盆底电刺激联合Kegal法对盆底功能障碍产妇尿失禁、盆底肌电生理及生活质量的影响

Effect of pelvic floor electrical stimulation combined with Kegal exercise on urinary incontinence,pelvic floor electrophysiological parameters,and quality of life in postpartum women with pelvic floor dysfunction

目的探讨盆底电刺激(PES)联合Kegal法对盆底功能障碍性疾病(PFD)产妇尿失禁、盆底肌电生理及生活质量的影响。方法选取2016年4月-2017年12月该院收治的符合国际尿控协会制定的PFD标准的经阴道分娩产妇85例,随机分为两组,对照组(42例)单纯采用Kegal法进行盆底肌功能训练,研究组(43例)采用PES联合Kegal法治疗,疗程6周,应用排尿日记、手测盆底肌收缩力测评分级(Oxford评分法)、盆底功能障碍评分(PFDI-20)、盆底功能影响评分(PFIQ-7)对比治疗前后两组患者尿失禁、盆底肌肉收缩力及生活质量的改善情况。结果研究组治疗后POP-Q分度0度比例明显增高(P<0.05),Ⅰ度和Ⅱ度比例明显降低(P<0.05),研究组治疗后POP-Q分度0度高于对照组(P<0.05),Ⅰ度和Ⅱ度小于对照组(P<0.05)。研究组治疗后尿失禁患者比例下降了55.81%,明显低于治疗前和对照组;研究组尿失禁患者24h平均尿失禁次数明显下降(t=5.235,P<0.05),且低于对照组(t=6.927,P<0.05)。研究组治疗后盆底肌力大于对照组(P<0.05),盆底Ⅰ类肌纤维肌电压、盆底Ⅱ类肌纤维肌电压及盆底Ⅰ类肌纤维疲劳度均高于对照组(P<0.05),盆底Ⅱ类肌纤维疲劳度与对照组比较,差异无统计学意义(P>0.05)。研究组PFIQ-7、PFDI-20评分显著低于治疗前及对照组(P<0.05)。结论PES联合Kegal法可改善PFD产妇尿失禁症状,促进盆底功能恢复,降低PFD对患者生活质量的影响。

Objective To explore the effect of pelvic floor electrical stimulation ( PES) combined with Kegal exercise on urinary incontinence,pelvic floor electrophysiological parameters,and quality of life in postpartum women with pelvic floor dysfunction ( PFD) .Methods Eighty-five women of vaginal delivery meeting PFD standard established by International Continence Society were selected from Maternal and Child Health Care Hospital of Changning District from April 2016 to December 2017,then they were randomly divided into two groups,42 women in control group were given Kegal exercise for pelvic floor muscle function training,and 43 women in study group were given PES combined with Kegal exercise,the women were treated for 6 weeks.Voiding record,Oxford score,PFDI-20,and PFIQ-7 were used to compare the improvements of urinary incontinence,pelvic floor muscle contractility,and quality of life between before and after treatment in the two groups.Results After treatment,the ratio of 0 degree of POP-Q in study group increased significantly ( P<0.05) ,while the ratios of Ⅰ degree and Ⅱ degree decreased significantly ( P<0.05) .After treatment,the ratio of 0 degree of POP-Q in study group was statistically significantly higher than that in control group ( P<0.05) ,while the ratios of Ⅰ degree and Ⅱ degree in study group were statistically significantly lower than those in control group ( P<0.05) .After treatment,the incidence rate of urinary incontinence in study group decreased by 55.81%,which was significantly lower than those before treatment and after treatment in control group.The average number of urinary incontinence within 24 hours in study group decreased significantly ( t = 5.235,P<0.05) ,which was statistically significantly lower than that in control group ( t = 6.927,P<0.05) .After treatment,pelvic floor muscle strength in study group was statistically significantly higher than that in control group ( P<0.05) .The voltages of pelvic floor type Ⅰ muscle fiber,pelvic floor type Ⅱ muscle fiber,and fatigue degree of pelvic floor type Ⅰ muscle fiber in study group were statistically significantly higher than those in control group ( P<0.05) .There was no statistically significant difference in fatigue degree of pelvic floor type Ⅱ muscle fiber between study group and control group ( P>0.05) .The scores of PFIQ-7 and PFDI-20 in study group were statistically significantly lower than those before treatment and in control group ( P<0.05) .Conclusion PES combined with Kegal exercise can improve the symptoms of urinary incontinence,promote the recovery of pelvic floor function,and reduce the influence of PFD on the quality of life of patients with PFD.