不同盆底康复疗法在改善产后盆底肌力的作用

The Different Methods of Pelvic Floor Reconstruction in Improving Function of Postpartum Pelvic Floor Muscle

目的：探讨不同康复疗法在改善产后盆底肌功能的临床效果。方法：对符合入选标准的产后42-60天的妇女,有产后尿失禁或盆底器官脱垂等产后盆底功能障碍的患者127例,其中能在医院接受电刺激和生物反馈治疗的87例患者为治疗组,其中的35例完成了2个疗程;而无法在医院接受治疗,在家进行Kegel锻炼法的40例患者为锻炼组,6-8周后来医院复查。并分别比较两者治疗或锻炼前后、1个疗程和2个疗程后的盆底肌收缩力的恢复情况及疗效。结果：1两组一般资料比较无明显差异（P〉0.05）。2两组1个疗程治疗前后比较,快速收缩力和持续收缩力有明显提高,差异有统计学意义（P〈0.01）。3持续收缩力增长值比较治疗组明显高于锻炼组（P〈0.05）;而快速收缩力增长值差异无统计学意义性（P〉0.05）。4治疗组2个疗程的快速收缩力优于1个疗程（P〈0.05）,持续收缩力与1个疗程无明显差异（P〉0.05）。结论：产后Kegel锻炼法、电刺激加生物反馈对提高盆底肌收缩力均有效,但电刺激加生物反馈优于单纯的盆底肌肉锻炼,疗程长效果更优。

Objective.To explore the different methods of reconstruction in improving the function of postpar- tum pelvic floor muscle. Methods：127 patients with pelvic floor dysfunction in postpartum 42 -60 days, such as postpartum urinary incontinence or pelvic organ prolapse,were recruited. 82 of them were treated in hospital with electrical stimulation and biofeedback treatment as the treatment group. The other 40 patients having Kegel pelvic floor muscle exercise was the exercise group. Among the treatment group, 87 patients had completed one full course（6 -8weeks） of treatment,35 of them had completed two full courses. Results.①There is no difference between the two groups in the age, pregnant week, post-natal days, pre-delivery body mass index, new born baby weight,the rate of vaginal delivery rates,and increased abdominal pressure（P〉0.05）. ②Both the rapid and the sustained contractility were significantly improved after one course of either treatment（ P〈0.01 ）. ③There was no significant difference in the increased value of the rapid contractility between two groups（ P 〉 0.05） ,while the in- creased value of sustained contractility in the treatment group was significantly higher than the exercise group （ P 〈 0.05）. ④There was significant improvements in the rapid contractility by comparing two-course treatment vs. one-course treatment（ P 〈 0. 05）. There was no significant improvements in the sustained contractility by comparing tow-course treatment vs. one-course treatment （P 〉 0.05）. Conclusions： Postpartum pelvic floor muscle exercises, biofeedback and electrical stimulation are all effective for the rehabilitation of pelvic floor muscle. Electric stimulation plus biological feedback is superior over the simple pelvic floor muscle exercises. Two courses of treat- ment is better than one course.