低频电刺激联合盆底康复训练治疗对女性压力性尿失禁患者盆腔功能及性生活质量的影响
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摘要
目的探讨低频电刺激联合盆底康复训练治疗对女性压力性尿失禁(stress urinary incontience,SUI)患者盆腔功能及性生活质量的影响。方法将2016年4月至2018年1月湖北省恩施市中心医院诊治的149例女性SUI患者为研究对象。按照就诊顺序将其分为联合组(75例,给予低频电刺激+盆底康复训练)和对照组(74例,给予盆底康复训练),治疗8周后,比较两组患者治疗前后盆底肌力、肌电位、A3反射、盆腔功能、尿失禁性生活质量问卷(PISQ)评分等变化。结果治疗后,两组患者盆底Ⅰ类纤维和Ⅱ类纤维肌力、SUI等级评分均有显著改善(均P<0.05),肌电位、PISQ各维度评分及总分均有显著提高(均P<0.05),A3反射异常、1h尿垫试验漏尿量及子宫脱垂、阴道前壁膨出、阴道后壁膨出发生率均有显著降低(均P<0.05),联合组患者盆底肌力、肌电位、A3反射、1h尿垫试验漏尿量、盆腔功能和PISQ评分改善幅度均大于对照组患者(均P<0.05)。结论低频电刺激联合盆底康复训练可以有效改善女性SUI患者尿失禁症状和盆腔功能,促进盆底肌力恢复,提高性生活质量。
Objective To explore the effects of low frequency electrical stimulation combined with pelvic floor rehabilitation training on the pelvic function and quality of sexual life in female patients with stress urinary incontinence(SUI). Methods 149 female SUI patients treated in Enshi Central Hospital from April 2016 to January 2018 were divided into the combined group(n=75, low frequency electrical stimulation and pelvic floor rehabilitation training) and the control group(n=74, pelvic floor rehabilitation training) according to the admission sequence, all treated for 8 weeks. The changes in pelvic floor muscle strength, myoelectric potential, A3 reflex, pelvic function, and prolapse and incontinence sexual function questionnaire(PISQ) score were compared between the two groups before and after treatment. Results After treatment, the muscular strength of pelvic floor type I fibers and type II fibers and the SUI grades scores were significantly improved in the two groups(all P<0.05); the myoelectric potential and the all dimensions scores and total score of PISQ scale were significantly increased(all P<0.05); the incidence rates of A3 abnormal reflex, 1 h urine pad test urine leakage and uterine prolapse, and anterior and posterior vaginal wall bulging were significantly decreased(all P<0.05). The pelvic floor muscle strength, myoelectric potential, A3 reflex, 1 h urine pad test urine leakage, pelvic function and PISQ score were improved more significant in the combined group than that in the control group(all P<0.05). Conclusions Low frequency electrical stimulation combined with pelvic floor rehabilitation training can effectively improve the urinary incontinence and pelvic function in female SUI patients, which can promote the recovery of pelvic floor muscle strength and improve the quality of sexual life.
Objective To explore the effects of low frequency electrical stimulation combined with pelvic floor rehabilitation training on the pelvic function and quality of sexual life in female patients with stress urinary incontinence(SUI). Methods 149 female SUI patients treated in Enshi Central Hospital from April 2016 to January 2018 were divided into the combined group(n=75, low frequency electrical stimulation and pelvic floor rehabilitation training) and the control group(n=74, pelvic floor rehabilitation training) according to the admission sequence, all treated for 8 weeks. The changes in pelvic floor muscle strength, myoelectric potential, A3 reflex, pelvic function, and prolapse and incontinence sexual function questionnaire(PISQ) score were compared between the two groups before and after treatment. Results After treatment, the muscular strength of pelvic floor type I fibers and type II fibers and the SUI grades scores were significantly improved in the two groups(all P<0.05); the myoelectric potential and the all dimensions scores and total score of PISQ scale were significantly increased(all P<0.05); the incidence rates of A3 abnormal reflex, 1 h urine pad test urine leakage and uterine prolapse, and anterior and posterior vaginal wall bulging were significantly decreased(all P<0.05). The pelvic floor muscle strength, myoelectric potential, A3 reflex, 1 h urine pad test urine leakage, pelvic function and PISQ score were improved more significant in the combined group than that in the control group(all P<0.05). Conclusions Low frequency electrical stimulation combined with pelvic floor rehabilitation training can effectively improve the urinary incontinence and pelvic function in female SUI patients, which can promote the recovery of pelvic floor muscle strength and improve the quality of sexual life.
引文
[1] 孙慧芳,来光华,黄亚胜.个体化行为干预模式对老年女性压力性尿失禁患者情绪及生活质量的干预效果[J].中国基层医药,2016,23(2):190-194.
[2] 程红.阜阳市912例产后妇女压力性尿失禁的影响因素分析[J].蚌埠医学院学报,2016,41(8):1012-1013.
[3] 薛宁,夏兆新,朱栋华.腹针疗法加低频电刺激结合盆底肌训练治疗女性压力性尿失禁的临床研究[J].上海中医药杂志,2016,50(8):54-57.
[4] 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(试行)[J].中华妇产科杂志,2011,46(10):796-798.
[5] 许焕芳,杜若桑,莫倩,等.电针治疗女性轻中度压力性尿失禁有效性的Ⅰ期临床研究[J].中华中医药杂志,2014,29(12):3755-3758.
[6] 杨文刚.自拟中风气化汤联合隔盐葱灸治疗中风后排尿功能障碍的疗效分析[J].四川中医,2014,32(2):82-84.
[7] 邓文慧,张毅,吕秋波,等.绝经后妇女前盆腔器官脱垂或张力性尿失禁治疗前后的性生活质量分析[J].中华全科医师杂志,2014,13(1):62-64.
[8] 林蓓蓓,龙玲,何小丽,等.电刺激联合生物反馈加雌激素治疗绝经后女性轻中度压力性尿失禁的临床研究[J].医学临床研究,2017,34(10):2067-2069.
[9] 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.
[10] 李霞,庞稼燕.肌电刺激联合生物反馈盆底肌训练治疗女性轻中度压力性尿失禁的临床观察[J].中国临床研究,2015,28(1):80-81.
[11] 周凤勤,欧红萍.不同盆底康复训练对产后压力性尿失禁的效果对比研究[J].实用临床医药杂志,2015,19(4):156-157.
[12] 贾艳红,孟利平,吴敏.Kegel训练联合低频脉冲反馈电刺激治疗盆底功能障碍的疗效观察[J].医学临床研究,2016,33(5):1001-1004.
[13] Stewart F,Berghmans B,B? K,et al.Electrical stimulation with non-implanted devices for stress urinary incontinence in women[J].Cochrane Database of Systematic Reviews,2017,22(12):CD012390.
[14] 杜亚飞,王旭,代丽丽,等.雌激素联合盆底康复治疗仪在妇女盆底功能障碍中的应用效果[J].重庆医学,2017,46(23):3261-3263.
[15] 杨云洁,程芳.神经肌肉刺激治疗仪治疗尿失禁并发会阴部湿疹一例[J].中国医师杂志,2015(2):205-205.
[16] 杨丹.女性盆底功能障碍性疾病的研究进展[J].中国计划生育和妇产科,2017,9(2):11-15.
[17] 孙智晶,朱兰,郎景和,等.产后盆底康复锻炼对女性盆底功能障碍性疾病的预防作用[J].中华妇产科杂志,2015,50(6):420-427.
[2] 程红.阜阳市912例产后妇女压力性尿失禁的影响因素分析[J].蚌埠医学院学报,2016,41(8):1012-1013.
[3] 薛宁,夏兆新,朱栋华.腹针疗法加低频电刺激结合盆底肌训练治疗女性压力性尿失禁的临床研究[J].上海中医药杂志,2016,50(8):54-57.
[4] 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(试行)[J].中华妇产科杂志,2011,46(10):796-798.
[5] 许焕芳,杜若桑,莫倩,等.电针治疗女性轻中度压力性尿失禁有效性的Ⅰ期临床研究[J].中华中医药杂志,2014,29(12):3755-3758.
[6] 杨文刚.自拟中风气化汤联合隔盐葱灸治疗中风后排尿功能障碍的疗效分析[J].四川中医,2014,32(2):82-84.
[7] 邓文慧,张毅,吕秋波,等.绝经后妇女前盆腔器官脱垂或张力性尿失禁治疗前后的性生活质量分析[J].中华全科医师杂志,2014,13(1):62-64.
[8] 林蓓蓓,龙玲,何小丽,等.电刺激联合生物反馈加雌激素治疗绝经后女性轻中度压力性尿失禁的临床研究[J].医学临床研究,2017,34(10):2067-2069.
[9] 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.
[10] 李霞,庞稼燕.肌电刺激联合生物反馈盆底肌训练治疗女性轻中度压力性尿失禁的临床观察[J].中国临床研究,2015,28(1):80-81.
[11] 周凤勤,欧红萍.不同盆底康复训练对产后压力性尿失禁的效果对比研究[J].实用临床医药杂志,2015,19(4):156-157.
[12] 贾艳红,孟利平,吴敏.Kegel训练联合低频脉冲反馈电刺激治疗盆底功能障碍的疗效观察[J].医学临床研究,2016,33(5):1001-1004.
[13] Stewart F,Berghmans B,B? K,et al.Electrical stimulation with non-implanted devices for stress urinary incontinence in women[J].Cochrane Database of Systematic Reviews,2017,22(12):CD012390.
[14] 杜亚飞,王旭,代丽丽,等.雌激素联合盆底康复治疗仪在妇女盆底功能障碍中的应用效果[J].重庆医学,2017,46(23):3261-3263.
[15] 杨云洁,程芳.神经肌肉刺激治疗仪治疗尿失禁并发会阴部湿疹一例[J].中国医师杂志,2015(2):205-205.
[16] 杨丹.女性盆底功能障碍性疾病的研究进展[J].中国计划生育和妇产科,2017,9(2):11-15.
[17] 孙智晶,朱兰,郎景和,等.产后盆底康复锻炼对女性盆底功能障碍性疾病的预防作用[J].中华妇产科杂志,2015,50(6):420-427.