生物反馈联合电刺激对产后妇女盆底功能及血清松弛素水平影响
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摘要
目的探讨生物反馈联合电刺激治疗产后妇女盆底功能障碍的有效性及其对血清松弛素水平的影响。方法选取盆底功能障碍病人150例为研究对象,所有病人盆底肌力检测均≤Ⅲ级,且伴有轻度压力性尿失禁及脏器脱垂。将病人随机分为两组:观察组90例,采用Kegle运动加生物反馈联合电刺激治疗;对照组60例,单纯采用Kegle运动自我锻炼。两组病人分别于治疗前(产后6周)和治疗后(产后3个月及6个月)进行盆底肌力检测,并对尿失禁症状的改善以及脏器脱垂的程度进行评估,同时检测病人血清松弛素水平的变化。结果治疗前两组病人盆底肌力、尿失禁症状及脏器脱垂程度差异均无显著性(P>0.05);产后3、6个月时,观察组盆底肌力显著高于对照组(Z=5.361、6.801,P<0.05),压力性尿失禁疗效显著优于对照组(Z=4.218、4.023,P<0.05),脏器脱垂程度较对照组明显减轻(Z=2.954、3.644,P<0.05)。治疗前后两组病人血清松弛素水平比较差异均无统计学意义(P>0.05)。结论生物反馈联合电刺激对产后盆底肌力下降合并压力性尿失禁和脏器脱垂病人的治疗效果优于单纯Kegle运动,但对血清松弛素水平无明显影响。
Objective To explore the efficacy of biofeedback combined with electrical stimulation in the treatment of pelvic floor dysfunction in postpartum women and its effect on serum relaxin level. Methods One hundred and fifty patients with pelvic floor dysfunction were selected as study subjects.The pelvic floor muscle strength of all patients was less than grade Ⅲ,accompanied by mild stress urinary incontinence and organ prolapse.The patients were randomly divided into two groups.There were90 patients in the observation group treated with Kegel exercise plus biofeedback combined with electrical stimulation.There were60 patients in the control group treated with Kegel self-exercise alone.The pelvic floor muscle strength test was performed before treatment(6 weeks postpartum)and after treatment(3 months and 6 months postpartum),and the improvement in urinary incontinence symptoms and the degree of organ prolapse were evaluated.Changes in serum relaxin levels in patients were measured.Results There were no significant differences in pelvic floor muscle strength,urinary incontinence symptoms,and the degree of pelvic organ prolapse between the two groups before treatment(P>0.05).At 3 and 6 months postpartum,the pelvic floor muscle strength was significantly better in the observation group than in the control group(Z=5.361 and 6.801,P<0.05),the therapeutic effect on stress urinary incontinence was significantly better in the observation group than in the control group(Z=4.218 and4.023,P<0.05),and the degree of organ prolapse was significantly reduced in the observation group than in the control group(Z=2.954 and 3.644,P<0.05).There was no significant difference in serum relaxin level between the two groups before and after treatment(P>0.05). Conclusion Biofeedback combined with electrical stimulation is superior to Kegel exercise alone in the treatment of postpartum pelvic floor muscle weakness with stress urinary incontinence and organ prolapse,but it has no significant effect on serum relaxin levels.
Objective To explore the efficacy of biofeedback combined with electrical stimulation in the treatment of pelvic floor dysfunction in postpartum women and its effect on serum relaxin level. Methods One hundred and fifty patients with pelvic floor dysfunction were selected as study subjects.The pelvic floor muscle strength of all patients was less than grade Ⅲ,accompanied by mild stress urinary incontinence and organ prolapse.The patients were randomly divided into two groups.There were90 patients in the observation group treated with Kegel exercise plus biofeedback combined with electrical stimulation.There were60 patients in the control group treated with Kegel self-exercise alone.The pelvic floor muscle strength test was performed before treatment(6 weeks postpartum)and after treatment(3 months and 6 months postpartum),and the improvement in urinary incontinence symptoms and the degree of organ prolapse were evaluated.Changes in serum relaxin levels in patients were measured.Results There were no significant differences in pelvic floor muscle strength,urinary incontinence symptoms,and the degree of pelvic organ prolapse between the two groups before treatment(P>0.05).At 3 and 6 months postpartum,the pelvic floor muscle strength was significantly better in the observation group than in the control group(Z=5.361 and 6.801,P<0.05),the therapeutic effect on stress urinary incontinence was significantly better in the observation group than in the control group(Z=4.218 and4.023,P<0.05),and the degree of organ prolapse was significantly reduced in the observation group than in the control group(Z=2.954 and 3.644,P<0.05).There was no significant difference in serum relaxin level between the two groups before and after treatment(P>0.05). Conclusion Biofeedback combined with electrical stimulation is superior to Kegel exercise alone in the treatment of postpartum pelvic floor muscle weakness with stress urinary incontinence and organ prolapse,but it has no significant effect on serum relaxin levels.
引文
[1]蔡静,张丹,张燕.女性产后发生盆腔脏器脱垂的危险因素分析[J].中国妇幼保健,2018,33(12):2652-2654.
[2]JUNDT K,PESCHERS U,KENTENICH H.The investigation and treatment of female pelvic floor dysfunction[J].Deutsches Arzteblatt International,2015,112(33/34):564-574.
[3]金清,赵明珠.不同分娩方式对女性盆底形态功能的影响[J].实用医技杂志,2015,26(3):302-303.
[4]张月,韩萍,张洁.妊娠、分娩所致盆底功能障碍性疾病的研究现状[J].中国煤炭工业医学杂志,2015,18(6):1054-1059.
[5]姜丽,吴氢凯,罗来敏,等.初产妇妊娠晚期血雌、孕激素和松弛素水平与压力性尿失禁的相关性[J].中国实用妇科与产科杂志,2011,27(8):599-601.
[6]周艳娜,吴氢凯,程慧,等.血清松弛素浓度与女性盆底器官脱垂关系的研究[J].上海交通大学学报(医学版),2012,32(4):393-395.
[7]郑颖,李瑞满,帅翰林,等.血清松弛素与孕产妇盆底功能变化的关系[J].中国妇产科临床杂志,2011,12(2):96-99.
[8]WOODLEY S J,BOYLE R,CODY J D,et al.Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women[J/OL].Cochrane Database of Systematic Reviews,2012,12(8):CD007471.
[9]邵彤华.妊娠期盆底肌肉锻炼联合产后生物反馈电刺激对盆底功能的影响[J].中国妇幼保健,2017,32(8):1798-1801.
[10]王小燕,王培霞,王雪梅.阴道哑铃训练联合生物反馈电刺激治疗产后女性盆底功能障碍的效果观察[J].临床研究,2017,27(4):89,92.
[11]黄粤.电刺激联合生物反馈盆底肌训练治疗产后压力性尿失禁的临床观察[J].现代诊断与治疗,2016,27(10):1887-1888.
[12]马向英,刘艳慧,吕英璞,等.电刺激+生物反馈预防女性产后盆底功能障碍的效果及对盆底肌收缩力的影响[J].河北医药,2018,40(10):50-53.
[13]王元,余进进,傅建玲,等.生物反馈联合电刺激结合阴道哑铃治疗围绝经期女性性功能障碍的疗效观察[J].中国妇幼保健,2016,31(15):3082-3084.
[14]张燕萍,高然,刘玲,等.电刺激联合生物反馈治疗盆底脏器脱垂疗效观察[J].云南医药,2015,36(5):521-523.
[15]覃健.盆底肌训练和盆底电刺激在产后盆底肌力康复中的应用价值[J].河北医药,2015,45(14):2089-2092.
[16]黎佩莹,殷婉萍,陈艳芳,等.生物反馈治疗产后压力性尿失禁患者的疗效观察[J].医学临床研究,2018,35(2):219-221.
[17]刘云杰.盆底康复训练理疗仪配合优质护理在子宫盆底脏器脱垂中的效果观察[J].中国现代药物应用,2018,12(23):190-191.
[18]关文畅,白枫,李辉,等.雌激素联合生物反馈电刺激治疗绝经后轻中度压力性尿失禁的临床研究[J].中华实用诊断与治疗杂志,2016,30(3):307-308.
[19]董玉楠,冷秀兰,龙敏.探讨产后压力性尿失禁应用盆底功能康复疗法的可行性[J].齐齐哈尔医学院学报,2016,37(18):2267-2269.
[20]罗建清.女性产后盆底功能障碍的康复干预效果研究[J].吉林医学,2015,36(18):4180-4181.
[21]曾金华,汪桂艳,林斯华,等.产后42d女性压力性尿失禁的流行病学调查[J].中国妇幼保健,2017,32(20):5103-5106.
[22]江江,彭娟,董旭东.女性盆底功能障碍性疾病高危因素及康复治疗效果研究[J].中国妇幼保健,2016,31(9):1835-1837.
[23]李华维,李桂梅,黄晓宇.不同时期生物反馈电刺激及盆底肌锻炼对产后女性盆底功能恢复的影响[J].中国当代医药,2018,509(22):107-109.
[24]邱洪梅,林金凤,赖定群.盆底肌肉电刺激联合生物反馈对产后女性性功能障碍患者的影响[J].中国当代医药,2017,24(22):105-107.
[25]金菊.生物反馈联合盆底肌肉锻炼对妇女产后盆底功能康复的影响[J].中国伤残医学,2016,24(19):83-85.
[26]马乐,刘娟,李环,等.产后盆底康复流程第一部分---产后盆底康复意义及基本原则[J].中国实用妇科与产科杂志,2015,31(4):314-321.
[27]李世琼,刘丽娜,勾青,等.盆底康复技术对产后盆底功能障碍的防治作用[J].海南医学院学报,2017,23(4):546-548,552.
[28]陈燕辉,古彩茹,杨卫萍.电刺激疗法与生物反馈盆底肌训练联合在产后压力性尿失禁治疗中的临床应用分析[J].中国妇幼保健,2012,27(21):3244-3246.
[29]范卫群.盆底肌肉锻炼联合生物电刺激疗法治疗产后压力性尿失禁疗效和尿动力学分析[J].中国妇幼保健,2014,29(3):471-473.
[30]周艳娜,吴氢凯,甘桂萍.松弛素生物学作用研究进展[J].临床和实验医学杂志,2014,13(19):1651-1653.
[31]蔡柏岑,韩燕华,苏园园,等.松弛素、盆底电生理与女性盆底功能障碍性疾病的相关性研究[J].中国医学创新,2015,12(15):10-12.
[32]苏秋梅,蒋建秋,郝建珍.盆底肌锻炼联合电刺激生物反馈对子宫全切术后盆底功能恢复及血清松弛素的影响[J].中国临床医生杂志,2017,45(3):95-98.
[2]JUNDT K,PESCHERS U,KENTENICH H.The investigation and treatment of female pelvic floor dysfunction[J].Deutsches Arzteblatt International,2015,112(33/34):564-574.
[3]金清,赵明珠.不同分娩方式对女性盆底形态功能的影响[J].实用医技杂志,2015,26(3):302-303.
[4]张月,韩萍,张洁.妊娠、分娩所致盆底功能障碍性疾病的研究现状[J].中国煤炭工业医学杂志,2015,18(6):1054-1059.
[5]姜丽,吴氢凯,罗来敏,等.初产妇妊娠晚期血雌、孕激素和松弛素水平与压力性尿失禁的相关性[J].中国实用妇科与产科杂志,2011,27(8):599-601.
[6]周艳娜,吴氢凯,程慧,等.血清松弛素浓度与女性盆底器官脱垂关系的研究[J].上海交通大学学报(医学版),2012,32(4):393-395.
[7]郑颖,李瑞满,帅翰林,等.血清松弛素与孕产妇盆底功能变化的关系[J].中国妇产科临床杂志,2011,12(2):96-99.
[8]WOODLEY S J,BOYLE R,CODY J D,et al.Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women[J/OL].Cochrane Database of Systematic Reviews,2012,12(8):CD007471.
[9]邵彤华.妊娠期盆底肌肉锻炼联合产后生物反馈电刺激对盆底功能的影响[J].中国妇幼保健,2017,32(8):1798-1801.
[10]王小燕,王培霞,王雪梅.阴道哑铃训练联合生物反馈电刺激治疗产后女性盆底功能障碍的效果观察[J].临床研究,2017,27(4):89,92.
[11]黄粤.电刺激联合生物反馈盆底肌训练治疗产后压力性尿失禁的临床观察[J].现代诊断与治疗,2016,27(10):1887-1888.
[12]马向英,刘艳慧,吕英璞,等.电刺激+生物反馈预防女性产后盆底功能障碍的效果及对盆底肌收缩力的影响[J].河北医药,2018,40(10):50-53.
[13]王元,余进进,傅建玲,等.生物反馈联合电刺激结合阴道哑铃治疗围绝经期女性性功能障碍的疗效观察[J].中国妇幼保健,2016,31(15):3082-3084.
[14]张燕萍,高然,刘玲,等.电刺激联合生物反馈治疗盆底脏器脱垂疗效观察[J].云南医药,2015,36(5):521-523.
[15]覃健.盆底肌训练和盆底电刺激在产后盆底肌力康复中的应用价值[J].河北医药,2015,45(14):2089-2092.
[16]黎佩莹,殷婉萍,陈艳芳,等.生物反馈治疗产后压力性尿失禁患者的疗效观察[J].医学临床研究,2018,35(2):219-221.
[17]刘云杰.盆底康复训练理疗仪配合优质护理在子宫盆底脏器脱垂中的效果观察[J].中国现代药物应用,2018,12(23):190-191.
[18]关文畅,白枫,李辉,等.雌激素联合生物反馈电刺激治疗绝经后轻中度压力性尿失禁的临床研究[J].中华实用诊断与治疗杂志,2016,30(3):307-308.
[19]董玉楠,冷秀兰,龙敏.探讨产后压力性尿失禁应用盆底功能康复疗法的可行性[J].齐齐哈尔医学院学报,2016,37(18):2267-2269.
[20]罗建清.女性产后盆底功能障碍的康复干预效果研究[J].吉林医学,2015,36(18):4180-4181.
[21]曾金华,汪桂艳,林斯华,等.产后42d女性压力性尿失禁的流行病学调查[J].中国妇幼保健,2017,32(20):5103-5106.
[22]江江,彭娟,董旭东.女性盆底功能障碍性疾病高危因素及康复治疗效果研究[J].中国妇幼保健,2016,31(9):1835-1837.
[23]李华维,李桂梅,黄晓宇.不同时期生物反馈电刺激及盆底肌锻炼对产后女性盆底功能恢复的影响[J].中国当代医药,2018,509(22):107-109.
[24]邱洪梅,林金凤,赖定群.盆底肌肉电刺激联合生物反馈对产后女性性功能障碍患者的影响[J].中国当代医药,2017,24(22):105-107.
[25]金菊.生物反馈联合盆底肌肉锻炼对妇女产后盆底功能康复的影响[J].中国伤残医学,2016,24(19):83-85.
[26]马乐,刘娟,李环,等.产后盆底康复流程第一部分---产后盆底康复意义及基本原则[J].中国实用妇科与产科杂志,2015,31(4):314-321.
[27]李世琼,刘丽娜,勾青,等.盆底康复技术对产后盆底功能障碍的防治作用[J].海南医学院学报,2017,23(4):546-548,552.
[28]陈燕辉,古彩茹,杨卫萍.电刺激疗法与生物反馈盆底肌训练联合在产后压力性尿失禁治疗中的临床应用分析[J].中国妇幼保健,2012,27(21):3244-3246.
[29]范卫群.盆底肌肉锻炼联合生物电刺激疗法治疗产后压力性尿失禁疗效和尿动力学分析[J].中国妇幼保健,2014,29(3):471-473.
[30]周艳娜,吴氢凯,甘桂萍.松弛素生物学作用研究进展[J].临床和实验医学杂志,2014,13(19):1651-1653.
[31]蔡柏岑,韩燕华,苏园园,等.松弛素、盆底电生理与女性盆底功能障碍性疾病的相关性研究[J].中国医学创新,2015,12(15):10-12.
[32]苏秋梅,蒋建秋,郝建珍.盆底肌锻炼联合电刺激生物反馈对子宫全切术后盆底功能恢复及血清松弛素的影响[J].中国临床医生杂志,2017,45(3):95-98.