Kegel运动联合盆底康复治疗初产妇阴道分娩后功能障碍及压力性尿失禁的临床疗效

Kegel exercise combined with pelvic floor rehabilitation for primipara dysfunction and stress urinary incontinence after vaginal delivery

目的探讨Kegel运动联合盆底康复治疗阴道分娩后初产妇功能障碍及压力性尿失禁的效果。方法选取2017年12月~2018年12月在海南省人民医院治疗的盆底功能障碍合并压力性尿失禁的复诊初产妇116例,依据随机数字的方法分为对照组(n=58)和观察者(n=58),对照组使用Kegel锻炼法,观察组在对照组基础上使用神经肌肉电刺激与肌电生物反馈治疗,对比治疗的效果。结果两组治疗前后的会阴部位肌力等级的数据差异有统计学意义(F=16.725,P<0.05),q检验结果显示,在治疗前两组的肌力等级差异无统计学意义,经过治疗后,两组的肌力等级均提升,且观察组的肌力等级优于对照组(P<0.05)。经过治疗后,对照组的尿道最大测量压从(6.28±1.02)kPa上升到(6.76±0.98)kPa,尿道最大闭合压从(6.12±1.07)kPa上升到(6.83±1.02)kPa,Valsalva漏尿点压从(8.57±1.02)kPa上升到(9.79±0.89)kPa,Sandvik评分从(2.34±0.31)分降低到(2.12±0.29)分。观察组的尿道最大测量压从(6.27±1.12)kPa上升到(9.15±1.03)kPa,尿道最大闭合压从(6.15±1.15)kPa上升到(8.35±1.04)kPa,Valsalva漏尿点压从(8.49±1.89)kPa上升到(12.02±0.97)kPa,Sandvik评分从(2.35±0.27)分降低到(1.89±0.27)分,与治疗前相比,数据差异均有统计学意义(t=-2.584,-3.658,-6.864,3.947,-14.415,-10.806,-12.655,9.175,P<0.05)。在治疗后的组间对比中,观察组的尿动力学指标均高于对照组,Sandvik评分低于对照组(t=-12.803,-7.947,-12.901,4.421,P<0.05)。观察组的治疗效果优于对照组(Z=2.505,P<0.05),对照组的HAMA评分从(15.37±3.25)分降低到(11.28±2.11)分,HAMD评分从(23.71±4.35)分降低到(15.32±4.02)分,观察组的HAMA评分从(16.18±4.03)分降低到(7.56±1.51)分,HAMD评分从(22.97±3.87)分降低到(9.32±2.15)分,与治疗前相比,数据差异均有统计学意义(t=8.039,10.788,15.254,23.481,P<0.05)。在治疗后的组间对比中,观察组的焦虑与抑郁评分低于对照组(t=10.919,10.023,P<0.05)。结论使用Kegel运动联合盆底康复治疗阴道分娩初产妇的功能障碍及压力性尿失禁,可以提升会阴部位肌力水平,改善尿动力学指标,缓解患者的不良情绪。

Objective To explore the effect of Kegel exercise combined with pelvic floor rehabilitation on primipara dysfunction and stress urinary incontinence after vaginal delivery.Methods 116 cases of primiparas with pelvic floor dysfunction and stress urinary incontinence treated in Hainan Provincial People′s Hospital from December 2017 to December 2018 were selected.According to the method of random number,it was divided into control group(n=58)and observer(n=58).The Kegel exercise method was used in the control group,and the observation group was treated with neuromuscular electrical stimulation and electromyography biofeedback on the basis of the control group.Contrast treatment effect.Results There were significant differences in the data of muscle strength between the two groups before and after treatment(F=16.725,P<0.05).The results of the q test showed no significant difference in muscle strength between the two groups before treatment.After treatment,the muscle strength of both groups increased,and the muscle strength of the observation group was better than that of the control group(P<0.05).After treatment,the maximum measurement pressure of the urethra of the control group increased from(6.28±1.02)kPa to(6.76±0.98)kPa,and the maximum closing pressure of the urethra increased from(6.12±1.07)kPa to(6.83±1.02)kPa,Valsalva leaked urine.The point pressure increased from(8.57±1.02)kPa to(9.79±0.89)kPa,and the Sandvik score decreased from(2.34±0.31)points to(2.12±0.29)points.The maximum measurement pressure of the urethra of the observation group increased from(6.27±1.12)kPa to(9.15±1.03)kPa,and the maximum closing pressure of the urethra increased from(6.15±1.15)kPa to(8.35±1.04)kPa,and Valsalva leaked urine pressure from(8.49±1.89)kPa rose to(12.02±0.97)kPa,Sandvik score decreased from(2.35±0.27)points to(1.89±0.27)points.Data differences were statistically significant(t=-2.584,-3.658,-6.864,3.947,-14.415,-10.806,-12.655,9.175,P<0.05).In the comparison between groups after treatment,the urodynamic parameters of the observation group were higher than those of the control group,and the Sandvik score was lower than that of the control group(t=-12.803,-7.747,-12.901,4.421,P<0.05).The therapeutic effect of the observation group was better than that of the control group(Z=2.505,P<0.05).After treatment,the HAMA score of the control group decreased from(15.37±3.25)points to(11.28±2.11)points,and the HAMD score decreased from(23.71±4.35)points to(15.32±4.02)points.The HAMA score of the observation group decreased from(16.18±4.03)points to(7.56±1.51)points,and the HAMD score decreased from(22.97±3.87)points to(9.32±2.15)points.The data were statistically significant compared with before treatment(t=8.039,10.788,15.254,23.481,P<0.05).In the comparison between groups after treatment,the anxiety and depression scores of the observation group were lower than those of the control group(t=10.919,10.023,P<0.05).Conclusions Kegel exercise combined with pelvic floor rehabilitation for vaginal delivery dysfunction and stress urinary incontinence can improve the level of muscle strength in the perineum,improve urodynamics,and alleviate the patient′s bad mood.