目的 探讨肌电生物反馈联合骶四针对老年患者前列腺电切术后压力性尿失禁的疗效.方法 选取2015年12月 ～2019年12月首都医科大学附属北京康复医院收治的前列腺增生患者98例,随机数表法分为对照组49例和实验组49例.所有患者接受2μm铥激光汽化前列腺切除术,术后口服索利那新及坦索罗辛,实验组在此基础上辅以肌电生物反馈联合骶四针治疗.比较两组患者术后尿失禁发生率、 排尿指标及生活质量评分.结果 实验组术后2周及3个月尿失禁发生率与对照组相比差异均无统计学意义(P>0.05),实验组术后1个月尿失禁发生率低于对照组(P<0.05);实验组术后最大尿流率(Qmax)、最大逼尿肌压力(MDP)高于对照组,残余尿量(PVR)低于对照组,差异均有统计学意义(P<0.05);实验组术后国际前列腺症状评分(IPSS)及生活质量评分(QOL)均低于对照组,差异有统计学意义(P<0.01).结论 肌电生物反馈联合骶四针相比对照组能有效改善老年前列腺电切术后患者排尿情况及生活质量.

Objectives:To study the value of the detrusor urine leakage point pressure(detrusor leak point pressure,DLPP) and the bladder safe capacity(safe bladder capacity,SBC) in patients with neurogenic bladder undergoing intermittent catheterization.Methods:From July 2015 to July 2016 40 patients with neurogenic bladder in our hospital accept intermittent catheterization.Randomly,cases were divided into observation group and control group with 20 cases in each group.The control group were given conventional intermittent catheterization,according to the amount of residual urine to determine the number of intermittent catheterization.Observation group was processed to blood test to check kidney function by parallel urinary tract ultrasound images and urine dynamics test to determine the upper urine tract,at same time,the SBC and DLPPwere measured,intermittent catheterization,was oerformed on the basis of water project and the regularity of voiding diary,the amount of urinary bladder was measured prior to the SBC time,the intermittent catheterization was performed strictly in SBC.40 cases with urinary leakage accepted pelvic floor muscle training on bed.All patients underwent 1 year of intervention,and all underwent the examination of the urine dynamics [including DLPP,SBC,residual urine volume(residual urine volume,RUV)],renal function examination (including blood urea nitrogen,creatinine),self-assessment lists of anxiety(self-rating anxiety scale,SAS),self rating scale for depression(self-rating depressive scale,SDS),the SF-36 quality of life scale(including diet,mental,and psychological sleep four dimensions) score to assess the patient's quality of life prior to intervention,and intervention after 1 year respectively.Results:Patients in each group of intervention 1 year later had obviously improved of DLPP,SBC,RUV,blood urea nitrogen,creatinine,SAS and SDS scores and diet,mental,sleep,psychological score than those before intervention(P＜0.05).Before intervention,the above indexes between the two groups showed no statistical difference(P＞0.05).Intervention after 1 year,DLPP,RUV in observation group were significantly lower than those in the control group,SBC was significantly higher than control group;Blood urea and creatinine were significantly lower than the control group;SAS,SDS scores were significantly lower than the control group,diet,mental,sleep,the psychological scores were significantly higher than that of control group(P＜0.05).Conclusions:For patients with neurogenie bladder to inspect,DLPP and SBC test are help to guide intermittent catheterization,which can effectively improve the patient's urine dynamics index,promote the recovery of renal function,while eliminating patients psychological feelings,and can significantly improve the quality of life.