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1、經(jīng)皮電脈沖刺激治療糖尿病神經(jīng)原膀胱的療效分析王新民盧偉文李路郭躍安徐光周獻(xiàn)忠駱新娥宋辛飛王玉麟【摘要】目的觀(guān)察體外電脈沖刺激膀胱(transcutaneouselectrostimulationofvesica,TEV)對(duì)糖尿病神經(jīng)源膀胱(diabeticneurogenicbladder,DNB)患者膀胱殘余尿(bladderresidueurine,BRU)和白細(xì)胞排泄率(u-rineleukocyteexcretionrate,ULR)的影響,探討DNB無(wú)創(chuàng)而有效的治療方法。方法所有BRU增多(≥50m1)的DNB患者在降糖治療的同時(shí),根
2、據(jù)其BRU的量分為輕(50~250m1)、中(251~450m1)、重(>450m1)度DNB,輕、中度DNB患者分別隨機(jī)分為刺激組和對(duì)照組,重度DNB患者則隨機(jī)分為刺激組和刺激+α1–阻滯劑組,刺激均采用電脈沖體外交替刺激兩側(cè)膀胱角和膀胱前、后壁方位,使膀胱平滑肌不斷收縮而排尿;主要觀(guān)察指標(biāo)有治療前、后患者的血糖、血脂、BRU及ULR等變化。結(jié)果DNB患者的年齡、糖尿病病程、ULR、BRU和GHb隨DNB的輕重而增加;而神經(jīng)傳導(dǎo)速度(nerveconductivevelocity,NCV)則減慢。輕、中度DNB患者中,刺激組和對(duì)照組治療前、后
3、的糖、脂和尿酸代謝改善程度相當(dāng),但刺激組的BRU和ULR明顯減少(P均<0.02),對(duì)照組則無(wú)明顯變化;在重度DNB患者中,刺激組的BRU和ULR明顯減少,尿意率(urinereflexrate,URR)明顯升高,但刺激+α1–阻滯劑組BRU和ULR的減少較刺激組更明顯。結(jié)論體外膀胱電脈沖刺激可有效減少或消除DNB患者的BRU和ULR,甚至恢復(fù)重度DNB患者的尿意,在重度治療DNB患者時(shí)與+α1–阻滯劑聯(lián)用療效更佳?!娟P(guān)鍵詞】糖尿病神經(jīng)源膀胱;體外電脈沖刺激;殘余尿;糖尿病Thetherapeuticeffectoftranscutaneous
4、electrostimulationofvesica(TEV)intreatmentofneurogenicblad-derWANGXinmin*,LUWeiwen,LILu,GUOYuean,XUGang,ZHOUXianzhong,LUOXin’e,SONGXinfei,WANGYulin.*DepartmentofEndocrinology,TheSecondAffliatedHospital,Ji'nanUniversity,Shenzhen5l8020,China【Abstract】ObjectiveToexploreanoptima
5、ltherapeuticmethodforthemanagementofdiabeticpatientwithneurogenicbladder(DNB).MethodsByusingoftheTEVdevice,patientwithmildDNBwastreatedfor40minutes,Bidforl0days,moderateDNBwastreatedfor40minutes,Tidfor20days,and40minutesQidfor30daysinseverecases.Thevolumeofresidualurineofthe
6、bladder(BRU),andtheurinaryleucocyteexcretionrate(ULR)wereusedasthemainindicesjnevaluationofthetherapeuticeffect.ResultsBoththeBRUandULRweresignificantly-reducedinpatientswithmildandmoderateDNBafterasessionoftreatment.ThistherapeuticeffectwasalsoobservedinthesevereDNBcasesinw
7、hichthetherapeuticeffectwasenhancedinthosereceivedthe+α1–receptorbloc-kerinadditiontotheTEVtherapy.ConclusionBoththeBRUandULRofthepatientwithDNBcanbereducedaftertheTEVtherapyandfavourableeffectcanalsobeexpectedinpatientwithsevereDNB.Forthemcombiningwithd+α1–receptorblockerwo
8、uldenhanceitstherapeuticeffectiveness.【Keywords】Neurogenicbladder;Transcuta