Effects of umbilical moxibustion combined with intermittent catheterization on lower urinary tract symptoms and bladder function in patients with neurogenic bladder following spinal cord injury
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摘要:
目的 探讨在常规间歇导尿基础上联合脐灸干预对改善脊髓损伤（SCI）后神经源性膀胱（NB）患者下尿路症状及膀胱功能的临床效果，旨在为优化SCI后NB的临床管理策略提供参考。 方法 选取2023年4月—2025年4月湖南中医药大学第一附属医院收治的84例SCI后NB患者为研究对象，按照随机信封法分为联合组和对照组，各42例，对照组予以间歇导尿治疗，联合组在对照组基础上联合脐灸治疗，均治疗4周。评价2组临床疗效与疗法安全性，统计排尿情况（最大排尿量、24 h单次尿量、24 h排尿次数），于治疗前后评估膀胱功能[最大膀胱容积（MCC）、膀胱顺应性（BC）、最大尿流率（Qmax）、残余尿量（PVR）]及尿路感染情况（尿白细胞数）以及下尿路症状[国际下尿路症候群症状（LUTS）评分]。 结果 联合组总有效率为92.86%（39/42），高于对照组[71.43%（30/42）, P＜0.05]。治疗4周后，2组最大排尿量、24 h单次尿量、MCC、BC与Qmax均升高，且联合组均高于对照组（P＜0.05）；2组24 h排尿次数、PVR、尿白细胞数与LUTS评分均降低，且联合组均低于对照组（P＜0.05）。 结论 脐灸联合间歇导尿治疗SCI后NB患者，有改善膀胱功能与下尿路症状、降低尿路感染的作用，且具有安全性。 Abstract:Objective To evaluate the effects of combining umbilical moxibustion with intermittent catheterization on lower urinary tract symptoms (LUTS) and bladder function in patients with neurogenic bladder (NB) following spinal cord injury (SCI), aiming to provide the optimization of management strategies for post-SCI NB. Methods A total of 84 NB patients following SCI admitted to the First Hospital of Hunan University of Chinese Medicine from April 2023 to April 2025 were enrolled and randomly divided into a combination group (n=42) and a control group (n=42) using the sealed envelope method. The control group received intermittent catheterization, while the combination group additionally received umbilical moxibustion for 4 weeks. Clinical efficacy and safety were evaluated. Urination parameters (maximum voided volume per void, single void volume over 24 h, 24-hour voiding frequency), bladder function [maximum bladder capacity (MCC), bladder compliance (BC), maximum urinary flow rate (Qmax), post-void residual volume (PVR)], urinary tract infection indicators (urinary white blood cell count), and LUTS [international LUTS symptom score] were assessed before and after treatment. Results The total effective rate in the combination group was 92.86% (39/42), which was higher than that in the control group [71.43% (30/42), P < 0.05]. After 4 weeks of treatment, both groups showed increased in maximum voided volume, single void volume over 24 h, MCC, BC, and Qmax, with greater improvements in the combination group (P < 0.05). Both groups also exhibited reduced 24-hour voiding frequency, PVR, urinary white blood cell count, and LUTS scores, with lower values in the combination group (P < 0.05). Conclusion Umbilical moxibustion combined with intermittent catheterization significantly improves bladder function and LUTS, reduces urinary tract infections, and demonstrates good safety in NB patients following SCI. -
表 1 2组SCI后NB患者一般资料比较
Table 1. Comparison of general data between the two groups of patients with NB after SCI
组别 例数 性别[例(%)] 年龄(x±s，岁) 病程(x±s，d) 损伤程度[例(%)] 男性 女性 A级 B级 联合组 42 29(69.05) 13(30.95) 47.67±7.17 57.41±8.31 14(33.33) 28(66.67) 对照组 42 27(64.29) 15(35.71) 48.31±7.94 55.17±10.74 20(47.62) 22(52.38) 统计量 0.214a 0.388b 1.069b 1.779a P值 0.643 0.699 0.288 0.182 注：a为χ2值，b为t值。 
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表 2 2组SCI后NB患者临床疗效比较[例(%)]
Table 2. Comparison of clinical efficacy between the two groups of patients with NB after SCI[cases(%)]
组别 例数 临床治愈 显效 有效 无效 总有效 联合组 42 12(28.57) 17(40.48) 10(23.81) 3(7.14) 39(92.86) 对照组 42 5(11.90) 11(26.19) 14(33.33) 12(28.57) 30(71.43) 统计量 3.115a 6.574b P值 0.002 0.010 注：a为U值，b为χ2值。
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表 3 2组SCI后NB患者治疗前后排尿情况比较
Table 3. Comparison of urination between the two groups of patients with NB after SCI
组别 例数 最大排尿量(x±s，mL) 24 h单次尿量(x±s，mL) 24 h排尿次数[M(P25, P75)，次] 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 联合组 42 225.48±49.14 326.72±61.52b 149.84±37.26 246.35±45.76b 14.0(12.0，16.0) 8.0(7.0，10.0)b 对照组 42 218.76±46.32 265.10±52.87b 152.62±33.59 181.94±40.25b 14.5(12.0，17.0) 12.0(10.0，14.0)b 统计量 0.645a 26.371c 0.359a 48.195c 799.000d 28.905d P值 0.521 ＜0.001 0.720 ＜0.001 0.345 ＜0.001 注：a为t值，c为F值，d为U值；与同组治疗前比较，bP＜0.05。
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表 4 2组SCI后NB患者治疗前后膀胱功能比较(x±s)
Table 4. Comparison of bladder function between the two groups of patients with NB after SCI(x±s)
组别 例数 MCC(mL) BC(mL/cmH2O) PVR(mL) Qmax(mL/s) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 联合组 42 253.65±32.18 326.44±38.28b 25.65±4.94 36.19±6.54b 10.21±3.13 17.38±4.15b 147.91±38.66 75.22±22.84b 对照组 42 248.92±29.74 281.52±33.75b 24.82±5.34 27.35±5.87b 9.84±2.61 12.14±3.23b 152.75±41.32 118.66±31.42b 统计量 0.700a 35.291c 0.739a 45.628c 0.588a 43.159c 0.554a 56.152c P值 0.486 ＜0.001 0.462 ＜0.001 0.558 ＜0.001 0.581 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 5 2组SCI后NB患者治疗前后尿路感染情况与下尿路症状评分比较(x±s)
Table 5. Comparison of urinary tract infection and lower urinary tract symptom scores between the two groups of patients with NB after SCI(x±s)
组别 例数 尿白细胞数(μL) LTUS评分(分) 治疗前 治疗后 治疗前 治疗后 联合组 42 162.86±38.91 58.53±12.38b 24.71±4.37 8.64±2.90b 对照组 42 156.38±42.72 92.41± 28.66b 5.25±4.85 17.53±3.86b 统计量 0.758a 52.731c 0.445a 158.682c P值 0.451 ＜0.001 0.657 ＜0.001 注：a为t值，c为F值；与同组治疗前比较，bP＜0.05。
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表 6 2组SCI后NB患者疗法安全性比较[例(%)]
Table 6. Comparison of treatment safety between the two groups of patients with NB after SCI[cases(%)]
组别 例数 尿路感染 尿道微量出血 自主神经反射异常 脐部皮肤轻微红肿 总发生 联合组 42 7(16.67) 4(9.52) 2(4.76) 3(7.14) 13(30.95) 对照组 42 9(21.43) 5(11.90) 3(7.14) 0 14(33.33) χ2值 0.309 ＜0.001 ＜0.001 1.383 0.055 P值 0.578 0.999 0.999 0.240 0.814 注：部分患者同时出现多种并发症，总发生率为至少发生一种并发症的患者比例。
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