电刺激联合生物反馈治疗不同分娩方式产后盆底肌力减退的比较研究

Therapeutic Effect of the Biofeedback Combined with Electrical Stimulation on Postpartum Pelvic Floor Dysfunction with Different Delivery Mode

目的观察不同分娩方式产后女性盆底肌力通过电刺激联合生物反馈治疗前后的变化、治疗效果，探索其变化机制。方法选取产后42 d复诊时经筛查发现存在重度盆底肌力减退的产妇130例，其中顺产70例、剖宫产60例。顺产组及剖宫产组受试者用数字法随机分为研究组及对照组。接受电刺激联合生物反馈治疗者为研究组，对照组在家中自行缩肛提肛运动康复训练。产后42 d用PHENIX检测仪量化评估盆底肌力后，采用电刺激联合生物反馈治疗16次，在产后3个月、6个月及12个月再次检测产妇盆底肌力情况。结果顺产组和剖宫产组重度盆底肌力减退患者Ⅰ类肌力和Ⅱ类肌力评分在治疗后均较治疗前（产后42 d）有显著增高，差异有统计学意义（P＜0.01）。经阴道分娩组和剖宫产组比较，治疗前盆底肌力评分差异无统计学意义（P＞0.05）；治疗后，产后3个月两组Ⅰ、Ⅱ类肌力评分差异无统计学意义（P＞0.05），产后6个月及12个月顺产组的Ⅰ、Ⅱ类肌力评分均高于剖宫产组，差异有统计学意义（P＜0.05）。研究组产后3个月、6个月和12个月的Ⅰ、Ⅱ类肌力评分均显著高于对照组，差异有统计学意义（P＜0.05）。结论电刺激联合生物反馈治疗重度盆底肌力减退疗效显著，不同分娩方式对产后早期盆底肌力均有影响，盆底肌电刺激康复治疗对产后女性健康具有重要的临床意义。

Objectives To evaluate the therapeutic effectiveness of biofeedback combined with electrical stimulation on severe postpartum pelvic floor dysfunction after vaginal delivery or cesarean section. Methods 130 cases of severe pelvic floor dysfunction diagnosed at 42 days postpartum visit were selected to accept ten times therapy of biofeedback combined with electrical stimulation,including 70 cases of vaginal birth and 60 cases of cesarean section. Quantitative reassessment of the maternal pelvic lfoor muscle strength of type Ⅰ and type Ⅱ were done using the PHENIX tester at 3 months and 6 months postpartum. Results Regardless of vaginal delivery or cesarean section,typeⅠand typeⅡsevere pelvic lfoor muscle strength decline in patients increased signiifcantly after one therapy procedure of biofeedback combined with electrical stimulation（P〈0.01）,type Ⅰand type Ⅱ of pelvic lfoor muscle strength continued to increase in vaginal birth group at 3 months and 6 monthes, otherwise, compared to the 3 months and 6 months,type Ⅰ muscle strength remained, while the class Ⅱ strength decreased slightly in cesarean section group. Conclusions Biofeedback electrical stimulation in treatment of severe pelvic lfoor dysfunction may have obvious curative effect. More therapy procedures should be needed in severe postpartum pelvic lfoor dysfunction patients after cesarean section.