低频电刺激结合康复训练治疗脊髓损伤神经源性膀胱疗效的Meta分析

Meta-Analysis of the Efficacy of Low Frequency Electrical Stimulation with Rehabilitation Training in the Treatment of Neurogenic Bladder Caused by Spinal Cord Injury

摘要: 目的：利用Meta分析的方法研究国内外关于低频电刺激结合康复训练治疗脊髓损伤神经源性膀胱患者疗效研究。方法：借鉴CNKI、万方数据库、VIP、PUBMED、Cochrane Library等数据库，检索2017年1月至2023年1月期间发表的低频电刺激结合康复训练治疗脊髓损伤神经源性膀胱疗效的随机对照研究(RCT)，并且已经正式发表的论著和学位论文，用RevMan5.4软件进行统计分析。结果：共13篇论文(1008例患者)入选，低频电刺激组506例，对照组502例。根据文献中的数据，确定采用治疗后的各项指标来完成评估。分析结果为，低频电刺激组与对照组比较，排尿次数增多[MD: 0.84, 95% Cl: (0.60, 1.08), P < 0.00001]，残余尿明显减少[MD: −38.00, 95% Cl: (−43.30, −32.71), P < 0.00001]，膀胱内压升高[MD: 14.19, 95% Cl: (12.88, 15.5), P < 0.00001]，膀胱容量明显增加[MD: 45.50, 95% Cl: (34.92, 56.08), P < 0.00001]，膀胱功能积分改善更明显[MD: −0.51, 95% Cl: (−0.65, −0.37), P < 0.00001]。单次排尿数据异质性较大，根据干预疗程进行亚组分析，疗程 < 1个月亚组[MD: 104.92, 95% Cl: (92.99, 116.84), P < 0.00001]，疗程 > 1个月亚组[MD: 21.44, 95% Cl: (16.89, 26.00), P < 0.00001]。结论：治疗后排尿次数、残余尿量、膀胱内压、膀胱容量、膀胱功能积分，低频电刺激组均优于对照组，低频电刺激组短期治疗单次排尿量改善更好。脊髓损伤神经源性膀胱患者结合低频电刺激治疗比单用康复治疗效果更好。

Abstract: Objective: To investigate the therapeutic effects of low-frequency electrical stimulation combined with rehabilitation training on patients with neurogenic bladder following spinal cord injury (SCI) using a meta-analysis approach. Methods: A randomized controlled study (RCT) on the efficacy of low-frequency electrical stimulation combined with rehabilitation training in the treatment of neurogenic bladder patients with spinal cord injury was retrieved from CNKI, Wanfang database, VIP, PUBMED, Cochrane Library and other databases from January 2017 to January 2023. The officially published papers and dissertations were statistically analyzed using RevMan5.4. Result: A total of 13 papers (1008 patients) were selected, including 506 cases in the low-frequency electrical stimulation group and 502 cases in the control group. Based on the data in the literature, it is determined to use various indicators after treatment to complete the evaluation. The analysis results showed that compared with the control group, the low-frequency electrical stimulation group showed an increase in frequency of urination [MD: 0.84, 95% Cl: (0.60, 1.08), P < 0.00001], a significant decrease in residual urine [MD: −38.00, 95% Cl: (−43.30, −32.71), P < 0.0001], an increase in bladder internal pressure [MD: 14.19, 95% Cl: (12.88, 15.5), P < 0.0001], and a significant increase in bladder capacity [MD: 45.50, 95% Cl: (34.92, 56.08), P < 0.0001], the improvement of bladder function score is more significant [MD: −0.51, 95% Cl: (−0.65, −0.37), P < 0.0001]. The heterogeneity of single urination data is significant. According to the intervention course, a subgroup analysis was conducted. The treatment course was less than 1 month in the subgroup [MD: 104.92, 95% Cl: (92.99, 116.84), P < 0.0001], and the treatment course was more than 1 month in the subgroup [MD: 21.44, 95% Cl: (16.89, 26.00), P < 0.0001]. Conclusion: Compared with the control group, the low-frequency electrical stimulation group showed an increase in urination frequency, a significant increase in residual urine volume, and an increase in bladder pressure and bladder volume after treatment, which improved bladder function and significantly increased single urination volume in the short term. The combination of low-frequency electrical stimulation therapy for patients with neurogenic bladder after spinal cord injury is more effective than rehabilitation therapy alone.