居家盆底神经肌肉电刺激治疗对尿失禁患者盆底功能持续改善的作用

Continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with urinary incontinence

目的评估经过在院短期盆底电生理治疗后，居家继续盆底神经肌肉电刺激治疗对尿失禁患者盆底功能持续改善的作用。方法2014年2月至2015年2月在中国医学科学院北京协和医院60例临床诊断为压力性尿失禁的妇女入选本随机对照临床研究，随机分为两组：对照组30例，只接受为期4周的在院盆底电生理治疗；观察组30例，在完成与对照组相同的在院短期治疗后，在医师指导下，应用便携式神经和肌肉刺激仪，居家继续进行12周的盆底神经肌肉电刺激治疗。治疗后6、9个月分别对两组患者进行1h尿垫试验检测漏尿量，并检测盆底电生理参数，应用国际尿失禁咨询委员会尿失禁问卷简表（ICI-Q—sv）评估患者尿失禁症状的主观改善情况。结果治疗后9个月随访，对照组和观察组压力性尿失禁患者漏尿量的平均降幅分别为（75±24）％、（99±3）％，两组比较，差异有统计学意义（P〈0．01）；观察组患者盆底I类肌纤维肌力（4．4±0．7）、Ⅱ类肌纤维肌力（4．8±0．4）和阴道动态压力[（96±12）emil20，1emil：0=0．098kPa]均优于对照组[分别为3．2±1．0、4．3±0．9、（86±10）emil：01，分别比较，差异均有统计学意义（P〈0．01）。治疗后9个月，观察组和对照组患者的尿失禁主观症状ICI-Q-SF评分[分别为（1．8±1．7）和（6．5±2．9）分]均有明显改善，观察组改善更加显著，两组比较，差异有统计学意义（P〈0．01）。结论经过在院短期盆底电生理治疗后，居家盆底神经肌肉电刺激治疗对压力性尿失禁患者的盆底功能有持续改善作用。

Objective To evaluate continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with stress urinary incontinence after short-term pelvic floor electrophysiological treatment in hospital. Methods Totally 60 women with stress urinary incontinence were recruited for this randomized controlled trial. The control group including a total of 30 patients, only received 4 weeks pelvic floor eleetrophysiological treatment in the hospital Family consolidation treatment group （experimental group） including 30 patients, after 4-week treatment in hospital, received 12-week of pelvic floor neuromuscular electrical stimulation using portable electrical stimulator at home under the guidance of doctors. In post-treatment 6 months and 9 months, 1-hour pad test was measured for urine leakage, pelvic floor electrical physiological parameters were assessed, and subjective improvement of symptoms of urinary incontinence were evaluated. All these data were analysed to compare the effect of the two groups. Results In 9 months after treatment, average change of urine leakage, the control group and experiment group were （75±24）% versus （99±3）%, the difference was statistically significant （P〈0.01）. In the experiment group, strength of type I muscle （4.4±0.7）, strength of type [[ muscle （4.8±0.4） and pelvic floor dynamic pressure [（96± 12） cmH20, 1 cmH20=0.098 kPa] were better than those of control group [3.2 ± 1.0, 4.3 ± 0.9, （86 ± 10） cmH20, respectively], the differences were statistically significant （P〈0.01）. Subjective outcome, the control group and experiment group were （6.5 ±2.9） versus （1.8± 1.7）, subjective outcome between the two groups had significant difference （P〈0.01）. Conclusion After short-term pelvic floor electrophysiological treatment in hospital, the portable domestic pelvic floor neuromuscular electrical stimulation in patients with stress urinary incontinence is helpful to continuous improvement of pelvic floor function.