Optimization Of Acupuncture Treatment For Post-stroke Urinary Incontinence Based On Orthogonal Test Design

Objective:Orthogonal design test was used to explore the four factors of acupuncture point selection,stimulation amount,acupuncture depth and needle retention time,and the effect of three levels of each factor on the efficacy of urinary incontinence after stroke.The optimal treatment plan provides accurate and reliable evidence for the clinic.Method:From May 2019 to January 2020,27 patients with post-stroke urinary incontinence who met the inclusion criteria and exclusion criteria at the inpatient department and outpatient department of the Second Affiliated Hospital of Tianjin University of TCM were enrolled.Firstly,based on the data mining technology,three groups of acupuncture points were determined.Then,according to the L₉（3⁴）orthogonal design test table,the patients were randomly divided into 9 groups,and each group of 3 people were tested repeatedly.Twenty-seven patients were given routine and symptomatic treatment of cerebrovascular disease and secondary prevention of cerebrovascular disease.The affected side was treated with“Tiao Shen Tong Luo”acupuncture for treatment,and a single-blind method was used to treat the acupuncture treatment with different factors.According to the patients’ICI score,the degree of urinary incontinence and the Barthel index change before and after treatment,visual analysis and variance analysis were performed to screen out the best treatment plan.Results:The ICI score,the degree of urinary incontinence and the Barthel index are significantly comparable before and after the treatment for 2 courses（P<0.05）.After acupuncture treatment,the effects of acupuncture points,acupuncture depth and needle retention time on the ICI score of urinary incontinence after stroke are significantly different（P<0.05）.The most influential factor is the acupuncture point selection,followed by the needle retention time,the needle penetration depth,and finally the stimulation amount.On the acupuncture points,the therapeutic effect of Shenshu points（double）+Huiyang points（double）is better than Guanyuan Point+Zhongji Point+Qihai Point and both are better than Sanyinjiao（double）;in terms of stimulation amount,the treatment effect of needle twice in the mid-term retention is better than that needle once and both are better than no needling during the needle retention period;in the depth of acupuncture,the deep thorn effect is better than the shallow thorn and both are better than the middle thorn;on the needle retention time,the needle retention for 40min is better than 20min and both are better than 30min.That is,deep thorny Shenshu point（double）+Huiyang point（double）and needle twice during the 40minutes’retention can significantly improve the ICI score of patients with urinary incontinence after stroke.The effect of acupuncture points on the Barthel index of urinary incontinence after stroke is significantly different（P<0.05）.The most influential factor is the acupuncture point selection,followed by the time of needle retention,the depth of acupuncture,and finally the amount of stimulation.The therapeutic effect of Guanyuan Point+Zhongji Point+Qihai Point is better than that of Shenshu points（double）+Huiyang points（double）and both are better than Sanyinjiao（double）;in terms of stimulation amount,the treatment effect of needle once in the mid-term retention is better than that needle twice and both are better than no needling during the needle retention period;in the depth of acupuncture,the middle thorn effect is better than the deep thorn and both are better than the shallow thorn;on the time of needle retention,the needle retention for 40min is better than 30min and both are better than20min.That is,middle thorn Guanyuan Point+Zhongji Point+Qihai Point and needle once during 40 minutes’needle retention can significantly improve the daily life of patients with urinary incontinence after stroke.There is a significant difference in the effect of acupuncture on the degree of urinary incontinence after stroke（P<0.05）,but the four factors have the same effect on the degree of urinary incontinence.The therapeutic effect of Shenshu（double）+Huiyang（double）is better than Guanyuan+Zhongji+Qihai points both are better than Sanyinjiao（double）;in terms of stimulation amount,the treatment effect of needle twice in the mid-term retention is better than that non-needle and both are better than needle once during the needle retention period;in the depth of acupuncture,shallow needles and middle needles have the same effect,and are both inferior to deep needles;on the time of needle retention,the needle retention for 40min is better than 30min and both are better than 20min.That is,deep thorn Guanyuan Point+Zhongji Point+Qihai Point and needle twice during 40 minutes’needle retention can significantly improve the degree of urinary incontinence in patients with urinary incontinence after stroke.Conclusion:The ICI score,the degree of urinary incontinence and the Barthel index of patients before and after acupuncture treatment were significantly comparable（P<0.05）,which could improve the symptoms of urinary incontinence and daily life after stroke.According to the test results,it is known that deep acupuncture at Shenshu（double）+Huiyang acupoint（double）,needling the needle twice during the treatment and keeping for 40minutes is the best treatment for acupuncture treatment of urinary incontinence after stroke.