经皮胫神经电刺激联合阶梯式膀胱训练对脊髓损伤后神经源性膀胱患者的影响OA
Effect of Percutaneous Tibial Nerve Stimulation Combined with Stepwise Bladder Training on Neurogenic Bladder after Spinal Cord Injury
目的:观察经皮胫神经电刺激(percutaneous tibial nerve stimulation,PTNS)联合阶梯式膀胱训练对脊髓损伤后神经源性膀胱(neurogenic bladder,NB)患者尿流动力学参数及生活质量的影响.方法:选取 2023 年 2 月—2025 年 5 月南京银城康复医院脊髓损伤后 NB 患者 68 例为研究对象,采用随机数字表法分为两组,各 34 例,训练组给予阶梯式膀胱训练,电刺激组在此基础上给予 PTNS,比较两组排尿情况、尿流动力学[排尿期最大尿流率(maximum flow rate,Qmax)、残余尿量(residual urine volume,RUV)、最大逼尿肌压力(maximum detrusor pressure,Pdet-max)]、盆底肌电值(静息、快速收缩、紧张收缩及耐力收缩阶段)、神经源性膀胱症状评分(neurogenic bladder symptom score,NBSS)、泌尿症状困扰量表(urinary symptom distress scale,USDS)评分.结果:与训练组相比,治疗 1 个月后电刺激组每日排尿次数、每日尿失禁次数较少,单次排尿量较多(P<0.05);与训练组相比,治疗 1 个月后电刺激组 RUV 较少,Qmax 较快,Pdet-max 较高(P<0.05);与训练组相比,治疗 1 个月后电刺激组耐力收缩、快速收缩、紧张收缩、静息阶段盆底肌电值较高(P<0.05);与训练组相比,治疗 1 个月后电刺激组 NBSS 的尿失禁、储尿和漏尿、结局评分均较低(P<0.05);治疗 1 个月后两组 USDS 评分差异无统计学意义(P>0.05).结论:PTNS 联合阶梯式膀胱训练应用于脊髓损伤后 NB 患者,有利于减轻症状,改善尿流动力学,增强盆底肌功能,恢复排尿功能.
Objective:To observe the effect of percutaneous tibial nerve stimulation(PTNS)combined with stepwise bladder training on urodynamic parameters and quality of life in patients with neurogenic bladder(NB)after spinal cord injury.Method:A total of 68 patients with NB after spinal cord injury admitted to Nanjing Yincheng Rehabilitation Hospital from February 2023 to May 2025 were selected as study subjects.They were divided into two groups using a random number table method,with 34 cases in each group.The training group received stepwise bladder training,while the electrical stimulation group underwent PTNS in addition to the training.The two groups were compared in terms of urination status,urodynamic[maximum flow rate(Qmax),residual urine volume(RUV),maximum detrusor pressure(Pdet-max)],pelvic floor electromyography values(at rest,fast contraction,tension contraction,and endurance contraction stages),neurogenic bladder symptom score(NBSS),and urinary symptom distress scale(USDS)score.Result:Compared with the training group,the electrical stimulation group showed significantly fewer daily voiding episodes and daily incontinence episodes,as well as larger single voiding volume after 1 month of treatment(P<0.05).In comparison with the training group,the electrical stimulation group exhibited less RUV,faster Qmax,and higher Pdet-max after 1 month of treatment(P<0.05).The electrical stimulation group demonstrated higher pelvic floor electromyography values during endurance contraction,fast contraction,tension contraction,and resting stages after 1 month of treatment compared to the training group(P<0.05).Compared with the training group,the electrical stimulation group had significantly lower scores for incontinence,storage and leakage,and outcome of NBSS after 1 month of treatment(P<0.05).No statistically significant difference was observed in USDS scores between the two groups at 1 month after treatment(P>0.05).Conclusion:The application of PTNS combined with stepwise bladder training in patients with NB after spinal cord injury is beneficial for alleviating symptoms,improving urodynamic,enhancing pelvic floor muscle function,and restoring urinary function.
汪仁元;孙慧
南京银城康复医院康复医学科 江苏 南京 210046南京银城康复医院康复医学科 江苏 南京 210046
医药卫生
脊髓损伤后神经源性膀胱经皮胫神经电刺激阶梯式膀胱训练尿流动力学参数生活质量
Neurogenic bladder after spinal cord injuryPercutaneous tibial nerve stimulationStepwise bladder trainingUrodynamic parametersQuality of life
《中国医学创新》 2026 (13)
11-16,6
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