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刘松涛, 陈菁, 邓石峰, 胡庆, 唐伟, 尹林玉, 艾坤.经皮胫神经电刺激联合针刺治疗骶上脊髓损伤后神经源性膀胱尿潴留患者的临床疗效观察[J].湖南中医药大学学报英文版,2026,46(8):1637-1644.[Click to copy
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| 经皮胫神经电刺激联合针刺治疗骶上脊髓损伤后神经源性膀胱尿潴留患者的临床疗效观察 |
| 刘松涛,陈菁,邓石峰,胡庆,唐伟,尹林玉,艾坤 |
| (湖南中医药大学针灸推拿与康复学院, 湖南 长沙 410208;湘南学院附属医院(临床学院)康复医学科, 湖南 郴州 423000;湘南学院医学影像检验与康复学院, 湖南 郴州 423000) |
| 摘要: |
| 目的 观察经皮胫神经电刺激（TTNS）联合针刺治疗骶上脊髓损伤（SCI）后神经源性膀胱（NB）尿潴留患者的临床疗效，并探索不同美国脊髓损伤协会（ASIA）损伤分级量表（AIS）分级患者的残余尿量（PVR）改善情况。方法 选取2024年3月至2026年3月在湘南学院附属医院康复医学科住院治疗的44例骶上SCI后NB尿潴留患者，随机分为对照组（22例，其中中止1例、脱落1例）和观察组（22例，其中中止1例）。对照组给予常规膀胱功能康复治疗和针刺治疗，观察组在对照组基础上加用TTNS治疗。均每日治疗1次，每周治疗5次，持续12周。治疗前后，采用尿流动力学检测患者最大膀胱内压和最大逼尿肌压；采用腹部超声检测患者排尿后PVR；记录两组患者治疗前后连续3 d的排尿日记，包括日均导尿次数、日均排尿次数、平均单次排尿量和单次最大排尿量；采用 SF-Qualiveen特异性生活质量量表评价患者NB相关生活质量。治疗后，评价患者的临床疗效。结果 治疗后，两组患者最大膀胱内压、最大逼尿肌压和PVR均较治疗前降低（P＜0.01），且观察组均低于对照组（P＜0.05，P＜0.01）。AIS分级分层分析显示，校正治疗前PVR后，组别和AIS分级主效应差异均有统计学意义（P＜0.01），组别×AIS分级交互作用差异无统计学意义（P＞0.05）；两组治疗后PVR均呈AIS B级＞C级＞D级的逐级下降变化（P＜0.05，P＜0.01）。治疗后，两组患者日均导尿次数较治疗前降低（P＜0.05，P＜0.01），且观察组低于对照组（P＜0.05）；两组患者日均排尿次数、平均单次排尿量和单次最大排尿量均较治疗前升高（P＜0.01），且观察组日均排尿次数、平均单次排尿量均高于对照组（P＜0.05）。治疗后，两组患者烦扰、受限、害怕、感觉维度评分和总量表评分均较治疗前降低（P＜0.05，P＜0.01），且观察组烦扰、受限维度评分和总量表评分均低于对照组（P＜0.05）。治疗后，观察组总有效率高于对照组（P＜0.05）。结论 在常规膀胱功能康复与针刺治疗基础上，联合TTNS可进一步改善骶上SCI后NB尿潴留患者的膀胱功能，减少PVR与导尿依赖，并提升NB相关生活质量；AIS分级与膀胱排尿功能恢复密切相关，SCI程度越轻，治疗后排尿功能恢复越好。 |
| 关键词: 骶上脊髓损伤|神经源性膀胱|经皮胫神经电刺激|针刺|尿流动力学|尿潴留|生活质量|AIS分级 |
| DOI：10.3969/j.issn.1674-070X.2026.08.014 |
| Received:May 15, 2026 |
| 基金项目:湖南省卫生健康委2023年度卫生科研课题（D202304048586）。 |
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| Clinical efficacy of transcutaneous tibial nerve stimulation and acupuncture for urinary retention in patients with neurogenic bladder following suprasacral spinal cord injury |
| LIU Songtao, CHEN Jing, DENG Shifeng, HU Qing, TANG Wei, YIN Linyu, AI Kun |
| (The School of Acupuncture, Moxibustion & Tuina, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China;Department of Rehabilitation Medicine, Affiliated Hospital of Xiangnan University (Clinical College), Chenzhou, Hunan 423000, China;College of Medical Imaging, Laboratory and Rehabilitation, Xiangnan University, Chenzhou, Hunan 423000, China) |
| Abstract: |
| Objective To investigate the clinical efficacy of transcutaneous tibial nerve stimulation (TTNS) and acupuncture in patients with urinary retention secondary to neurogenic bladder (NB) following suprasacral spinal cord injury (SCI), and to explore changes in post-void residual volume (PVR) among patients with different American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades. Methods Forty-four inpatients with urinary retention secondary to NB following suprasacral SCI were enrolled from the department of rehabilitation medicine, affiliated hospital of Xiangnan University, between March 2024 and March 2026. Patients were randomly assigned to a control group (n=22; 1 treatment discontinuation and 1 dropout) and an observation group (n=22; 1 treatment discontinuation). The control group received conventional bladder rehabilitation and acupuncture, while the observation group additionally received TTNS. Treatment was administered once daily, five times per week, for 12 weeks. Before and after treatment, maximum vesical pressure and maximum detrusor pressure were assessed by urodynamic testing, and PVR was measured by abdominal ultrasonography. Three-day voiding diaries were recorded, including the mean daily number of catheterizations, mean daily voiding frequency, mean voided volume, and maximum voided volume. NB-related quality of life was assessed using the SF-Qualiveen questionnaire. After treatment, clinical efficacy of patients was evaluated. Results After treatment, maximum vesical pressure, maximum detrusor pressure, and PVR significantly decreased in both groups compared with the baseline (P<0.01), and had lower values in the observation group than those in the control group (P<0.05, P<0.01). Stratified analysis by AIS grade showed that, after adjustment for baseline PVR, the main effects of group and AIS grade were statistically significant (P<0.01), whereas the group-by-AIS grade interaction was not statistically significant (P>0.05). In both groups, post-treatment PVR decreased progressively from AIS grade B to grade C and grade D (P<0.05, P<0.01). After treatment, the mean daily number of catheterizations decreased in both groups compared with baseline (P<0.05, P<0.01) and was lower in the observation group than in the control group (P<0.05). Mean daily voiding frequency, mean voided volume, and maximum voided volume increased in both groups compared with baseline (P<0.01), and mean daily voiding frequency and mean voided volume had higher values in the observation group than in the control group (P<0.05). After treatment, scores for bother, limitations, fears, feelings, and the total SF-Qualiveen score decreased in both groups compared with baseline (P<0.05, P<0.01), while bother, limitations, and total scores were lower in the observation group than in the control group (P<0.05). After treatment, the overall response rate was higher in the observation group than in the control group (P<0.05). Conclusion On the basis of conventional bladder rehabilitation and acupuncture, the addition of TTNS can further improve bladder function, reduce PVR and catheter dependence, as well as improve NB-related quality of life in patients with urinary retention secondary to NB following suprasacral SCI. AIS grade is closely associated with recovery of bladder-emptying function, with less severe SCI being associated with better recovery after treatment. |
| Key words: suprasacral spinal cord injury|neurogenic bladder|transcutaneous tibial nerve stimulation|acupuncture|urodynamics|urinary retention|quality of life|American Spinal Injury Association Impairment Scale grade |
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