温针隔姜灸联合“醒脑开窍”针刺法治疗脑卒中后尿失禁的随机对照研究

利小华; 王凌燕; 颜俊华; 方艳; 诸葛乐君; 金敏娟

doi:10.16766/j.cnki.issn.1674-4152.003176

温针隔姜灸联合“醒脑开窍”针刺法治疗脑卒中后尿失禁的随机对照研究

doi: 10.16766/j.cnki.issn.1674-4152.003176

1.
浙江中医药大学附属金华中医院针灸推拿科，浙江金华 321017
2.
浙江中医药大学附属金华中医院康复医学科，浙江金华 321017
3.
浙江中医药大学附属金华中医院超声科，浙江金华 321017

基金项目:

浙江省金华市科技计划公益基金类项目 2021-4-284

浙江省基础公益研究计划项目 LGF20H170002

详细信息

通讯作者:
利小华，E-mail：lixiaohua519@163.com

中图分类号: R245 R694.54
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出版历程
- 收稿日期: 2022-11-18
- 网络出版日期: 2023-10-19

A randomized controlled study of warm needle ginger moxibustion combined with Xingnao Kaiqiao acupuncture method in treatment of urinary incontinence after stroke

1.
Acupuncture and Massage Department, Jinhua Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medicine University, Jinhua, Zhejiang 321017, China

摘要

摘要: 目的尿失禁是脑卒中后常见的后遗症，本研究采用温针隔姜灸联合“醒脑开窍”针刺法治疗脑卒中后尿失禁，旨在寻找更有效治疗脑卒中后尿失禁的方法。方法选择2021年1月—2022年6月在浙江中医药大学附属金华中医院就诊的45例采用温针隔姜灸联合“醒脑开窍”针刺法治疗的脑卒中尿失禁患者作为观察组，再同期纳入45例采用“醒脑开窍”针刺法治疗的脑卒中尿失禁患者作为对照组。比较2组临床疗效、不良事件及治疗前后各项评分的变化。结果观察组临床总有效率明显高于对照组；治疗2周、4周及1个月、3个月时，观察组国际尿失禁咨询委员会问卷简表评分(14.52±3.16，10.49±3.20，9.24±2.47，7.63±2.34 vs. 14.68±3.41，12.23±2.66，11.50±1.97，10.33±2.62)、夜间尿失禁程度分级评分(3.71±1.23，3.06±1.28，2.26±0.87，2.59±0.73 vs. 4.54±1.66，4.13±1.85，3.41±0.96，3.29±0.87)、膀胱残余尿量水平明显低于对照组，最大逼尿肌压、最大尿流率、最大膀胱容量、单次尿量水平明显高于对照组(均P < 0.05)。结论温针隔姜灸联合“醒脑开窍”针刺法治疗脑卒中后尿失禁可有效改善排尿功能，降低尿失禁及夜间尿失禁程度，且安全性较好。
- 温针隔姜灸 /
- “醒脑开窍”针刺法 /
- 脑卒中 /
- 尿失禁
Abstract: Objective Urinary incontinence is a common sequela after stroke. In this study, warm acupuncture and ginger moxibustion combined with Xingnao Kaiqiao acupuncture were used to treat urinary incontinence after stroke, aiming to find a more effective treatment method for urinary incontinence after stroke. Methods A total of 45 patients with stroke and urinary incontinence treated with warm needle and ginger moxibustion combined with Xingnao Kaiqiao acupuncture method were selected as the observation group from January 2021 to June 2022 in Jinhua Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Chinese Medicine, and 45 patients with stroke and urinary incontinence treated with Xingnao Kaiqiao acupuncture method were enrolled as the control group during the same period. The clinical efficacy, adverse events and scores before and after treatment were compared between the two groups. Results The total effective rate of clinical efficacy in the observation group was significantly higher than that in the control group. At 2, 4 weeks, 1 and 3 months of treatment, international continence advisory committee urinary incontinence questionnaire short form (ICIQ-SF) score (14.52±3.16, 10.49±3.20, 9.24±2.47, 7.63±2.34 vs. 14.68±3.41, 12.23±2.66, 11.50±1.97, 10.33±2.62), nocturnal incontinence grade score (3.71±1.23, 3.06±1.28, 2.26±0.87, 2.59±0.73 vs. 4.54±1.66, 4.13±1.85, 3.41±0.96, 3.29±0.87) and residual urinary volume of the observation group were significantly lower than those of the control group, while the maximum detrusor muscle pressure, maximum urine flow rate, maximum bladder volume and single urine volume in observation group were significantly higher than those in control group (all P < 0.05). Conclusion Warm needle ginger moxibustion combined with Xingnao Kaiqiao acupuncture and pelvic floor muscle function training in the treatment of urinary incontinence after stroke can effectively improve urination function, reduce the degree of urinary incontinence and nocturnal urinary incontinence, and the security is better.
- Warm needle ginger moxibustion /
- Xingnao Kaiqiao acupuncture method /
- Stroke /
- Urinary incontinence

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表 1 2组脑卒中后尿失禁患者一般资料比较

Table 1. Comparison of general data of urinary incontinence patients after stroke in two groups

组别	例数	性别(例)		年龄(x±s, 岁)	脑卒中种类(例)		脑卒中病程(x±s, 周)	日均排尿次数(x±s, 次)	尿失禁分级(例)				尿失禁病程(x±s, 周)
组别	例数	男性	女性	年龄(x±s, 岁)	脑出血	脑梗死	脑卒中病程(x±s, 周)	日均排尿次数(x±s, 次)	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	尿失禁病程(x±s, 周)
对照组	45	27	18	68.49±7.21	20	25	14.25±3.48	7.42±2.56	6	12	17	10	18.75±4.82
观察组	45	21	24	67.53±8.42	26	19	13.89±4.51	7.19±2.97	11	9	20	5	19.14±5.30
统计量		1.607^a		0.581^b	1.601^a		0.424^b	0.393^b	-1.199^c				0.365^b
P值		0.205		0.563	0.206		0.673	0.694	0.230				0.716
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组脑卒中后尿失禁患者临床总有效率比较[例(%)]

Table 2. Comparison of clinical total effective rate of urinary incontinence patients after stroke in two groups[cases (%)]

组别	例数	治愈	显效	有效	无效	总有效
对照组	45	11(24.44)	16(35.56)	5(11.11)	13(28.89)	32(71.11)
观察组	45	19(42.22)	8(17.78)	14(31.11)	4(8.89)	41(91.11)
注：2组总有效率比较，χ²=23.728，P < 0.001。

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表 3 2组脑卒中后尿失禁患者治疗前后ICIQ-SF评分比较(x±s，分)

Table 3. Comparison of ICIQ-SF scores of patients with urinary incontinence after stroke in two groups before and after treatment(x±s, points)

组别	例数	治疗前	治疗2周	治疗4周	治疗1个月	治疗3个月
观察组	45	16.96±2.53	14.52±3.16^a	10.49±3.20^a	9.24±2.47^a	7.63±2.34^a
对照组	45	17.05±2.69	14.68±3.41^a	12.23±2.66^a	11.50±1.97^a	10.33±2.62^a
t值		-0.163	-0.188	-2.805	-4.799	-5.156
P值		0.871	0.852	0.006	< 0.001	< 0.001
注：与治疗前比较，^aP < 0.05。

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表 4 2组脑卒中后尿失禁患者治疗前后排尿指标比较(x±s)

Table 4. Comparison of urinary indexes of patients with urinary incontinence after stroke in two groups before and after treatment(x±s)

组别	例数	最大逼尿肌压(cm/H₂O)
组别	例数	治疗前	治疗2周	治疗4周	治疗1个月	治疗3个月
观察组	45	9.16±1.15	10.60±0.72^ab	11.32±0.91^ab	12.38±0.84^ab	13.47±1.46^ab
对照组	45	9.28±0.71	9.73±0.76^a	10.05±0.37^a	10.42±1.44^a	11.72±1.85^a

组别	例数	最大尿流率(mL/s)
组别	例数	治疗前	治疗2周	治疗4周	治疗1个月	治疗3个月
观察组	45	12.34±1.03	15.00±0.56^ab	15.27±0.96^ab	16.14±0.82^ab	18.23±1.31^ab
对照组	45	12.11±1.04	13.99±0.37^a	14.15±0.72^a	15.25±0.72^a	16.15±0.94^a

组别	例数	最大膀胱容量(mL)
组别	例数	治疗前	治疗2周	治疗4周	治疗1个月	治疗3个月
观察组	45	204.82±7.10	221.76±5.97^ab	223.00±10.07^ab	244.39±10.71^ab	300.54±10.95^ab
对照组	45	203.54±6.34	211.81±8.50^a	217.26±6.11^a	230.63±9.10^a	289.05±10.29^a

组别	例数	单次尿量(mL)
组别	例数	治疗前	治疗2周	治疗4周	治疗1个月	治疗3个月
观察组	45	128.49±4.96	135.62±8.45^ab	143.84±6.19^ab	142.90±8.27^ab	145.44±7.01^ab
对照组	45	125.91±6.97	131.32±6.01a	131.43±6.23^a	133.74±6.76^a	134.78±5.93^a

组别	例数	膀胱残余尿量(mL)
组别	例数	治疗前	治疗2周	治疗4周	治疗1个月	治疗3个月
观察组	45	74.78±5.79	64.71±6.06^ab	62.16±5.02^ab	41.06±5.45^ab	30.17±4.83^ab
对照组	45	73.98±6.36	68.94±8.08^a	64.99±6.48^a	49.50±8.72^a	38.46±6.04^a
注：与治疗前比较，^aP < 0.05；与对照组比较，^bP < 0.05。

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表 5 2组脑卒中后尿失禁患者治疗前后夜间尿失禁程度分级评分比较(x±s，次)

Table 5. Comparison of nocturnal urinary incontinence grade scores of patients with urinary incontinence after stroke in two groups before and after treatment(x±s, times)

组别	例数	治疗前	治疗2周	治疗4周	治疗1个月	治疗3个月
观察组	45	5.84±2.48	3.71±1.23^a	3.06±1.28^a	2.26±0.87^a	2.59±0.73^a
对照组	45	6.12±1.78	4.54±1.66^a	4.13±1.85^a	3.41±0.96^a	3.29±0.87^a
t值		-0.615	-2.695	-3.191	-5.954	-4.135
P值		0.540	0.008	0.002	< 0.001	< 0.001
注：与治疗前比较，^aP < 0.05。

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