autonomous urine volume,bladder capacity and bladder compliance were better than those before treatment in both groups.In the control group,the residual urine volume was reduced,and the autonomous urine volume and bladder capacity were increased compared with those before treatment(P<0.05).The bladder compliance was slightly improved compared with that before treatment,and the difference was not statistically significant;the above indices in the observation group were statistically significant compared with those before treatment(P<0.05);the above indicators were better than those in the control group after treatment(P<0.05);after treatment,the efficacy was evaluated according to urinary function.The control group was significantly effective in 5 cases,effective in 7 cases,and ineffective in 22 cases;the observation group was significantly effective in 8 cases,effective in 12 cases,and ineffective in 14 cases.The difference in the curative effect between thetwo groups was statistically significant(P<0.05);the incidence rate of urinary tract infection in the observation group was significantly lower than that in the control group(P<0.05).Conclusion The comprehensive treatment methods of clean intermittent catheterization and neuromuscular electrical stimulation,combined with pelvic floor muscle training and behavioral therapy in the treatment of neurogenic bladder,has an exact curative effect and is worthy of clinical promotion and application.