生物反馈疗法联合电刺激治疗产妇产后盆底功能障碍性疾病的临床疗效及影响因素分析

Analysis on clinical effect and influencing factors of biofeedback therapy combined with electrical stimulation in treatment of postpartum pelvic floor dysfunction

目的探讨生物反馈疗法联合电刺激治疗产妇产后盆底功能障碍性疾病(PFD)的临床疗效及影响因素,为产妇产后PFD合并压力性尿失禁(SUI)患者个体化治疗方案的制定提供参考依据。方法选取2017年12月-2018年12月台州第一人民医院收治的产妇产后PFD合并SUI患者116例,单盲、数字标号、随机分组,对照组58例,开展Kegal训练;观察组58例,采取生物反馈疗法联合电刺激治疗,比较两组盆底肌力及尿失禁改善情况。并基于观察组患者是否痊愈,行Logistic多因素分析年龄、分娩方式、孕次、孕期体质量增量、新生儿体质量等因素对治疗疗效的影响。结果两组治疗前,盆底肌力与尿失禁分级比较,差异无统计学意义(χ2=0.3456,0.3043,均P>0.05)。治疗后,观察组盆底肌力与尿失禁改善效果明显优于对照组,差异有统计学意义(χ2=7.3282,14.7769,均P<0.05)。观察组治疗有效率显著高于对照组,差异有统计学意义(P<0.05)。单因素比较,痊愈组(42例),产次、新生儿体质量、孕期体质量增量、盆底肌力、尿失禁严重程度与未愈组(16例)比较,差异有统计学意义(均P<0.05);Logistic多因素分析,产次、孕期体质量增量、盆底肌力、尿失禁严重程度及新生儿体质量是影响PFD合并SUI痊愈的独立因素。结论生物反馈疗法联合电刺激治疗产妇产后PFD合并SUI疗效良好,增强盆底肌力,改善尿失禁症状。产次、孕期体质量增量、盆底肌力、尿失禁严重程度及新生儿体质量是影响产妇产后PFD合并SUI痊愈的独立因素。

Objective To explore the clinical effect and influencing factors of biofeedback therapy combined with electrical stimulation in treatment of postpartum pelvic floor dysfunction(PFD),provide a reference basis for making individualized treatment regimens for patients with postpartum PFD combined with stress urinary incontinence(SUI).Methods From December 2017 to December 2018,116 patients with postpartum PFD combined with SUI treated in the First People’s Hospital of Taizhou City were selected and randomly divided into two groups,58 patients in control group were given Kegal training,and 58 patients in observation group were given biofeedback therapy combined with electrical stimulation.The improvements of pelvic floor muscle strength and SUI in the two groups were compared.Based on cured or not in observation group,the effects of age,delivery mode,gravidity,weight gain during pregnancy,and neonatal weight on therapeutic effect were analyzed by Logistic multivariate analysis.Results Before treatment,there was no statistically significant difference in pelvic floor muscle strength and urinary incontinence grade between the two groups(χ~2=0.3456,0.3043,P>0.05).After treatment,the improvement effect of pelvic floor muscle strength and urinary incontinence in observation group was statistically significantly better than that in control group(χ~2=7.3282,14.7769,P<0.05).The effective rate of treatment in observation group was statistically significantly higher than that in control group(P<0.05).Univariate analysis showed that there were statistically significant differences in parity,neonatal weight,weight gain during pregnancy,pelvic floor muscle strength,and severity of urinary incontinence between cured group(42 patients)and noncured group(16 patients)(P<0.05).Logistic multivariate analysis showed that parity,weight gain during pregnancy,pelvic floor muscle strength,severity of urinary incontinence,and neonatal weight were independent factors affecting recovery of patients with postpartum PFD combined with SUI.Conclusion Biofeedback therapy combined with electrical stimulation is effective in treatment of patients with postpartum PFD combined with SUI,which can enhance pelvic floor muscle strength and improve symptoms of urinary incontinence.Parity,weight gain during pregnancy,pelvic floor muscle strength,severity of urinary incontinence,and neonatal weight are independent factors affecting recovery of patients with postpartum PFD combined with SUI.