经颅联合外周双向反馈磁刺激对脊髓损伤后神经源性膀胱患者膀胱及排尿功能的效果

doi:10.3969/j.issn.1006-5725.2025.06.013

Abstract

Abstract:

Objective To explore the clinical efficacy of transcranial combined peripheral magnetic stimulation on bladder and voiding ability in patients with NB after spinal cord injury. Methods From September 2023 to October 2024， 60 patients with NB after spinal cord injury were chosen from the Department of Rehabilitation Medicine of the First Affiliated Hospital of Bengbu Medical University， and were separated into the regular group （n = 15）， M1 area stimulation group （n = 15）， sacral nerve root stimulation group （n = 15）， and combined stimulation group （n = 15）. The control group underwent conventional rehabilitation treatment， the M1 area stimulation group added repetitive transcranial magnetic stimulation （rTMS） of the M1 area of the motor cortex， the sacral nerve root stimulation group added repetitive peripheral magnetic stimulation （rPMS） of the sacral 3 nerve roots， and the co-stimulation group added rTMS of the M1 area and rPMS of the sacral 3 nerve roots， and the treatment was carried out for 4 weeks in total. Urodynamic indices， voiding diaries， and neurogenic bladder symptom scores （NBSS） were assessed before and after therapy in the four groups. Results Before therapy， the differences in maximum bladder capacity， bladder capacity at the time of the first urge to urinate， maximum urine flow rate， residual urine volume， average number of urination per day， average daily urinary output， and NBSS scores of the four groups were not statistically significant when compared with those of the pre-treatment group （P < 0.05）； after treatment， the maximum bladder capacity， bladder capacity at the time of the first urge to urinate， maximum urine flow rate， residual urine volume， average number of urination per day， average daily urinary output， and NBSS scores were all improved compared with those before treatment （P < 0.05）； in comparison between the groups， after treatment， the Urodynamic indices， voiding diaries， and NBSS scores of the combined group were better than those of the other three groups （P < 0.05）. Conclusion Transcranial combined peripheral bidirectional feedback magnetic stimulation therapy can improve urodynamic and voiding symptoms and promote the recovery of bladder and voiding function in patients with NB after spinal cord injury

Key words: spinal cord injury, bladder, magnetic stimulation, rehabilitation, urodynamics

CLC Number:

R493

Xiaole LOU,Jianing SONG,Xue HAN,Huan LIU,Yong. JIANG. Effectiveness of bidirectional feedback magnetic stimulation on bladder and voiding function in patients with neurogenic bladder after spinal cord injury[J]. The Journal of Practical Medicine, 2025, 41(6): 859-865.

Figures/Tables 8

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References 31

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组别	例数	性别（男/女）/例	年龄/岁	病程/月	ASIA分级/例
组别	例数	性别（男/女）/例	年龄/岁	病程/月	B	C	D
对照组	15	12/3	51.6 ± 16.81	3.26 ± 1.04	6	5	4
M1区刺激组	15	10/5	57.9 ± 11.42	3.54 ± 0.92	5	6	4
骶神经根刺激组	15	11/4	55.8 ± 13.05	3.78 ± 0.98	3	6	6
联合刺激组	15	9/6	52.4 ± 10.93	3.42 ± 1.07	4	7	4
χ²/F值		0.398	0.890	0.711	1.147
P值		0.472	0.452	0.549	0.615

组别	例数	治疗前	治疗后	t值	P值
对照组	15	304.67 ± 29.73	323.33 ± 33.31	-4.369	< 0.001
M1区刺激组	15	307.20 ± 24.06	343.20 ± 19.67^?	-10.247	< 0.001
骶神经根刺激组	15	293.33 ± 24.76	348.33 ± 32.44^?	-9.408	< 0.001
联合刺激组	15	303.00 ± 30.05	373.00 ± 24.70^?#△	-17.294	< 0.001
F值		0.740	7.928
P值		0.533	< 0.001

组别	例数	治疗前	治疗后	t值	P值
对照组	15	359.67 ± 48.93	323.33 ± 46.66	11.563	< 0.001
M1区刺激组	15	352.80 ± 27.19	307.73 ± 30.90^?	12.855	< 0.001
骶神经根刺激组	15	347.33 ± 48.02	285.33 ± 52.38^?#	13.119	< 0.001
联合刺激组	15	361.67 ± 29.68	254.67 ± 31.36^?#△	32.054	< 0.001
F值		0.409	7.770
P值		0.747	< 0.001

组别	例数	治疗前	治疗后	t值	P值
对照组	15	5.80 ± 1.56	8.20 ± 1.47	-7.483	< 0.001
M1区刺激组	15	7.00 ± 1.51	9.47 ± 1.41^?	-7.668	< 0.001
骶神经根刺激组	15	7.06 ± 2.40	10.06 ± 1.67^?	-7.246	< 0.001
联合刺激组	15	7.13 ± 1.40	11.60 ± 1.40^?#△	-13.287	< 0.001
F值		1.939	13.426
P值		0.134	< 0.001

组别	例数	治疗前	治疗后	t值	P值
对照组	15	385.53 ± 12.96	311.93 ± 14.36	63.558	< 0.001
M1区刺激组	15	383.00 ± 13.12	299.86 ± 11.63^?	28.257	< 0.001
骶神经根刺激组	15	384.93 ± 12.88	280.46 ± 13.44^?#	27.715	< 0.001
联合刺激组	15	380.66 ± 14.03	268.73 ± 14.80^?#△	62.904	< 0.001
F值		0.411	30.244
P值		0.745	< 0.001

Effectiveness of bidirectional feedback magnetic stimulation on bladder and voiding function in patients with neurogenic bladder after spinal cord injury

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组别	例数	治疗前	治疗后	Z值	P值
对照组	15	1.00（0.00，2.00）	2.00（1.00，2.00）	-2.739	0.006
M1区刺激组	15	1.00（0.00，2.00）	3.00（2.00，5.00）^?	-3.219	0.001
骶神经根刺激组	15	1.00（0.00，1.00）	3.00（3.00，4.00）^?	-3.330	< 0.001
联合刺激组	15	1.00（1.00，2.00）	5.00（5.00，6.00）^?#△	-3.431	< 0.001
H值		3.211	25.511
P值		0.360	0.002

组别	例数	治疗前	治疗后	t值	P值
对照组	15	120.66 ± 14.74	145.66 ± 16.78	-11.456	< 0.001
M1区刺激组	15	119.33 ± 10.67	156.00 ± 12.13^?	-18.407	< 0.001
骶神经根刺激组	15	126.66 ± 8.99	162.00 ± 10.98^?	-16.006	< 0.001
联合刺激组	15	127.00 ± 9.96	184.66 ± 11.72^?#△	-24.191	< 0.001
F值		1.863	23.774
P值		0.146	< 0.001

组别	例数	治疗前	治疗后	t值	P值
对照组	15	29.53 ± 3.99	25.33 ± 3.56	8.408	< 0.001
M1区刺激组	15	29.67 ± 3.00	23.13 ± 3.14^?	14.317	< 0.001
骶神经根刺激组	15	30.46 ± 2.41	21.53 ± 1.72^?	17.157	< 0.001
联合刺激组	15	29.60 ± 1.50	18.46 ± 1.92^?#△	10.049	< 0.001
F值		0.347	17.164
P值		0.792	< 0.001

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