摘要
目的探讨强化生物反馈治疗儿童神经源性逼尿肌尿道无收缩(NADS)尿失禁的近期疗效。方法选取经尿动力学检查证实为NADS的尿失禁患儿30例[男18例,女12例;年龄(8±4)岁],进行强化生物反馈治疗。治疗30min/次,上、下午各1次,4d/周,疗程为12周。在最初治疗的4周内嘱患儿逐渐增加盆底肌收缩力量,至治疗开始时患儿直肠内压增加到基础值的130%,然后维持该标准盆底肌收缩力量至治疗结束。治疗前后分别记录3d排尿和7d排便日记,填写国际尿失禁咨询委员会问卷简表(ICI-Q-SF),并进行尿动力学检查评估疗效。在治疗结束后3个月门诊或电话随访疗效。结果治疗后总漏尿事件次数、总大便失禁和污便次数及ICI-Q-SF评分分别为(25±8)次、(2.1±1.0)次和(9±5)分,均显著低于治疗前[(32±12)次、(3.2±1.7)次和(15±3)分Pa<0.05];功能性膀胱容量、功能性尿道长度和最大尿道闭合压分别为(62±24)mL、(28±13)mm和(5.4±2.4)kPa,均显著高于治疗前[(54±17)mL、(25±11)mm和(3.8±1.4)kPaPa<0.05]。治疗结束时治愈8例,有效12例,有效率67%;随访3个月时治愈5例,有效10例,有效率达50%,2次疗效评估的有效率比较无统计学差异(P>0.05)。结论强化生物反馈是治疗儿童NADS尿失禁的一种有效方法,尿动力学检查可为其疗效评估提供客观依据。
Objective To evaluate the short - term effect of intensive biofeedback on children with urinary incontinence due to neuropathic aeontractile detrusor and sphincter （NADS）. Methods Thirty children with urinary incontinence due to NADS confirmed by urodynamic study were selected. Among them, 18 cases were boys and 12 were girls ,aged （8 ±4）years old. Intensive biofeedback was successfully accomplished in all patients 2 times/day,30 minutes/time ,4 days/week for 12 weeks. The change of pelvic myoeleetricity and rectum pressure was detected by a urodynamic system. During the first 4 weeks, pelvic myoeleetrieity and rectum pressure increased gradually to 130 percent of outset treatment, which was retained to termination. After treatment every time, the patients were required to contract pelvic floor at home. Three - day urinary diary,7 - day fecal diary, the score of international continence inquiring committee＇s questionnaire （ ICI - Q - SF） and urodynamic evaluation were completed before and after treatment. Three months later,follow - up visits were carried out. Results After treatment, the times of urinary and fecal incontinence and the score of ICI - Q - SF were respective （25 ± 8 ） times, （2.1 ± 1.0 ） times and （9 ± 5 ） scores in children with NADS, significantly lower than those before treatment [ （32 ± 12 ） times, （3. 2 ± 1.7 ） times and （ 15 ± 3 ） scores Pa 〈 0.05 ]. However, functional bladder capacity, functional urethral length and max urethral closure pressure were （62 ± 24 ） mL, （28 ± 13 ）mm and （5.4 ±2.4） kPa respectively,significantly higher than those before treatment[ （54 ± 17） mL, （25 ± 11） mm and （3.8 ± 1.4） kPa Pa 〈 0. 053. After txeatment,8 eases were cured, 12 cases were effective and the effective rate was 67%. Five eases were cured, 10 cases were effective and the effective rate was 50% ,when they were followed up for 3 months,there was no significant difference between them（P 〉 0. 05 ）. Conclusions The intensive biofeedback has satisfactory therapeutic efficacy on children with urinary incontinence due to NADS in short term. Uradynamie testing can provide a reliable obiective evidence for the therapeutic effect evaluation.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第11期815-817,共3页
Journal of Applied Clinical Pediatrics
基金
国家自然科学基金项目资助(30571931)
河南省医学科技创新人才工程项目资助(200703040)
河南省科技厅普及攻关项目资助(340600531410)
郑州市技术研究与开发经费支持项目(074SGHH32262)
