文章摘要
庄竞翔,陈晓彤,阮传亮,黄梅,林子涵,曾丽蓉.基于成对关联刺激理论观察针刺联合经颅直流电刺激足运感区对卒中后尿失禁患者的临床疗效[J].中国康复,2022,37(1):12-16
基于成对关联刺激理论观察针刺联合经颅直流电刺激足运感区对卒中后尿失禁患者的临床疗效
Clinical efficacy of acupuncture combined with transcranial direct current stimulation of the foot movement sensory area for patients with post-stroke urinary incontinence based on the theory of paired correlation stimulation
  
DOI:
中文关键词: 卒中  尿失禁  排尿障碍  盆底肌电  经颅直流电  成对关联
英文关键词: stroke  urinary incontinence  dysuria  pelvic floor electromyography  transcranial direct current stimulation  paired associative stimulation
基金项目:福建省泉州市科技计划项目(2020N065s)
作者单位
庄竞翔 泉州市中医院针灸康复科福建 泉州 362000 
陈晓彤 福建中医药大学福州 350000 
阮传亮 泉州市中医院针灸康复科福建 泉州 362000 
黄梅 泉州市中医院针灸康复科福建 泉州 362000 
林子涵 泉州市中医院针灸康复科福建 泉州 362000 
曾丽蓉 泉州市中医院针灸康复科福建 泉州 362000 
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中文摘要:
  目的:基于成对关联刺激理论观察针刺联合经颅直流电刺激足运感区对卒中后尿失禁患者的临床疗效。方法:将81例符合纳入标准的患者随机分为针刺组、经颅直流电组和联合刺激组,3组均进行基础治疗,在此基础上,针刺组取关元、中极、肾俞、膀胱俞针刺治疗;经颅直流电组采用经颅直流电刺激足运感区治疗;联合刺激组在行经颅直流电刺激足运感区同时针刺关元、中极、肾俞、膀胱俞治疗。在首次治疗前、治疗4周后对3组患者进行国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF)、尿失禁生活质量问卷(I-QOL)以及盆底肌电评估分析膀胱功能及盆底肌电电生理改变。结果:治疗后,3组盆底肌电快肌、综合肌、慢肌收缩均较治疗前提高(P<0.05),且ICI-Q-SF评分明显降低、I-QOL评分明显提高(P<0.05)。组间比较:治疗后,3组间快肌纤维快速收缩波幅变化差异无统计学意义。综合肌纤维收缩波幅变化比较:联合刺激组较针刺组和经颅直流电组明显提高,差异有统计学意义(P<0.05);针刺组与经颅直流电组比较,差异无统计学意义。慢肌纤维收缩波幅变化比较:联合刺激组较针刺组和经颅直流电组明显提高,差异有统计学意义(P<0.05);针刺组与经颅直流电组对比,差异无统计学意义。治疗后,联合刺激组ICI-Q-SF、I-QOL量表分值变化明显大于针刺组和经颅直流电组,差异具有统计学意义(P<0.05);针刺组与经颅直流电组比较,量表评分差异无统计学意义。结论:针刺联合经颅直流电刺激足运感区能够更大程度地提高盆底肌肉的耐力和协调性。
英文摘要:
  Objective: To observe the clinical efficacy of acupuncture combined with transcranial direct current stimulation of the foot movement sensor for post-stroke urinary incontinence based on the theory of pair-associative stimulation. Methods: A total of 81 patients who met the inclusion criteria were randomly divided into acupuncture group, transcranial direct current group and combined stimulation group. The three groups received basic treatment. In the acupuncture group, Guanyuan, Zhongji, Shenshu and Bladdershu were selected; the transcranial direct current group was given transcranial direct current to stimulate the foot movement sensing area; In the combined stimulation group, the patients received acupuncture at Guanyuan, Zhongji, Shenshu, and Yiyanshu at the same time during transcranial direct current stimulation of the foot movement sense area. Before the initial treatment and at four weeks after the treatment, all three groups of patients were analyzed by the same person on the International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire (ICI-Q-SF), Urinary Incontinence Quality of Life Questionnaire (I-QOL) and pelvic floor electromyography to evaluate bladder function and electrophysiological changes of pelvic floor muscles. Results: After treatment, the contractions of pelvic floor myoelectric fast muscle, comprehensive muscle, and slow muscle increased as compared with those before treatment (P<0.05), and the scores of ICI-Q-SF and I-QOL were all improved (P<0.05). After treatment, there was no significant difference in the amplitude of fast-twitch muscle fiber contraction among the three groups (P>0.05). The changes of comprehensive muscle fiber contraction amplitude in the combined stimulation group was significantly higher than in the acupuncture group and the transcranial direct current group (P<0.05), but there was no signific-ant difference between the acupuncture group and the transcranial direct current group (P>0.05). The changes of slow muscle fiber contraction amplitude in the combined stimulation group were significantly greater than in the acupuncture group and the transcranial direct current group (P<0.05), but there was no sig-nificant difference between the acupuncture group and the transcranial direct current group (P>0.05). After treatment, the changes in ICI-Q-SF and I-QOL scale scores in the combined stimulation group were significantly greater than those in the acupuncture group and transcranial direct current group (P<0.05), but there was no significant difference between the acupuncture group and transcranial direct current group (P>0.05). Conclusion: Acupuncture combined with transcranial direct current stimulation of the foot movement area can improve the endurance and coordination of the pelvic floor muscles to a greater extent.
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