Abstract: Background　Cervical hyperextension injury is a common disease in middle-aged and elderly patients，and dysuria is one of the main complications. In recent years，pelvic floor electrobiofeedback method has been used to treat dysuria，and has been gradually promoted in clinical practice. However，the effect of using only a single physical or pharmaceutical method to treat dysuria in middle-aged and elderly patients is often unsatisfactory. Objective　To evaluate the effect of pelvic floor biofeedback therapy （PFBT） on postoperative dysuresia in middle-aged and elderly people with cervical spinal cord injury （CSCI）．Methods　We enrolled 82 middle-aged and elderly patients with postoperative dysuresia following CSCI surgery from the Third Affiliated Hospital of Wenzhou Medical University from May 2012 to May 2015.We divided them into control group （n=42） and treatment group （n=40） by random number table，receiving bladder training，bladder training combined with PFBT，respectively.The treatment effect was evaluated by the duration of indwelling urethral catheter and the rate of successful spontaneous voiding measured during the active voiding trial，and urodynamic parameters （including the residual urine volume，maximum capacity of the bladder，maximum urinary flow rate，average urinary flow rate，detrusor pressure at the end of filling） measured after treatment.Results　All patients were followed up for an average of 4.5 months.The average duration of indwelling urethral catheter in the treatment group was significant less than that of the control group〔（24.5±3.9） d vs （45.6±5.5） d，t=19.950，P<0.001〕.Spontaneous voiding recovery was achieved in 37 （92.5%） in the treatment group，and 28 （66.7%）in the control group including 13 demonstrated different degrees of dysuresia after the removal of the urethral catheter，indicating that the treatment group had a higher rate of successful spontaneous voiding （χ2=8.329，P=0.004）．After treatment，the maximum capacity of the bladder，maximun arinary flow rate，and the average urinary flow rate significantly increased while the residual urine volume decreased，and the detrusor pressure at the end of filling dropped obviously in both groups compared to the baseline （P<0.05）；the treatment group demonstrated substantially less residual urine volume and detrusor pressure at the end of filling and significantly increased maximum capacity of the bladder and average urinary flow rate compared with the control group （P<0.05）．Conclusion　PFBT can effectively improve the postoperative voiding function and shorten the duration of indwelling urethral catheter in middle-aged and elderly patients with CSCI，which is worthy of clinical application.

Key words: Urination disorders；Urinary bladder, overactive；Electric biofeedback therapy；Bladder training therapy；Spinal cord injuries；Middle aged；Aged

摘要： 背景　颈椎过伸性损伤是临床中老年患者常见疾病，排尿困难是主要并发症之一。近年来，盆底电生物反馈法被用于治疗排尿困难，且逐渐得到临床推广。但是，中老年患者仅用单一的物理或药物方法治疗排尿困难的效果常并不理想。目的　探讨盆底电生物反馈法治疗中老年颈部脊髓损伤术后患者排尿困难的疗效。方法　选取2012年5月—2015年5月温州医科大学附属第三医院收治的中老年颈部脊髓损伤术后排尿困难患者82例，采用随机数字表法分为对照组（42例）与治疗组（40例），其中对照组行膀胱训练法，治疗组在此基础上采用盆底电生物反馈法治疗。采用自主排尿试验测定留置导尿时间和自主排尿成功率。治疗前后进行尿流动力学检查，包括膀胱残余尿量、最大膀胱容量、最大尿流率、尿流率、充盈期末逼尿肌压力。结果　82例患者均获得随访，平均随访4.5个月。治疗组留置导尿时间为（24.5±3.9）d，短于对照组的（45.6±5.5）d（t=19.950，P<0.001）。治疗组37例（92.5%）患者恢复自主排尿；对照组28例（66.7%）患者恢复自主排尿，其中13例患者拔除导尿管后均出现不同程度的排尿困难症状。治疗组恢复自主排尿成功率高于对照组（χ2=8.329，P=0.004）。治疗后治疗组膀胱残余尿量、充盈期末逼尿肌压力小于对照组，最大膀胱容量、最大尿流率、尿流率大于对照组（P<0.05）。两组患者治疗后膀胱残余尿量、充盈期末逼尿肌压力小于治疗前，最大膀胱容量、最大尿流率、尿流率大于治疗前（P<0.05）。结论　盆底电生物反馈法可有效改善中老年颈部脊髓损伤术后患者的排尿功能，缩短留置导尿时间，值得临床推广应用。

关键词: 排尿障碍；膀胱, 过度活动性；电生物反馈法；膀胱训练；脊髓损伤；中年人；老年人