经皮神经电刺激治疗神经源性膀胱过度活动症

Efficacy of transcutaneous electrical nerve stimulation in the treatment of neurogenic overactive bladder

关键词:  经皮神经电刺激  神经源性膀胱过度活动症  膀胱过度活动症状

Key words:  transcutaneous electrical nerve stimulation  neurogenic overactive bladder  overactive bladder symptom

摘要:

目的探讨经皮电神经刺激（transcutaneous electrical nerve stimulation, TENS）对神经源性膀胱过度活动症（neurogenic overactive bladder, NOAB）的治疗作用。方法83例经抗胆碱药物治疗症状未改善的NOAB患者分为A组（n=42）和B组（n=41）。A组每天1次接受30min的频率为20Hz、波宽为150μs的双相方波TENS治疗90d，B组继续接受抗胆碱物药治疗90d。治疗前后分别评估参与者的膀胱过度活动症评分（overactive bladder syndrome score, OABSS），健康调查简表（SF-36），排尿日记，尿动力学。结果治疗90d后，A组的OABSS评分比B组显著降低（P<0.01）。A组的SF-36评分有部分明显改善（P<0.05）。A组排尿日记治疗前后比较每24h排尿次数、平均排尿量、每24h尿失禁次数（P<0.001，P=0.005和P=0.003）均明显优于B组。A组患者在尿动力学检查中最大膀胱容量、逼尿肌压力、最大尿流率都明显优于B组（P<0.001、P=0.030和P<0.001）。结论20Hz的TENS可以改善NOAB患者的OAB症状。

Abstract:

ObjectiveTo investigate the therapeutic effect of transcutaneous electrical nerve stimulation(TENS) on neurogenic overactive bladder(NOAB). MethodsEighty three NOAB patients whose symptoms did not improve after anticholinergic drug treatment were divided into group A(n=42) and group B(n=41). Group A received 30-minute TENS treatment using biphasic square wave with a frequency of 20Hz and a wave width of 150μs once a day for 90 days, and group B continued to receive anticholinergic drugs for 90 days. The overactive bladder syndrome score(OABSS), the MOS 36-Item Short-Form Health Survey(SF-36), and voiding diary were assessed before and after treatment. ResultsAfter 90 days of treatment, the OABSS scores of group A were significantly lower than that of group B(P<0.01). The SF-36 scores of group A were significantly improved(P<0.05). The voiding diary showed that the voiding frequency per 24h, average voided volume and incontinence episodes per 24h of group A were significantly better than those of group B(P＜0.001, P=0.005 and P=0.003, respectively). The patients of group A had superior in the several urodynamic examination values： maximum cystometric capacity, detrusor pressure and maximum flow rate(P<0.001, P=0.030 and P<0.001, respectively). ConclusionThe transcutaneous electrical nerve stimulation with frequency of 20Hz can improve symptoms in patients with drug-refractory neurogenic overactive bladder.