摘要
Objective:To observe the clinical efficacy of turtle-shell-insulated moxibustion combined with acupuncture at Baliao points in treating difficult catheter removal in poststroke urinary retention.Methods:Eighty patients with poststroke urinary retention experiencing difficult catheter removal were randomly allocated to an observation group and a control group using the random number table method,each consisting of 40 cases.The control group received intermittent catheterization,based on which,the observation group additionally received turtle-shell-insulated moxibustion plus acupuncture at Baliao points 5 times weekly.The number of successful catheter removals after 1,2,and 3 weeks of treatment,respectively,the postvoid residual urine volume before and after 1,2,and 3 weeks of treatment,bladder safe volume,end-filling bladder resting pressure,and bladder compliance before and after 2 weeks of treatment were recorded.Adverse reactions that occurred during the treatment period were observed.Results:There was no significant difference in the number of successful catheter removals between the observation group and control group after 1 week of treatment(P>0.05);the observation group had more successful catheter removals than the control group after 2 and 3 weeks of treatment(P<0.05).The between-group difference in the postvoid residual urine volume was statistically insignificant at treatment week 1(P>0.05),while the residual volume was smaller in the observation group than in the control group at treatment weeks 2 and 3(P<0.05).Compared to the control group,the observation group had lower bladder safe capacity and compliance(P<0.01)and higher end-filling bladder resting pressure(P<0.01)after 2 weeks of treatment.During the treatment period,the observation group had a lower adverse reaction rate than the control group(P<0.05).Conclusion:Based on intermittent catheterization,turtle-shell-insulated moxibustion plus acupuncture at Baliao points can increase the success rate of urine catheter removal and lower the adverse reaction rate in patients with poststroke urinary retention.The mechanism may be associated with elevating the end-filling bladder resting pressure and decreasing bladder safe capacity,thus restoring normal bladder compliance and reducing residual urine volume.
目的:观察隔鳖甲灸联合针刺八髎穴治疗脑卒中后尿潴留患者拔管困难的临床疗效。方法:将80例脑卒中后尿潴留拔管困难患者依据随机数字表法随机分为观察组和对照组,每组40例。对照组接受间歇性导尿疗法;观察组在对照组基础上加用隔鳖甲灸及针刺八髎穴治疗,每周5次。分别记录患者治疗1、2、3周后的拔管成功数,治疗前及治疗1、2、3周后的膀胱残余尿量,治疗前及治疗2周后膀胱安全容量、膀胱充盈静止压、膀胱顺应性。观察治疗期间不良反应发生情况。结果:治疗1周后观察组拔管成功数与对照组无统计学差异(P>0.05);治疗2周及3周后观察组的拔管成功数均高于对照组(P<0.05)。治疗1周后两组膀胱残余尿量无统计学差异(P>0.05),治疗2周及3周后观察组的残余尿量均低于对照组(P<0.05)。治疗2周后,观察组的膀胱安全容量与膀胱顺应性均低于对照组(P<0.01),膀胱充盈静止压高于对照组(P<0.01)。治疗期间,观察组不良反应发生率低于对照组(P<0.05)。结论:在间歇性导尿治疗基础上,隔鳖甲灸联合针刺八髎穴可提高脑卒中后尿潴留患者拔管成功率,降低不良反应发生率。其机制可能与提高膀胱充盈静止压,降低膀胱安全容量,从而使膀胱恢复正常顺应性,减少膀胱残余尿量有关。
基金
南京市江宁区科技惠民计划项目,No.2023028S.
