电针、中药二法联合盆底肌训练治疗围绝经期妇女压力性尿失禁的临床研究
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摘要
目的:探讨电针、中药二法联合盆底肌训练治疗围绝经期妇女压力性尿失禁(stress urinary incontinence,SUI)的疗效。方法:选择2016年10月至2017年9月在浙江中医药大学附属第二医院围绝经期门诊确诊的轻中度SUI患者178例,最终有162例(对照组54例,治疗组1 52例,治疗组2 56例)患者完成治疗及随访。对照组给予Kegel运动训练,治疗组1在对照组的基础上给予电刺激生物反馈治疗,治疗组2进行中医辨证分型后在对照组的基础上给予补中益气汤加减及电针的综合治疗,三组均治疗2个疗程并定期随访6个月;于治疗结束时、结束后3、6个月行1 h尿垫试验、填写国际尿失禁咨询委员会尿失禁问卷简表(ICI-Q-SF),于治疗结束时、结束后6个月行尿动力学检测,并进行疗效评价。结果:三组治疗结束时、结束后3、6个月1 h尿垫试验尿漏量、ICI-Q-SF评分较治疗前明显减少(P<0.05);治疗结束时、结束后6个月腹压漏尿点压力(ALPP)、最大尿道闭合压(MUCP)、膀胱顺应性(BC)较治疗前明显增加(P<0.05);治疗组1、2上述指标改善情况均显著优于对照组(P均<0.05);而治疗组2在1 h尿垫试验尿漏量上的疗效更优于治疗组1(P<0.05),在ICI-Q-SF评分,各项尿动力学指标上的改善与治疗组1无统计学差异(P>0.05)。结论:通过电针、中药二法联合盆底肌训练对于治疗轻中度围绝经期妇女SUI,能减少尿漏量,增加ALPP、MUCP,提高BC,明显改善患者生活质量。
AIM: To explore the effect of electroacupuncture and traditional Chinese medicine combined with pelvic floor muscle training on stress urinary incontinence(SUI)in perimenopausal women. METHODS: 178 patients with mild to moderate SUI were diagnosed in the perimenopausal clinic of the Second Affiliated Hospital of Zhejiang Chinese Medical University from October 2016 to September 2017. Finally, 162 patients completed the treatment and follow-up(Control group n=54, therapy group 1 n=52, therapy group 2 n=56). Kegel exercise training was given to the control group, electrical stimulation biofeedback therapy was given to the therapy group 1 on the basis of the control group. In the therapy group 2, after TCM syndrome differentiation, the treatment of Buzhong Yiqi Decoction and electroacupuncture was given on the basis of the control group. All three groups were treated for 2 courses and regularly followed for 6 months. At the end of treatment, 3 and 6 months after treatment, 1 h urine pad test were performed, and the International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire(ICI-Q-SF) were completed. At the end of treatment and 6 months after treatment, urodynamics test were taken, and the efficacy were evaluated. RESULTS:At the end of treatment, 3 and 6 months after treatment, 1 h urine pad test urine leakage and ICI-Q-SF score were significantly lower than those before treatment(P<0.05); at the end of treatment and 6 months after treatment, abdominal pressure leak point pressure(ALPP), maximum urethral closure pressure(MUCP), bladder compliance(BC) significantly increased as compared with before treatment(P<0.05). The improvement of the above indicators in the therapy group 1 and 2 was significantly better than those in the control group(P<0.05), while the therapy group 2 was better than the therapy group 1 in the 1 h urine pad test(P<0.05). In the ICI-Q-SF score, various urodynamic indicators, there was no significant difference between therapy group 1 and 2(P>0.05).CONCLUSION:The combination of electroacupuncture and traditional Chinese medicine combined with pelvic floor muscle training for the treatment of mild to moderate perimenopausal women with SUI can reduce urine leakage, increase abdominal pressure leakage point pressure(ALPP), maximum urethral closure pressure(MUCP), and improve bladder compliance(BC), significantly improve the quality of life of patients.
AIM: To explore the effect of electroacupuncture and traditional Chinese medicine combined with pelvic floor muscle training on stress urinary incontinence(SUI)in perimenopausal women. METHODS: 178 patients with mild to moderate SUI were diagnosed in the perimenopausal clinic of the Second Affiliated Hospital of Zhejiang Chinese Medical University from October 2016 to September 2017. Finally, 162 patients completed the treatment and follow-up(Control group n=54, therapy group 1 n=52, therapy group 2 n=56). Kegel exercise training was given to the control group, electrical stimulation biofeedback therapy was given to the therapy group 1 on the basis of the control group. In the therapy group 2, after TCM syndrome differentiation, the treatment of Buzhong Yiqi Decoction and electroacupuncture was given on the basis of the control group. All three groups were treated for 2 courses and regularly followed for 6 months. At the end of treatment, 3 and 6 months after treatment, 1 h urine pad test were performed, and the International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire(ICI-Q-SF) were completed. At the end of treatment and 6 months after treatment, urodynamics test were taken, and the efficacy were evaluated. RESULTS:At the end of treatment, 3 and 6 months after treatment, 1 h urine pad test urine leakage and ICI-Q-SF score were significantly lower than those before treatment(P<0.05); at the end of treatment and 6 months after treatment, abdominal pressure leak point pressure(ALPP), maximum urethral closure pressure(MUCP), bladder compliance(BC) significantly increased as compared with before treatment(P<0.05). The improvement of the above indicators in the therapy group 1 and 2 was significantly better than those in the control group(P<0.05), while the therapy group 2 was better than the therapy group 1 in the 1 h urine pad test(P<0.05). In the ICI-Q-SF score, various urodynamic indicators, there was no significant difference between therapy group 1 and 2(P>0.05).CONCLUSION:The combination of electroacupuncture and traditional Chinese medicine combined with pelvic floor muscle training for the treatment of mild to moderate perimenopausal women with SUI can reduce urine leakage, increase abdominal pressure leakage point pressure(ALPP), maximum urethral closure pressure(MUCP), and improve bladder compliance(BC), significantly improve the quality of life of patients.
引文
[1] 李晓伟,王建六.尿失禁的病因和发病机制[J].实用妇产科志,2018,34(3):162-164.
[2] 中华医学会妇产科学分会妇科盆底学组.女性压力性尿失禁诊断和治疗指南(2017)[J].中华妇产科杂志,2017,52 (5):289-293.
[3] De vries AM,Heesakkers JPFA.Contemporary diagnostics and treatment options for female stress urinary incontinence [J].Asian J Urol,2018,5(3):141-148.
[4] 那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:345.
[5] 马乐.压力性尿失禁的发病机制[J].中华妇幼临床医学杂志(电子版),2007,3(5):241-245.
[6] Min J,Li B,Liu C,et al.Therapeutic effect and mechanism of electrical stimulation in female stress urinary incontinence[J].Urology,2017,104:45-51.
[7] Jundt K,Peschers UM,Dimpfl T.Long-term efficacy of pelvic floor re-education with EMG-controlled biofeedback [J].Eur J Obstet Gynecol Reprod Biol,2002,105(2):181-185.
[8] 吕婷婷,汪司右.不同操作者电针阴部神经刺激疗法治疗女性压力性尿失禁疗效比较研究[J].上海针灸杂志,2014,33(3):231-233.
[9] 王伟,姜义明,王蓉,等.电针治疗轻中度女性压力性尿失禁疗效观察[J].上海针灸杂志,2016,35(1):47-49.
[10] Zhang L,Zhu L,Xu T,et al.A population-based survey of the prevalence,potential risk Factors,and symptom-specific bother of lower urinary tract symptoms in adult chinese women [J].Eur Urol,2015,68(1):97-112.
[11] 马艳群,谈诚,杨欣.补中益气颗粒治疗产后压力性尿失禁患者的临床效果分析[J].中国妇幼保健,2018,33(12):2692-2694.
[12] Irwin DE,Milsom I,Hunskaar S,et al.Population-based survey of urinary incontinence,overactive bladder,and other lower urinary tract symptoms in five countries:results of the EPIC study[J].Eur Urol,2006,50(6):1306-1314.
[13] 杨明,叶和松,秦远,等.针灸联合生物反馈治疗女性轻中度压力性尿失禁[J].中国中西医结合外科杂志,2018,24(3):290-293.
[14] 王慈,宗蕾.针灸治疗功能便秘规律分析[J].中医药临床杂志,2016,28(8):1097-1099.
[2] 中华医学会妇产科学分会妇科盆底学组.女性压力性尿失禁诊断和治疗指南(2017)[J].中华妇产科杂志,2017,52 (5):289-293.
[3] De vries AM,Heesakkers JPFA.Contemporary diagnostics and treatment options for female stress urinary incontinence [J].Asian J Urol,2018,5(3):141-148.
[4] 那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南(2014版)[M].北京:人民卫生出版社,2014:345.
[5] 马乐.压力性尿失禁的发病机制[J].中华妇幼临床医学杂志(电子版),2007,3(5):241-245.
[6] Min J,Li B,Liu C,et al.Therapeutic effect and mechanism of electrical stimulation in female stress urinary incontinence[J].Urology,2017,104:45-51.
[7] Jundt K,Peschers UM,Dimpfl T.Long-term efficacy of pelvic floor re-education with EMG-controlled biofeedback [J].Eur J Obstet Gynecol Reprod Biol,2002,105(2):181-185.
[8] 吕婷婷,汪司右.不同操作者电针阴部神经刺激疗法治疗女性压力性尿失禁疗效比较研究[J].上海针灸杂志,2014,33(3):231-233.
[9] 王伟,姜义明,王蓉,等.电针治疗轻中度女性压力性尿失禁疗效观察[J].上海针灸杂志,2016,35(1):47-49.
[10] Zhang L,Zhu L,Xu T,et al.A population-based survey of the prevalence,potential risk Factors,and symptom-specific bother of lower urinary tract symptoms in adult chinese women [J].Eur Urol,2015,68(1):97-112.
[11] 马艳群,谈诚,杨欣.补中益气颗粒治疗产后压力性尿失禁患者的临床效果分析[J].中国妇幼保健,2018,33(12):2692-2694.
[12] Irwin DE,Milsom I,Hunskaar S,et al.Population-based survey of urinary incontinence,overactive bladder,and other lower urinary tract symptoms in five countries:results of the EPIC study[J].Eur Urol,2006,50(6):1306-1314.
[13] 杨明,叶和松,秦远,等.针灸联合生物反馈治疗女性轻中度压力性尿失禁[J].中国中西医结合外科杂志,2018,24(3):290-293.
[14] 王慈,宗蕾.针灸治疗功能便秘规律分析[J].中医药临床杂志,2016,28(8):1097-1099.