针灸可能对膀胱过动症有效


  Aug. 26, 2005 - 根据一项刊登于7月号妇产科学期刊的随机分派试验结果,针灸可能对膀胱过动症有效。
  
  波特兰奥勒冈健康与科技大学Sandra L. Emmons与Lesley Otto医师表示,许多试验结果支持针灸可能是尿急、频尿与尿失禁一种成功的治疗;之前这些临床试验既不是随机分派的、也不是双盲的;我们假设针对膀胱过动症的针灸疗法可以改善尿失禁、频尿与急尿的情形,而且可以降低以urinary distress inventory(UDI)与incontinence inventory(II)问卷调查的精神压力。
  
  在这项试验中,85位女性被随机分派接受一种被认为可以改善膀胱症状的针灸治疗、或是一种让人放松的安慰剂针灸疗法;在针灸治疗前与四周后,这些女性接受膀胱压力计的检验,并且纪录三天的排尿、UDI与II问卷;试验的主要终点为三天内尿失禁发作的次数,而次要终点为排尿量、以及UDI与II问卷的分数。
  
  在85位受试者中,74位完成整个试验;两组的尿失禁次数都显著地下降(治疗组为59%、安慰剂组为40%),而两组之间并没有什么差异;在治疗组中,排尿频次下降了14%(P=.013),与急尿有关的排尿比例下降了30%(P=.016),而最大排尿量与最高膀胱压力计读数上升了13%(P=.01)。
  
  两组的UDI与II问卷分数都有改善(治疗组减少了54%、而安慰剂组减少了30%;两组之间变化的差距P=.001)。
  
  作者表示,相较于接受安慰剂针灸的女性,接受每周一次、为期四周针对膀胱的特定针灸疗法,可以显著地改善膀胱容量、减少急尿与频尿的次数、并且改善生活质量指数。
  
  试验限制包括11件没有完成试验的病例使得该试验没有足够的检定力来侦测75%的差异;使用的是为期三天的排尿纪录,而不是七天的;以及缺乏针灸好的安慰剂试验方法。
  
  作者的结论是,在这项试验中,针灸对于膀胱过动症有显著的短期效果,类似于药物疗法与行为疗法所提供的好处;这些结果需要于更大型的试验中接受检验,以确定这样的效果是否可以持续下去。

Acupuncture May Be Effective f

By Laurie Barclay, MD
Medscape Medical News

Aug. 26, 2005 — Acupuncture may be effective therapy for overactive bladder, according to the results of a randomized study reported in the July issue of Obstetrics & Gynecology.

"Several studies support acupuncture as a potentially successful treatment of urinary urgency, frequency, and urgency incontinence," write Sandra L. Emmons, MD, and Lesley Otto, MD, from the Oregon Health and Science University in Portland. "These [previous] trials were neither randomized nor blinded. We hypothesized that acupuncture treatments directed at overactive bladder would reduce urinary incontinence, frequency, and urgency as reported by voiding diary, and would reduce the psychological distress of overactive bladder as captured by the urinary distress inventory and the incontinence inventory questionnaire."

In this trial, 85 women were randomized to receive an acupuncture treatment expected to improve their bladder symptoms, or to a placebo acupuncture treatment designed to promote relaxation. Before and after four weekly acupuncture treatments, these women underwent cystometric testing and completed a three-day voiding diary, urinary distress inventory, and incontinence impact questionnaire. The primary outcome was number of incontinent episodes over three days, and secondary outcomes were voiding frequency and urgency, cystometric bladder capacity, maximum voided volume, and scores on the urinary distress inventory and incontinence impact questionnaire.

Of the 85 participants, 74 completed the study. Both groups had significant decreases in number of incontinent episodes (59% for treatment, 40% for placebo) with no significant difference between groups. In the treatment group, there was a 14% decrease in urinary frequency (P = .013), a 30% decrease in the proportion of voids associated with urgency (P = .016), and a 13% increase in both maximum voided volume and maximum cystometric capacity (P = .01).

Urinary distress inventory and incontinence impact questionnaire scores improved in both groups (54% decrease with treatment, 30% decrease with placebo; P = .001 for the difference in change between groups).

"Women who received four weekly bladder-specific acupuncture treatments had significant improvements in bladder capacity, urgency, frequency, and quality-of-life scores as compared with women who received placebo acupuncture treatments," the authors write.

Study limitations include 11 incomplete evaluations creating insufficient power to detect a 75% reduction in incontinent episodes; use of a three-day rather than a seven-day voiding diary; and lack of a good placebo for acupuncture.

"In this study, acupuncture had a significant short-term effect on overactive bladder, similar in scope to the improvement offered by drug therapy and physical or behavioral therapy," the authors conclude. "These results need to be confirmed with a larger sample, and extended to see whether the effect is sustained."

The Oregon Health Science Foundation supported this study in part.

Obstet Gynecol. 2005;106:138-143

Reviewed by Gary D. Vogin, MD

    
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