心理干预联合盆底肌肉训练治疗盆底功能障碍性疾病的疗效观察
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摘要
目的:探讨心理干预联合盆底肌肉训练(PFMT)治疗盆底功能障碍性疾病(PFD)的临床疗效。方法:选取2017年6月—2018年8月在山东省中医院产科接受治疗的60例PFD患者作为研究对象,分为对照组和试验组,每组各30例。对照组给予PFMT,试验组在对照组的基础上增加针对性心理干预。对2组患者治疗前后盆底表面肌电、心理功能、生活质量和治疗效果进行评估和比较。结果:①治疗前2组患者各阶段肌电值比较差异无统计学意义(P>0.05)。治疗后2组患者除后基线静息阶段外,其余评估阶段肌电值较治疗前均升高(均P<0.05),且治疗后试验组各阶段肌电值均高于对照组(均P<0.05)。②治疗前2组患者焦虑自评量表(SAS)和抑郁自评量表(SDS)评分比较差异无统计学意义(P>0.05)。治疗后2组患者SAS和SDS评分较治疗前下降(P<0.05),且试验组SAS和SDS评分均低于对照组(P<0.05)。③治疗前2组患者盆底功能障碍问卷(PFDI-20)和盆底障碍影响简易问卷(PFIQ-7)评分比较差异无统计学意义(P>0.05)。治疗后2组患者PFDI-20和PFIQ-7评分较治疗前下降(P<0.05),且试验组PFDI-20和PFIQ-7评分均低于对照组(P<0.05)。④试验组治疗总有效率(93.3%)高于对照组(70.0%),差异有统计学意义(χ2=5.455,P=0.020)。结论:心理干预联合PFMT能改善患者的不良心理状态,减轻患者焦虑和抑郁程度,增强盆底肌肉整体收缩力,提高其治疗积极性、依从性和生活质量。
Objective:To explore the clinical effect of psychological intervention combined with pelvic floor muscle training(PFMT) on pelvic floor dysfunction(PFD). Methods:A total of 60 patients with PFD who were treated in the obstetrics department of Shandong Hospital of Traditional Chinese Medicine from June 2017 to August 2018 were selected and divided into the control group and the experimental group, with 30 cases in each group. The control group was given PFMT, and the experimental group was given the targeted psychological intervention plus PFMT. The pelvic floor surface electromyography(sEMG), psychological function and life quality were assessed before and after treatment. Results:(1) There was no significant difference in the value of sEMG before treatment between the two groups(P>0.05). After treatment, the EMG values of the two groups were higher than those before treatment except for the pos-baseline step(P<0.05), and this value of the experimental group was higher than that of the control group(P <0.05).(2) The differences in the scores of SAS and SDS before treatment between the two groups were no significant(P>0.05). In both groups, the scores of SAS and SDS after treatment were significantly lower than those before treatment(P <0.05), and the scores of SAS and SDS after treatment in the experimental group were lower than that in the control group(P<0.05).(3)The differences of the scores of PFDI-20 and PFIQ-7 before treatment between the two groups were no significant(P >0.05). After treatment, the scores of PFDI-20 and PFIQ-7 in both groups were significant lower than those before treatment(P<0.05), and two scores in the experimental group were lower than those in the control group(P<0.05).(4)The total effective rate(93.3%) of the experimental group was significantly higher than that of the control group(70.0%)( χ~2=5.455, P=0.020). Conclusions:The psychological intervention combined with PFMT can improve the mental state of patients, alleviate the anxiety and depression and enhance the pelvic floor muscle contraction amplitude, which is beneficial to improve treatment enthusiasm, therapy compliance and life quality.
Objective:To explore the clinical effect of psychological intervention combined with pelvic floor muscle training(PFMT) on pelvic floor dysfunction(PFD). Methods:A total of 60 patients with PFD who were treated in the obstetrics department of Shandong Hospital of Traditional Chinese Medicine from June 2017 to August 2018 were selected and divided into the control group and the experimental group, with 30 cases in each group. The control group was given PFMT, and the experimental group was given the targeted psychological intervention plus PFMT. The pelvic floor surface electromyography(sEMG), psychological function and life quality were assessed before and after treatment. Results:(1) There was no significant difference in the value of sEMG before treatment between the two groups(P>0.05). After treatment, the EMG values of the two groups were higher than those before treatment except for the pos-baseline step(P<0.05), and this value of the experimental group was higher than that of the control group(P <0.05).(2) The differences in the scores of SAS and SDS before treatment between the two groups were no significant(P>0.05). In both groups, the scores of SAS and SDS after treatment were significantly lower than those before treatment(P <0.05), and the scores of SAS and SDS after treatment in the experimental group were lower than that in the control group(P<0.05).(3)The differences of the scores of PFDI-20 and PFIQ-7 before treatment between the two groups were no significant(P >0.05). After treatment, the scores of PFDI-20 and PFIQ-7 in both groups were significant lower than those before treatment(P<0.05), and two scores in the experimental group were lower than those in the control group(P<0.05).(4)The total effective rate(93.3%) of the experimental group was significantly higher than that of the control group(70.0%)( χ~2=5.455, P=0.020). Conclusions:The psychological intervention combined with PFMT can improve the mental state of patients, alleviate the anxiety and depression and enhance the pelvic floor muscle contraction amplitude, which is beneficial to improve treatment enthusiasm, therapy compliance and life quality.
引文
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[19]Kao HT,Hayter M,Hinchliff S,et al.Experience of pelvic floor muscle exercises among women in Taiwan:a qualitative study of improvement in urinary incontinence and sexuality[J].J Clin Nurs,2015,24(13/14):1985-1994.
[20]Nazarpour S,Simbar M,Majd HA,et al.Beneficial effects of pelvic floor muscle exercises on sexual function among postmenopausal women:a randomised clinical trial[J].Sex Health,2018,[Epub ahead of print].
[21]Oblasser C,Christie J,McCourt C.Vaginal cones or balls to improve pelvic floor muscle performance and urinary continence in women post partum:A quantitative systematic review[J].Midwifery,2015,31(11):1017-1025.
[22]Singh N,Rashid M,Bayliss L,et al.Pelvic floor muscle training for female urinary incontinence:Does it work?[J].Arch Gynecol Obstet,2016,293(6):1263-1269
[23]Abrams P,Andersson KE,Birder L,et al.Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee:Evaluation and treatment of urinary incontinence,pelvic organ prolapse,and fecal incontinence[J].Neurourol Urodyn,2010,29(1):213-240.
[24]National Collaborating Centre for Women's and Children's Health(UK).Urinary Incontinence in Women:The Management of Urinary Incontinence in Women[M].London:Royal College of Obstetricians and Gynaecologists(UK),2013.
[25]Glazer HI.Biofeedback vs electrophysiology[J].Rehab Manag,2005,18(9):32-34.
[2]Walker GJ,Gunasekera P.Pelvic organ prolapse and incontinence in developing countries:review of prevalence and risk factors[J].Int Urogynecol J,2011,22(2):127-135.
[3]Hallock JL,Handa VL.The Epidemiology of Pelvic Floor Disorders and Childbirth:An Update[J].Obstet Gynecol Clin North Am,2016,43(1):1-13.
[4]Howard D,Makhlouf M.Can pelvic floor dysfunction after vaginal birth be prevented?[J].Int Urogynecol J,2016,27(12):1811-1815.
[5]Vrijens D,Berghmans B,Nieman F,et al.Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions-A cross sectional cohort study at a Pelvic Care Centre[J].Neurourol Urodyn,2017,36(7):1816-1823.
[6]Thubert T,Deffieux X,Jousse M,et al.Influence of a distraction task on pelvic floor muscle contraction[J].Neurourol Urodyn,2015,34(2):139-143.
[7]Jundt K,Peschers U,Kentenich H.The investigation and treatment of female pelvic floor dysfunction[J].Dtsch Arztebl Int,2015,112(33/34):564-574.
[8]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.
[9]谢幸,孔北华,段涛.妇产科学[M].9版.北京:人民卫生出版社,2018.
[10]Roza TD,Brandao S,Mascarenhas T,et al.Pelvic Floor Muscles Behavior in Practitioners of High and Low Impact Sports[M].Computational and Experimental Biomedical Sciences:Methods and Applications.Springer International Publishing,2015:75-82.
[11]邵彤华.产后盆底功能障碍性疾病影响因素的回顾分析[J].中国妇幼保健,2016,31(24):5342-5344.
[12]Iwanowicz-Palus GJ,Stadnicka G,W覥oszczak-Szubzda A.Medical and psychosocial factors conditioning development of stress urinary incontinence(SUI)[J].Ann Agric Environ Med,2013,20(1):135-139.
[13]Lisicka E,Dzigowski P,Radziszewski P,et al.C17 anxiety,depression and quality of life in woman with urinary incontinence[J].Eur Urol Suppl,2010,9(6):623.
[14]Debus G,Kastner R.Psychosomatic Aspects of Urinary Incontinence in Women[J].Geburtshilfe Frauenheilkd,2015,75(2):165-169.
[15]梁敏,章文静,付俊霞,等.产后抑郁症与产后尿失禁的相关性研究[J].蚌埠医学院学报,2018,43(1):27-29,33.
[16]Thubert T,Deffieux X,Jousse M,et al.Influence of a distraction task on pelvic floor muscle contraction[J].Neurourol Urodyn,2015,34(2):139-143.
[17]李龙坤,宋波,金锡御.盆底肌电刺激对羊尿道功能影响的实验研究[J].中华泌尿外科杂志,2002,23(5):307-309.
[18]Price N,Dawood R,Jackson SR.Pelvic floor exercise for urinary incontinence:a systematic literature review[J].Maturitas,2010,67(4):309-315.
[19]Kao HT,Hayter M,Hinchliff S,et al.Experience of pelvic floor muscle exercises among women in Taiwan:a qualitative study of improvement in urinary incontinence and sexuality[J].J Clin Nurs,2015,24(13/14):1985-1994.
[20]Nazarpour S,Simbar M,Majd HA,et al.Beneficial effects of pelvic floor muscle exercises on sexual function among postmenopausal women:a randomised clinical trial[J].Sex Health,2018,[Epub ahead of print].
[21]Oblasser C,Christie J,McCourt C.Vaginal cones or balls to improve pelvic floor muscle performance and urinary continence in women post partum:A quantitative systematic review[J].Midwifery,2015,31(11):1017-1025.
[22]Singh N,Rashid M,Bayliss L,et al.Pelvic floor muscle training for female urinary incontinence:Does it work?[J].Arch Gynecol Obstet,2016,293(6):1263-1269
[23]Abrams P,Andersson KE,Birder L,et al.Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee:Evaluation and treatment of urinary incontinence,pelvic organ prolapse,and fecal incontinence[J].Neurourol Urodyn,2010,29(1):213-240.
[24]National Collaborating Centre for Women's and Children's Health(UK).Urinary Incontinence in Women:The Management of Urinary Incontinence in Women[M].London:Royal College of Obstetricians and Gynaecologists(UK),2013.
[25]Glazer HI.Biofeedback vs electrophysiology[J].Rehab Manag,2005,18(9):32-34.