針灸可能對膀胱過動症有效


  Aug. 26, 2005 - 根據一項刊登於7月號婦產科學期刊的隨機分派試驗結果,針灸可能對膀胱過動症有效。
  
  波特蘭奧勒岡健康與科技大學Sandra L. Emmons與Lesley Otto醫師表示,許多試驗結果支持針灸可能是尿急、頻尿與尿失禁一種成功的治療;之前這些臨床試驗既不是隨機分派的、也不是雙盲的;我們假設針對膀胱過動症的針灸療法可以改善尿失禁、頻尿與急尿的情形,而且可以降低以urinary distress inventory(UDI)與incontinence inventory(II)問卷調查的精神壓力。
  
  在這項試驗中,85位女性被隨機分派接受一種被認為可以改善膀胱症狀的針灸治療、或是一種讓人放鬆的安慰劑針灸療法;在針灸治療前與四週後,這些女性接受膀胱壓力計的檢驗,並且紀錄三天的排尿、UDI與II問卷;試驗的主要終點為三天內尿失禁發作的次數,而次要終點為排尿量、以及UDI與II問卷的分數。
  
  在85位受試者中,74位完成整個試驗;兩組的尿失禁次數都顯著地下降(治療組為59%、安慰劑組為40%),而兩組之間並沒有什麼差異;在治療組中,排尿頻次下降了14%(P=.013),與急尿有關的排尿比例下降了30%(P=.016),而最大排尿量與最高膀胱壓力計讀數上升了13%(P=.01)。
  
  兩組的UDI與II問卷分數都有改善(治療組減少了54%、而安慰劑組減少了30%;兩組之間變化的差距P=.001)。
  
  作者表示,相較於接受安慰劑針灸的女性,接受每週一次、為期四週針對膀胱的特定針灸療法,可以顯著地改善膀胱容量、減少急尿與頻尿的次數、並且改善生活品質指數。
  
  試驗限制包括11件沒有完成試驗的病例使得該試驗沒有足夠的檢定力來偵測75%的差異;使用的是為期三天的排尿紀錄,而不是七天的;以及缺乏針灸好的安慰劑試驗方法。
  
  作者的結論是,在這項試驗中,針灸對於膀胱過動症有顯著的短期效果,類似於藥物療法與行為療法所提供的好處;這些結果需要於更大型的試驗中接受檢驗,以確定這樣的效果是否可以持續下去。

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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