盆底康复训练对改善产后盆底肌功能的作用

Evaluation of the effect of postpartum electrical stimulation and biofeedback combined with vaginal dumbbell exercise in improving pelvic floor function

目的:评价电刺激联合生物反馈结合阴道哑铃盆底康复训练对改善产后盆底肌功能的作用。方法:选择2010年10月—2011年10月,在中山大学附属第一医院产科住院阴道分娩,产后6周复诊盆底肌力筛查小于3级的产妇,进行1疗程盆底康复训练(电刺激联合生物反馈盆底肌肉训练辅以阴道哑铃训练)。产后6周及治疗1个疗程后测定盆底肌肉Ⅰ类、Ⅱ类及总肌纤维的最大肌电值及张力,填写国际尿失禁咨询委员会尿失禁问卷表简表(ICIQ-SF)调查尿失禁发生情况。其中资料完整者有91例。结果:康复训练后手测盆底肌力及PHENIXUSB4盆底生物反馈治疗仪(神经肌肉刺激治疗仪)测总肌电值(10.41±5.23vs8.24±4.14μV)、Ⅰ类肌纤维肌电值(4.93±2.47vs3.71±1.88μV)、Ⅱ类肌纤维肌电值(5.75±2.83vs4.71±2.43μV)均较前提高,差异有显著性意义,其中提高50%以上者(治疗有效者)为40.7%。存在尿失禁者康复训练后ICIQ-SF各项及总分(1.83±2.66vs9.17±2.18)均较前改善,差异有显著性意义。结论:产后电刺激联合生物反馈盆底肌肉训练辅以阴道哑铃训练能提高盆底肌力,改善尿失禁发生情况。

Objective： To evaluate the effect of postpartum electrical stimulation and biofeedback combined with vaginal dumbbell exercise treatment in improving the pelvic floor function.Method： The postpartum women （delivered between October 2010 and October 2011 in the First Affiliated Hospital of Sun Yat-Sen University were selected. The pelvic floor muscle strength was below stage 3 evaluated at 42dafter delivery by manual examination. Pelvic floor electrical stimulation and biofeedback combined with vaginal dumbbell exercise treatment were given for a course （10-15 times/twice a week）. Manual examination and bio-feedback instrument were used to measure the pelvic floor muscle strength and myoelectric current. The international consultation on incontinence questionnaire-short form （ICIQ-SF） was used in assessment at 6 weeks afterdelivery and after 1 course treatment. The informations of 91 participants were intact. Result： The voltage of total pelvic floor muscle were 10.41 ± 5.231μV vs 8.24 ± 4.141μV, the voltage of muscle fi-ber I were 4.93 4± 2.471μV vs 3.71 ± 1.881μV, the voltage of muscle fiber 11 were 5.75 ± 2.83pμV vs 4.71 ± 2.43μV. There were significantly improvement after the treatment, the effective rate was 40.7%. The pelvic floormuscle strength measured by manual examination also improved after treatment. The women＇s urinary incontinences were alleviated and the ICIQ-SF score （1.83 ± 2.66 vs 9.17 ± 2.18） improved after treatment.Conclusion： Postpartum electrical stimulation and biofeedback combined with vaginal dumbbell exercise can im-prove the pelvic floor muscle strength and alleviate the urinary incontinence. Author＇s address Department of Obstetrics and Gynecology, the First Affiliated Hospital of Sun Yat-Sen Univer-sity, Guangzhou, 510080