The Clinical Study Of Moxibustion On Bladder With Dysfunction After Spinal Cord Injury

The incidence of spinal cord injury(SCI) has been on the rise both at home and abroad in recent years. According to related literature, the incidence of SCI is 0.002%-0.0045%, and the prevalence is 0.09% in the United States. In China, the incidence of SCI has also been on the rise due to constantly improved living standard and the popularity of automobile. A survey conducted in Beijing shows that the annual incidence of SCI was 0.0068%, and the age of those patients ranges from 25 to 40. Bladder dysfunction caused by neurogenic bladder with spinal cord injury could last for a lifetime. Besides, it also leads to urinary system infection, urinary stone, hydronephrosis, renal insufficiency and even renal failure which are major causes of death. So studies on effective treatments of neurogenic bladder dysfunction have drawn attention of international medical circle.ObjectiveTo study the atction mechanism of moxibustion with intermittent catheterization(IC) and its clinical effect, and to provide more definitive evidence for further clinical application and experimental research on it. Variables of residualurine(RU), maximum bladder capacity(MBC), pressur of detrusor maximum(Pdet.max),maximum urethral pressure(MUP),quantitativevariation of white blood cells(WBC) in the bladder capacity and bladder equilibrium state of patients with neurogenic bladder dysfunction are compared before and after the treatment.MethodsBased on “neurogenic bladder diagnosis”(Archies of clinical diagnosis and treatment guidelines-physical medicine and rehabilitation(2005)) and “criteria” and “test case standard”(Criteria of Diagnosis and Therapeutic effect of Traditional Chinese Medicine), 120 patients were randomized into one of two groups: treatment group, with intermittent catheterization(IC) and moxibustion everyday for 6 weeks; control group, with intermittent catheterization(IC) everyday for 6 weeks. Residualurine(RU), maximum bladder capacity(MBC), pressur of detrusor maximum(Pdet.max),maximum urethral pressure(MUP),quantitative variation of white blood cells(WBC) in the bladder capacity and bladder equilibrium state were recorded before and after the patients receive treatment. Statistics and analysis: description- quantitative index on normal distribution, with mean and standard deviation, and on non-normal distribution, with median and four percentile; qualitative index, with frequency and percentage. Test- quantitative data: on normal distribution and of homogeneity, with T-test; of heterogeneity, with –T’-test; on non-normal distribution, with Wilcoxon rank sum test; ranked data of curative effect of each group, with Ridit analysis; quantitative data, with χ2 test. The difference suggests statistical significance if P≤0.05.Results1. Comparison of clinical curative effectTreatment group: among 60 patients, 49 cased were cured, 7 cases with excellent result, 4 cases with ineffectiveness and the effective rate is 93.4%. Control group: among 60 patients, 20 cased were cured, 21 cases with excellent result, 19 cases with ineffectiveness and the effective rate is 68.3%. According to Ridit analysis, a=0.05, and there is no overlap between the two confidence interval, which indicates that the difference between two groups is of statistical significance.2. Change of urine dynamics before and after the treatmentRU, MBC, MUP, and Pdet.max: before treatment- P>0.05, which shows no statistical significance, and they are comparable. Before and after the treatmenttreatment group: statistic results of RU, MBC, MUP, and Pdet. max indicate statistical significance(P<0.05), which proves that moxibustion combined with intermittent catheterization(IC) could reduce RU and Pdet. max, increase MBC and MUP, and improve the compliance of low compliance bladder; control group: statistic results of MBC、MUP、Pdet. max are the same(P>0.05), except for RU(P<0.05), which suggests that intermittent catheterization(IC) is effective in reducing RU and is ineffective in improving low compliance bladder compliance. RU: P<0.05(after the treatment for each group), which means the therapy of the treatment group is better than the control group in reducing RU.3. Quantitative changes of white blood cells in the urine before and after treatmentThe quantitative change of white blood cells in the urine: before treatmentP>0.05, which shows no statistical significance, and they are comparable. Before and after the treatment- treatment group: statistic results indicate statistical significance(P<0.05), which proves that moxibustion combined with intermittent catheterization(IC) could reduce urinary tract infection in patients with neurogenic bladder; control group: statistic results show statistical significance(P<0.05). After treatment – P<0.05(the effective index of quantitative change of white blood cells of each group), which shows no statistical significance in reducing urinary tract infection in patients with neurogenic bladder.4. The comparison of the balance state of bladder functionχ2 test is used to compare the balance state of bladder function of each group after treatment(P<0.0.5), which indicates statistical significance. This demonstrates that both treatments are effective in improving the balance state of bladder function, but the former moxibustion combined with IC is superior to IC treatment.ConclusionThe therapeutic effects of intermittent catheterization(IC) with and without moxibustion on the prevention and treatment to urinary tract infection are similar. However, the former could obviously improve the bladder function of patients with nuerogenic bladder dysfunction, reduce residual urine capacity and the detrusor pressure in filling phase, increase the maximum bladder capacity and maximum urethral pressure and promote the balance state of bladder function. The latter is ineffective in improving low compliance bladder, that is, it is effective for urination but not for the evacuation of bladder. Besides, it is ineffective for low pressure storing urine, urinary continence, and low pressure micturition.