摘要
目的
探讨尿流率—尿道括约肌肌电图(EMG)同步检测在慢性前列腺炎(CP)临床诊治中的作用,并观察电针(EA)治疗慢性前列腺炎的临床疗效,初步探讨其作用机制,为其临床推广应用提供实验依据。
本研究分为两部分:
实验一:慢性前列腺炎患者尿流率—尿道括约肌肌电图检测
实验二:电针治疗慢性前列腺炎的疗效观察
方法
实验一:对128例CP患者和30例正常自愿者(NP)进行尿流率—尿道括约肌EMG同步检测,用Qmax、Qave、TL值和EMG lag Time等参数分析尿流率—尿道括约肌EMG。
实验二:将48例CP患者随机分为电针组和西药组,每组24例。电针组行电针治疗,主穴取关元、中极、次髎、会阳,配穴根据证型辨证取穴;西药组口服司帕沙星和舍尼通片。观察治疗前后患者尿流率—尿道括约肌EMG、NIH-CPSI评分变化及评价临床疗效。
结果
实验一:Qmax、Qave、TL值在CP组与NP组比较时均明显降低,差异有统计学意义(p<0.05);128例CP患者排尿时尿道括约肌肌电活动异常共107例(占83.6%),EMG lag Time异常7例(占5.5%);CP患者TL值与Qmax之间存在正相关关系(r= 0.864,P<0.001),与NIH-CPSI之间存在负相关关系(r=-0.762,P<0.001)。
实验二:电针组总有效率87.5%,优于西药组的62.5%,差异有统计学意义(P<0.05)。电针组NIH-CPSI评分、Qmax、Qave、TL值与治疗前比较均明显好转,差异有统计学意义(P<0.05);治疗后NIH-CPSI评分、Qmax、Qave、TL值与西药组比较,差异有统计学意义(P<0.05)。
结论
本实验初步观察了尿流率—尿道括约肌EMG检测在慢性前列腺炎临床诊断中的作用,并评估了电针治疗慢性前列腺炎的临床疗效,结论如下:
1、尿流率—尿道括约肌EMG检测是评估功能性下尿路梗阻的无创、简便有效方法,在CP的诊断及疗效评估中具有重要临床指导意义,有望得到推广应用。
2、电针对慢性前列腺炎具有治疗作用,其疗效优于临床常规药物治疗方法。
3、电针治疗慢性前列腺炎的机制可能是通过抑制骶髓排尿中枢过度兴奋的有关神经元,从而松弛尿道括约肌、盆底肌,降低尿道阻力来实现的。
Objective
To investigate the effect of the uroflow rate—EMG in chronic prostatitis, observe the clinical therapeutic effect of electroacupuncture for chronic prostatitis and investigate the mechanism of action. There is to provide experimental basis for its clinical application.
Experiment I:. The Clinical study of Uroflow Rate—urethral sphincter EMG on patients with chronic prostatitis.
Experiment II: The Clinical study of Electroacupuncture therapy on patients with chronic prostatitis.
Methods
Experiment I: 128 patients with chronic prostatitis and 30 normal persons were both examined by Laborie urodynamic system.The Qmax ,Qave ,TL value and EMG lag Time were used to explain the Uroflow Rate—urethral sphincter EMG.
Experiment II: 48 cases of chronic prostatitis were randomly divided into an electroacupuncture group(n=24)and a medicine contrast group(n=24). The electroacupuncture group was treated with electroacupuncture at Guanyuan, Zhongji, Ciliao , Huiyang, etc.and the contrast group with oral administration of Sparfloxacin tablets, Prostat tablets. The NIH-CPSI and the Uroflow Rate—urethral sphincter EMG before and after treatment and their therapeutic effects were observed.
Results
Experiment I: The Qmax ,Qave and TL value in CP group were significantly lower than those in normal contrast group (p<0.05);107 cases had abnormal urethral sphincter EMG in the 128 cases patients (83.6%),and 7 cases had abnormal EMG lag Time(5.5%);There was a positive correlation between TL value and Qmax(r= 0.864,P<0.001),and there was a negative corelation between TL value and NIH-CPSI(r=-0.762,P<0.001).
Experiment II: The total effective rate was 87.5% in the electroacupuncture group and 62.5% in the contrast group with a significant difference between the two groups (P<0.05),the former being better than the latter . There were significant differences in whole NIH-CPSI、Qmax、Qave、TL value before and after treatment in the electroacupuncture group(P<0.05); and with a significant difference in whole NIH-CPSI、Qmax、Qave、TL value after treatment between the two groups (P<0.05)
Conclusion
Our study is a preliminary study of Uroflow Rate—urethral sphincter EMG on patients with chronic prostatitis and Electroacupuncture therapy, the conclusion as follow:
1. The uroflow rate—EMG technique is a noninvasive,simple,effective method for evaluating lower urinary tract obstruction,and it would play an important role in diagnosis of chronic prostatitis and is useful for clinical practice.
2. Electroacupuncture has a significant therapeutic effect on chronic prostatitis, which is better than that of the medicine.
3. Electroacupuncture has a therapeutic effect for chronic prostatitis. Its mechanism may be through inhibiting the over-excited sacral micturition center neurons, relaxing urethral sphincter and pelvic floor muscles, reducing the urethral resistance.
引文
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