Objective To observe the effect of electrical stimulation combined with bladder function training on autonomic bladder patients after S2-4 spinal cord injury or cauda equina and pelvic nerve injury. Methods From January, 2016 to August, 2017, 76 patients with autonomic bladder after spinal cord injury were divided into control group (n=29) and observation groups (n=47) in real world study. The control group received routine bladder function training, and the observation group received bladder muscle stimulation therapy in addition. The micturition diary and urodynamic indexes were assessed before and three months after treatment. Results After treatment, the frequency of urinary incontinence and the number of micturition in 24 hours, and residual urine volume significantly reduced (t>3.251, P<0.01), the urine output every time significantly increased (t>5.000, P<0.001), the maximum bladder capacity and urine flow rate increased (t>1.922, P<0.05), and the detrusor pressure in the end of filling period significantly reduced (t>8.302, P<0.001). All the indexes above were better in the observation group than in the control group (t>1.919, P<0.05). Conclusion Electrical muscular stimulation combined with the bladder functional training could improve the urination function in the patients with autonomic bladder after spinal cord injury.
ZHANG Yan
,
NIU Jian-sheng
,
YU Hui-jin
,
LI Hui-ling
,
ZENG Wei-jie
,
ZHAO Li-sheng
,
YE Ji-ping
,
SUN Jun-di
. Effects of Surface Electrical Stimulation on Urination Function of Autonomic Bladder[J]. Chinese Journal of Rehabilitation Theory and Practice, 2017
, 23(12)
: 1420
-1424
.
DOI: 10.3969/j.issn.1006-9771.2017.12.011
[1] Van Rey FS, Heesakkers JP. Applications of neurostimulation for urinary storage and voiding dysfunction in neurological patients [J]. Urol Int, 2008, 81(4): 373-378.
[2] Goessaert AS, Everaert KC. Onabotulinum toxin A for the treatment of neurogenic detrusor overactivity due to spinal cord injury or multiple sclerosis [J]. Expert Rev Neurother, 2012, 12(7): 763-775.
[3] 王一吉,周红俊,李建军,等. 脊髓损伤神经学分类国际标准检查表最新修订及解读[J]. 中国康复理论与实践, 2015, 21(8): 879-882.
[4] 廖利民,丛惠伶. 神经源性膀胱的诊断与治疗[J]. 临床外科杂志, 2010, 18(11): 725-727.
[5] 刘铁军,赵盟杰,沙可夫. 相对安全膀胱容量间歇导尿法保护上尿路的临床研究[J]. 中国康复理论与实践, 2010, 16(8): 792-793.
[6] 熊宗胜,高丽娟,赵超男. 间歇导尿在脊髓损伤患者中的应用[J]. 中国康复理论与实践, 2003, 9(4): 223-225.
[7] Wyndaele JJ. Intermittent catheterization: which is the optimal technique? [J]. Spinal Cord, 2002, 40: 432-437.
[8] 郭应禄,杨勇. 尿失禁[M]. 济南:山东科学技术出版社, 2003: 330.
[9] Kennelly M, Dmochowski R, Ethans K, et al. Long-term efficacy and safety of onabotulinum toxin A in patients with urinary incontinence due to neurogenic detrusor overactivity: an interim analysis [J]. Urology, 2013, 81(3): 491-497.
[10] 廖利民,鞠彦合. 第三届国际尿失禁咨询委员会最终推荐意见：神经源性尿失禁部分[J].中国康复理论与实践, 2005, 11(11): 881-882.
[11] 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.
[12] Hattori T. [Diagnosis and treatment of neurogenic bladder] [J]. [in Japanese]. Rinsho Shinkeigaku, 2007, 47(11): 766-768.
[13] D'Ancona CA, Ferreira RS, Rassi MC. Botulinum toxin in neurogenic detrusor overactivity [J]. Int Neurourol J, 2012, 16(3): 139-143.
[14] Hikita K, Honda M, Kawamoto B, et al. Botulinum toxin type A injection for neurogenic detrusor overactivity: clinical outcome in Japanese patients [J]. Int J Urol, 2013, 20(1): 94-99.
[15] 陈国庆,廖利民. 骶上脊髓损伤后神经源性膀胱的电刺激治疗[J]. 中国康复理论与实践, 2010, 16(12): 1117-1120.
[16] 吴娟,廖利民,万里,等. 电刺激治疗神经源性膀胱感觉功能障碍的疗效观[J]. 中国脊柱脊髓杂志, 2012, 22(12): 1059-1062.
[17] 丛惠伶,廖利民,司同,等. 电针调节骶3 神经治疗神经源性逼尿肌过度活动的效果研究[J]. 中华泌尿外科杂志, 2010, 31(11): 741-744.
[18] 陈立霞,张杨,岳寿伟. 低频电刺激治疗脊髓损伤后神经源性膀胱尿潴留疗效观察[J]. 山东医药, 2014, 54(28): 55-57.
[19] 陈舜喜,郑家鼎,王宏秀. 神经肌肉电刺激辅助治疗脊髓损伤神经源性膀胱的临床探析[J]. 新医学, 2014, 45(1): 57-59.
[20] 陈虹,李俊岑,党彦丽,等. 电刺激对大鼠脊髓损伤后神经生长因子表达的影响[J]. 中国康复理论与实践, 2012, 18(1): 33-36.
[21] 魏清川,奚颖,马惠,等. 体表电刺激治疗急性脑卒中后排尿障碍的临床观察[J]. 中国康复医学杂志, 2012, 21(3): 235-239.
[22] 刘奕,徐贞杰,向连,等. 体表神经电刺激治疗脊髓损伤后神经源性膀胱的临床观察[J]. 中医药导报, 2013, 19(11): 1-3.
[23] Brose SW, Bourbeau DJ, Gustafson KJ. Genital nerve stimulation is tolerable and effective for bladder inhibition in sensate individuals with incomplete SCI [J]. Spinal Cord Med, 2017, 10: 1-8. [Epub ahead of print].
[24] McGee MJ, Swan BD, Danziger ZC. Multiple reflex pathways contribute to bladder activation by intraurethral stimulation in person with spinal cord injury [J]. Urology, 2017, 109: 210-215.
[25] 谢静茹,李娇. 体表膀胱及骶神经电刺激联合冷热交替膀胱冲洗法对脊髓损伤后神经源性膀胱功能恢复的影响[J]. 实用临床医学, 2014, 15(11): 25-27.
[26] Lavelle JP, Teahan S, Kim DY, et al. Medical and minimally invasive treatment of urinary incontinence [J]. Rev Urol, 1999, 1(2): 111-119.
