生物反馈、电刺激联合盆底肌锻炼对产后盆底康复的疗效观察

The effect observation of biofeedback,electrical stimulation combined with pelvic floor muscle exercises for postpartum pelvic floor rehabilitation

目的:探讨生物反馈、电刺激联合盆底肌锻炼对产后盆底康复的疗效。方法:选择2010年6月至2011年6月江西省妇幼保健院产后6周的初产妇609例,肌力为Ⅱ～Ⅳ级,随机分为8组:锻炼组、电刺激组、生物反馈组、两两联合组(3组)、三者联合组、对照组。用Phenix盆底治疗仪检测各组产妇治疗前后Ⅰ、Ⅱ类盆底肌纤维及肌电位均值和疲劳度情况;采用ICI-Q-SF问卷、POP-Q量表、FSFI问卷分别判定产妇的尿失禁(SUI)、盆腔器官脱垂(POP)及性生活质量情况。结果:治疗后,各组盆底肌电位均值明显升高、疲劳度明显降低(P<0.01);三者联合组盆底脱垂情况较对照组明显改善(P<0.0042);盆底肌锻炼联合生物反馈、电刺激联合生物反馈、三者联合组SUI发生率较对照组显著降低(P<0.0042);两两联合、三者联合组性生活质量较对照组明显提高(P<0.0042)。结论:单纯、联合康复治疗对产后盆底康复均有疗效,其中电刺激联合生物反馈治疗、三者联合治疗具有协同效应。

Objective：To investigate the effect of biofeedback,electrical stimulation combined with pelvic floor muscle training on postpartum pelvic floor rehabilitation.Methods：A total of 609 primiparas at 6 weeks postpartum,whose pelvic floor muscles were among the levels of Ⅱ~Ⅳ,were recruited from the Maternal and Child Health Hospital of Jiangxi Province.These patients were randomly divided into eight groups：pelvic floor muscle trainning group,electrical stimulation group,biofeedback group,two-two joint groups（including three groups）,three joint group and control group.Phenix pelvic treatment instrument was used to detect the levels of the Ⅰand Ⅱ fibers,the pelvic floor muscle electromyography（EMG） mean value and fatigue before and after the treatment.The ICI-Q-SF,POP-Q indexing and FSFI were used to evaluate the maternal stress urinary incontinence（SUI）,pelvic organ prolapse（POP） and quality of sexual life.Results：Each treated group presented with significant increment of mean value of pelvic muscle electromyography and decreased fatigability（P0.05）.The POP situation was significantly improved in the three joint group when compared with the control group（P0.0042）.The SUI incidence was significantly decreased in the pelvic floor muscle training combined with biofeedback,electrical stimulation combined with biofeedback and three joint group when compared with the control group（P0.0042）.There was also significant improvement of sexual life in the two-two joint,three combined group when compared with the control group（P0.0042）.Conclusions：The single and combined rehabilitations are effective for postpartum pelvic floor rehabilitation,among which the electrical stimulation combined with biofeedback and three-combined-way have synergistic effects.