盆底电刺激联合膀胱功能训练对脊髓损伤急迫性尿失禁患者生活质量的影响

关键词：盆底电刺激  尿失禁  脊髓损伤  生活质量  远期疗效

Keywords:pelvic floor myoelectric stimulation  spinal injury  urinary incontinence  quality of life  long-term results

摘要：

      摘要 目的：评价盆底肌电刺激联合膀胱功能训练对脊髓损伤急迫性尿失禁患者生活质量的影响并随访观察其长期疗效。 方法：①采用真实世界研究方法将176例骶髓以上脊髓损伤急迫性尿失禁患者分为对照组（n=67例）、观察组（n=109例）。对照组给予膀胱功能训练，观察组给予膀胱功能训练联合盆底电刺激。于治疗前、治疗3个月后分别检测2组患者排尿日记和尿动力学指标，并通过尿失禁生存质量量表（I-QOL）评估患者的日常生活质量。②观察组治疗结束半年及以上，通过门诊随诊和电话随访的方式对临床症状有效的脊髓损伤急迫性尿失禁患者63例进行随访，以观察该方法的长期疗效。 结果：①治疗前2组患者24h排尿次数、24h漏尿次数、残余尿量、每次排尿量、最大膀胱容量、初始尿意膀胱容量、膀胱顺应性、充盈末期逼尿肌压、生活质量评分的差异无显著性意义（P>0.05）。②治疗后2组患者24h排尿次数、24h漏尿次数、残余尿量减少，每次排尿量增加。最大膀胱容量、初始尿意膀胱容量、膀胱顺应性增加，充盈末期逼尿肌压减小。生活质量明显改善（P<0.05），同时对照组与观察组在上述指标的差异均有显著性意义（P<0.05）。③入选的76例随访对象中，成功随访63例，随访时临床症状评分与治疗前和治疗结束时比较，差异均有显著性意义（P<0.05）。 结论：盆底电刺激联合膀胱功能训练，可进一步改善脊髓损伤急迫性尿失禁患者的排尿功能，提高其生活质量且能保持较好的远期疗效。

Abstract:

      Abstract Objective: To evaluate the immediate and long-term effect of pelvic floor myoelectric stimulation combined with bladder function training on quality of life in patients with urge urinary incontinence. Method: ①176 urgent urinary incontinence patients with spinal injury were divided into the control group (n=67) and the observation group (n=109) by real world study. The control group patients received bladder function training, and the observation group patients received pelvic floor electric stimulation combined with bladder function training. The patients’ micturition diaries, urodynamic index were documented before and after 3 months treatment. At the same time, the quality of life was assessed by I-QOL. ②To study the long-term efficacy of the treatment, 63 patients with urgent urinary incontinence with spinal cord injury who had clinical symptoms for more than half a year after treatment in the observation group were tracked by outpatient follow-up and telephone follow-up. Result: ①Before treatment, the number of urination in 24h, the number of urine leakage in 24h, the residual urine volume, every time urine output volume, maximum cystometric capacity, first desire to void, bladder compliance, detrusor pressure at the end of filling period had no statistical significant difference between two groups(P＞0.05). ②After treatment, the number of urination in 24 hours, the number of urine leakage in 24 hours and the residual urine volume were decreased in both groups. However, every time urine output volume, maximum cystometric capacity, first desire to void and bladder compliance were increased in both groups. In addition, the detrusor pressure at the end of filling period, the maximum urethral closure pressure were decreased in both groups. Meanwhile, the quality of life was improved in two groups. At the same time, there were significant differences between observation group and control group in above outcomes (P<0.05). ③a total of 63 patients were successfully followed up. The clinical symptom scores had no significant difference with those at the end of treatment. Conclusion: Pelvic floor myoelectric stimulation combined with bladder function training could enhance the micturition function of urgent urinary incontinence in patients with spinal injury, and the improvement last long-term.