| 摘要: | 目前全球中風人口日益增加，隨著平均人口老年化及飲食、生活型態的改變下，更提升了中風的發生率。中風後的併發症亦相當多，包括認知能力、行動能力及基本生理需求等皆會受到影響，其中排尿發生障礙造成尿液瀦留的問題在中風後病人身上更是常見，尿瀦留不僅會造成病人的不適感，亦會增加生殖泌尿道感染的危險性，對於患者的生活品質是一莫大的影響。
電針已廣泛地用於治療中風後患者併發症，但文獻中針對中風後尿液瀦留的療效評估的資料卻略嫌不足，且對於收案條件及療效分析缺乏嚴謹客觀的角度。本研究採前瞻性研究設計，目的在於探討電針對於中風後患者尿液瀦留的改善程度。
我們共收入7位急性中風後患有尿液瀦留症狀患者（無法自解小便或自解後餘尿量大於100c.c.），排除泌尿道感染後，先以尿路動力學檢查其膀胱排尿功能，再行電針十次療程後，以排尿日記記錄來評估實驗結果，並以重複測量變異數分析（Repeated measure ANOVA）執行統計資料分析。
研究結果顯示，十次電針治療後，對中風後尿液瀦留患者確有減低尿餘量比例的療效（P<0.05），惟在其他變項，包括：性別、糖尿病病史、中風型態及FIM得分及巴氏量表得分等，皆沒有顯著性差異（P>0.05），但在中風部位該項結果顯示；隨著電針的療程，會因不同的中風部位而影響餘尿量比例，若單看是否中風部位的不同會影響餘尿量比例則沒有顯著性，因此在這部份的統計結果，我們要檢討因延髓中風的收案數不足，無法構成統計上真正意義的問題。
結論是電針對中風後患者尿液瀦留的改善是有助益的，但因收案個數不足，無法設立對照組來比對療效甚為可惜；另外針對小腦部位中風，要觀察患者排尿功能是否真因電針而改善時，可能會有影響評估結果的情形，在受試者條件中可斟酌排除；至於對延腦中風患者療效的顯著程度，若能更大量地收取這類患者，所評估出來的結果將更具有說服力。
Recently stroke population is growing in the whole world. With the aging population and the change of diet and life style,the incidence of stroke is increased.Considerable complications after stroke,including cognitive ability, mobility and basical physiologic needs will be affected.When stroke patients suffering from voiding disorder of urine retention is common,patients with urinary retention will not only cause discomfort,but increase the risk of genitourinary infections.This is a great influence on patient's quality of life.
Electroacupuncture (EA) has been widely used to treat post-stroke complications,but the related literature of evaluating post-stroke urine retention is inadequate,and there were lack of strict and objective point of view for closing the case and efficacy analysis.This study used prospective study designs aims to explore the degree of improvement in urine retention with the treatment of EA for patients after stroke.
We received a total of seven acute stroke patients with symptoms of urinary retention (unable to urinate or after themselves voiding residual urine volume greater than 100c.c.). When excluding patients with urinary tract infection, we used urodynamics to exam their bladder function.After ten times EA treatment,the results were evaluated by the urine records, and repeated measurement analysis of variance (Repeated measure ANOVA) was used to run the analysis of statistics data.
The results of our study showed that the efficacy of EA treatment for the stroke patients with urinary retention of urine was effective.It was indeed reduced the residual urine volume(P <0.05),but in other variables,including:gender,history of diabetes,stroke subtype,FIM scores and Barthel Index scores etc. were not significantly different（P>0.05）.However,the statistics results related to stroke area showed that the EA treatment for different sites of stroke can influence the ratio of residual urine volume.According to this part of the statistical results,we need to review insufficient number of medulla stroke patients,resulting in the problem of inadequate statistical significance.
Furthermore,for cerebellar stroke patients to observe the recovery of urinary function with EA,there may be impact assessment of the situation.So considering the conditions,the subjects might be excluded.If we can enroll more medulla stroke patients in this study,the results of assessment will be more persuasive. |
