经表面电极电刺激胫神经治疗脊髓损伤后经源性逼尿肌过度活动

Tibial nerve stimulation using adhesive skin surface electrodes to treat patients with neurogenic detrusor overactivity secondary to spinal cord injury

中文关键词:  【关键词】 神经源性膀胱  脊髓损伤  胫神经电刺激  表面电极  膀胱容量

英文关键词:【Key words】 Neurogenic detrusor overactivity  Spinal cord injury  Tibial nerve stimulation  Surface electrodes  Bladder capacity

中文摘要:

  【摘要】 目的：观察经表面电极电刺激胫神经对脊髓损伤患者神经源性逼尿肌过度活动的抑制效应。方法：2013年6月~2014年4月，采用自主研发的膀胱盆底康复治疗仪行经表面电极电刺激胫神经治疗脊髓损伤后神经源性逼尿肌过度活动的患者23例，男19例，女4例；颈段脊髓损伤3例，胸段脊髓损伤15例，腰段脊髓损伤5例。完全性脊髓损伤18例；不完全性脊髓损伤5例。每周治疗2次，共治疗4周。治疗前及治疗2周、4周时分别记录患者3d排尿日记，并进行患者自我判别的膀胱状态评分（patient perception of bladder condition scale，PPBC-S）。排尿日记包括间歇导尿的次数、每次间歇导尿的尿量以及每天的漏尿量。在记录排尿日记的周期中，患者保持一致的饮水量以及每日间歇导尿的次数，并记录治疗过程中发生的不良反应。结果：患者均完成4周治疗，治疗过程中无不良反应发生。与治疗前相比，治疗2周后患者每次导尿量由258.7±14.7ml增加至282.5±15.2ml（P<0.05），每天漏尿量由766.4±61.5ml降低到563.3±45.4ml（P<0.05），PPBC-S评分由5.2±0.1分改善到4.6±0.1分（P<0.05）。治疗4周后，患者每次导尿量为294.1±15.4ml，每日漏尿量为541.4±47.5ml，PPBC-S评分为4.4±0.1分，与治疗前相比均有显著性差异（P<0.05），与治疗2周相比无显著性差异（P>0.05）。治疗前、治疗2周、4周后记录排尿日记期间，间歇导尿次数分别为4.3±0.3、4.1±0.3和4.0±0.2次，差异无显著性（P>0.05）。结论：经表面电极电刺激胫神经能够抑制脊髓损伤患者神经源性逼尿肌过度活动，可增加膀胱容量，减少漏尿量。

英文摘要:

  【Abstract】 Objectives: To investigate the inhibitory effect of percutaneous tibial nerve stimulation(PTNS) by using adhesive skin surface electrodes in patients with neurogenic detrusor overactivity(NDO) secondary to spinal cord injury(SCI). Methods: From June 2013 to April 2014, 23 patients(19 males and 4 females) with NDO secondary to SCI underwent PTNS(Bladder-Pelvic Stimulator developed by Neural Electro-Mechanics Center of Chinese Academy Sciences and Department of Urology of China Rehabilitation Research Center) using adhesive skin surface electrodes. Among them, there were 3 patients with cervical spinal cord injury, 15 patients with thoracic spinal cord injury and 5 patients with lumbar spinal cord injury. 18 cases presented with complete spinal cord injury and 5 cases were incomplete spinal cord injury. All patients received PTNS twice a week for 4 weeks. Before the treatment, 2 and 4 weeks after the treatment respectively, patients were asked to keep 3-day bladder diaries and the quality of life was evaluated by patient perception of bladder condition scale(PPBC-S). Bladder diaries included the CIC times, volume per catheterization and the total leakage volume per day. During the period of the bladder diary entries, the patients were asked to maintain a consistent volume of fluid intake. The patients were also asked about any other unanticipated adverse event during treatment. Results: All the patients completed treatment, and no unanticipated adverse events were reported. Compared with baseline, after stimulation for 2 weeks, the volume per catheterization increased from 258.7±14.7ml to 282.5±15.2ml(P<0.05), the total leakage volume per day decreased from 766.4±61.5ml to 563.3±45.4ml(P<0.05), and the PPBC-S improved from 5.2±0.1 to 4.6±0.1(P<0.05). Four weeks later, the volume per catheterization was 294.1+15.4ml, the total leakage volume per day was 541.4±47.5ml, and PPBC-S was 4.4±0.1. All indexes improved significantly compared with baseline(P<0.05), but similar to the data 2 weeks after treatment(P>0.05). Before treatment, 2 and 4 weeks after treatment, the CIC frequency was 4.3±0.3, 4.1±0.3 and 4.0±0.2 respectively(P>0.05). No unanticipated adverse events were reported. Conclusions: Tibial nerve stimulation with adhesive skin surface electrodes can inhibit detrusor overactivity, increase bladder capacity and decrease leakage volume in patients with NDO secondary to SCI.