Clinical Observation On Treatment Of Middle-aged And Elderly Women With Frequent Urinary Frequency By Modification And Subtraction Of Qilufenqing Decoction And Ultrasound Drug Penetratio

1.BackgroundFemale lower urinary tract symptoms(Lower Urinary Tract Symptoms,LUTS)is a disease that is more common worldwide and seriously affects the quality of life of patients.Female LUTS symptoms include frequent urination,urgency,urinary weakness,dysuria,inexhaustible and urinary incontinence,ect.It is a group of common clinical syndromes caused by lesions of different causes and mechanisms.Its etiology is complex,its manifestations are diverse and its clinical symptoms are lack of specificity.At present,there is no definite conclusion.It is more common in perimenopausal and postmenopausal women.An Internet survey(EpiLUTS)based on the epidemiology of lower urinary tract symptoms in Sweden,the United States and the United Kingdom reported that the prevalence of LUTS in men and women was as high as 72.3%and 76.3%,respectively[1].Male LUTS is mostly caused by benign prostatic hyperplasia(BPH).At present,the LUTS diagnosis and treatment guidelines at home and abroad are aimed at men,and there are relatively detailed studies on them.Female LUTS research is relatively rare,and it has only been paid attention to by clinicians in recent years.Due to the inlfluence of traditional concepts,female patients have more symptoms related to gynecology.Most patients feel embarrassed or think that symptoms such as frequent urination and nocturia are the natural result of aging and functional deterioration.Therefore,despite the high incidence of female LUTS,However,the rate of visits is relatively low,resulting in many patients not getting the correct diagnosis and treatment in the clinic.According to the definition of the International Association of Urinary Control(ICS)in 2012,LUTS symptoms include symptoms of storage,urination(dysuria)and post-urination.The symptoms of storage are usually referred to as overactive bladder(OAB).LUTS may be caused by a variety of bladder urethral lesions,such as urinary tract infection,bladder outlet obstruction(pelvic organ prolapse,urethral stricture,anti-urinary incontinence surgery,etc.),detrusor dysfunction(drug,advanced age,overfill injury,chronic Urinary retention,detrusor weakness,neurogenic bladder,spinal cord injury,etc.),stress urinary incontinence,etc.Some systemic diseases,such as diabetes,cardiac insufficiency,congestive heart failure,spinal sclerosis and so on,can also be secondary to various types of LUTS symptoms.Life-related factors such as drinking,smoking,advanced age,constipation,mentality and so on also have a certain impact on various types of LUTS.At present,modern medicine has not yet established a clear conclusion on the pathogenesis of LUTS.Clinically,it is generally classified according to the female OAB,female dysuria and coexistence of both.The first emphasis in treatment is health education and disease management,through urodynamic testing combined with other examinations to find the cause.On the basis of evidence-based medicine for the type of bladder and urinary tract dysfunction,a combination of behavioral therapy,psychology,drug therapy and individualized approach is recommended for comprehensive treatment.In recent years,with the deepening of domestic research on female LUTS,the traditional Chinese medicine plays an important role in the comprehensive treatment of this disease.The specific traditional Chinese medicine treatment methods and treatment principles are different.Referring to the latest literature on female LUTS in recent years,this paper summarizes the clinical data of urodynamics of female urinary frequency in the past ten years.From the two parts of clinical observation and clinical research,the feasibility of the treatment of urinary frequency in middle-aged and elderly women with the Bixiefenqing decoction plus or substract combined with ultrasound drug penetration was discussed.2.Part one:Study on urodynamic data of urinary frequency patients in middle-aged and elderly women.2.1 ObjectiveThe clinical data of urodynamics of middle-aged and elderly female patients with urinary frequency as the chief complaint diagnosed and treated in our hospital from 2007 to 2017 were retrospectively analyzed,the urodynamic examination and other examinations were summarized to provide a more comprehensive,systematic and scientific and standardized feasibility plan for patients and evidence-based medical evidence for clinical research.2.2 MethodThe urodynamic examination was performed on 234 middle-aged and elderly women with frequency of urine.The age ranged from 42 to 76 years old,with an average of 51±5.87 years.There was no abnormality in routine urine examination.The clinical manifestations were lower urinary tract symptoms,with 169 cases of storage symptoms and 65 cases of urinary symptoms.There were 7 cases of cerebral vascular accident sequelae,16 cases of hypertension,5 cases of coronary heart disease,7 cases of diabetes,42 cases of repeated urinary tract infection,3 cases of spinal cord disease,1 case of rectal cancer,and 1 case of cervical cancer.10 cases with different degrees of uterine prolapse,of which 4 cases were severe pelvic organ prolapse.2.3 Results Among the 234 patients with urinary frequency,the main complaints were 169 cases with symptoms of storage in the urine,and 65 cases with symptoms of urination.There were 42 patients with Qmax>20ml/s,mainly including 30 patients with stress incontinence and mixed incontinence,and the remaining 12 patients with residual urine,ranging from 30 to 50ml.The pressure flow rate was measured in all patients,89 patients with sensory urgency(without detrusor instability),41 patients with simple detrusor hyperactivity,and 34 patients with simple urinary incontinence(stress and mixed urinary incontinence),33 patients with bladder outflow obstruction,6 patients withurethral lesions,21 patients with low detrusor activity,and 10 patients with neurogenic bladder.2.4 ConclusionAs a subjective symptom expression,LUTS is not a detrusor instability activity in all patients with overactive bladder.Patient's emotions and expressions can easily affect the accuracy of clinician's judgment.Urodynamic examination before treatment can not only confirm the diagnosis,but also improve the curative effect,which is helpful to the formulation of surgical plan.Behavior therapy combined with traditional Chinese medicine has a certain therapeutic effect on patients with low detrusor activity.3.Part two:Clinical observation on the treatment of urinary frequency in middle-aged and elderly women with the Bixiefenqing decoction plus or substract combined with ultrasound drug penetration.3.1 ObjectiveTo evaluate the clinical efficacy of Bixiefenqing decoction plus or substract combined with acupoint application in the treatment of urinary frequency in middle-aged and elderly women on the basis of behavioral therapy and to explore a new clinical treatment scheme.3.2 MethodsFrom March 2017 to March 2018 in our hospital,60 middle-aged and elderly women with LUTS who were mainly complained of frequent urination were randomly divided into two groups.The treatment group was treated with Bixiefenqing decoction plus or substract combined with ultrasound drug penetration,while the control group was treated with pure western medicine M receptor blocker,course of 4 weeks.During the study,patients were asked to fill out the questionnaire,including the urination diary,the overactive bladder score(OABSS)questionnaire,the quality of life(Quality of life,QOL)score and the TCM syndrome score.To evalucate of the effectiveness and safety of Bixiefenqing decoction plus or substract combined with acupoint application in the treatment of urinary frequency in middle-aged and elderly women,and to observe the remission of symptom and the improvement of quality of life in them.3.3 ResultsCompared with the control group,the effective rate of the treatment group was higher than that of the control group.There were significant differences in OABSS symptom score,QoL index,maximum urinary flow rate,urination volume and TCM syndrome score between the treatment group and the control group before and after treatment(P<0.05).After treatment,there was no significant difference in OABSS symptom score between the treatment group and the control group,but there was significant difference in the maximum urinary flow rate,urination volume,QoL index,TCM syndrome score between the two groups(P<0.05).3.4 ConclusionIt is safe and effective to treat urinary frequency in middle-aged and elderly women with Bixiefenqing decoction plus or substract combined with ultrasound drug penetration has advantages in relieving symptoms and improving quality of life.