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目的 观察体外电脉冲刺激膀胱 (transcutaneouselectrostimulationofvesica ,TEV)对糖尿病神经源膀胱 (diabeticneurogenicbladder,DNB)患者膀胱残余尿 (bladderresidueurine,BRU)和白细胞排泄率(urineleukocyteexcretionrate,ULR)的影响 ,探讨DNB无创而有效的治疗方法。方法 所有BRU增多 (≥ 50ml)的DNB患者在降糖治疗的同时 ,根据其BRU的量分为轻 (50～ 2 50ml)、中 (2 51～ 450ml)、重 (>450ml)度DNB ,轻、中度DNB患者分别随机分为刺激组和对照组 ,重度DNB患者则随机分为刺激组和刺激 +α1 阻滞剂组 ,刺激均采用电脉冲体外交替刺激两侧膀胱角和膀胱前、后壁方位 ,使膀胱平滑肌不断收缩而排尿 ;主要观察指标有治疗前、后患者的血糖、血脂、BRU及ULR等变化。结果 DNB患者的年龄、糖尿病病程、ULR、BRU和GHb随DNB的轻重而增加 ;而神经传导速度 (nerveconductivevelocity ,NCV)则减慢。轻、中度DNB患者中 ,刺激组和对照组治疗前、后的糖、脂和尿酸代谢改善程度相当 ,但刺激组的BRU和ULR明显减少 (P均 <0 .0 2 ) ,对照组则无明显变化 ;在重度DNB患者中 ,刺激组的BRU和ULR明显减少 ,尿意率 (urinereflexrate,URR)明显升高 ,但刺激 +α1 阻滞剂组BRU和ULR的减少较刺激组更明显。结论 体外膀胱电脉冲刺
Objective To observe the effect of transcutaneouselectrostimulation ofvesica (TEV) on bladder residual urine (urinary bladder and urinary excretion rate, ULR) in patients with diabeticneurogenicbladder (DNB) and to investigate the feasibility of noninvasive and effective DNB treatment method. Methods All DNB patients with more BRU (≥50ml) were treated with hypoglycemic treatment and were divided into mild (50 ~ 250ml), moderate (250ml ~ 450ml) and severe (> 450ml) DNB according to the amount of BRU , Moderate DNB patients were randomly divided into stimulation group and control group, severe DNB patients were randomly divided into stimulation group and stimulation + α1 blocker group, the stimulation were used in vitro electrical stimulation of both sides of the bladder angle and bladder alternately before and after Wall orientation, the bladder smooth muscle contraction and urination; main observation indicators before and after treatment in patients with blood glucose, blood lipids, BRU and ULR and other changes. Results The age, duration of diabetes, ULR, BRU and GHb in patients with DNB increased with the severity of DNB, while the nerve conduction velocity (NCV) was slowed down. In mild and moderate DNB patients, the improvement of glucose, lipid and uric acid metabolism was similar in the stimulation group and the control group before and after treatment, but the BRU and ULR in the stimulation group were significantly decreased (all P <0. 02), while those in the control group In severe DNB patients, the BRU and ULR of the stimulated group were significantly decreased and the urinary reflex rate (URR) was significantly increased, but the reduction of BRU and ULR in the stimulated + α1 blocker group was more obvious than that in the stimulated group. Conclusions In vitro bladder electropuncture