产后压力性尿失禁病人生物反馈治疗后盆底肌表面电信号变化观察

Clinical observation on surface electromyography value of pelvic muscle under biofeedback treatment in postpartum stress urinary incontinence

目的探讨产后女性压力性尿失禁病人生物反馈治疗果效及盆底肌表面电信号变化的临床意义。方法选择62例产后轻度压力性尿失禁病人进入前瞻性研究;应用SOKO9003型治疗仪进行生物反馈治疗,对自然分娩和选择性剖宫产组治疗前后盆底肌表面肌电信号包括盆底肌Ⅰ、Ⅱ类纤维的活力值及肌力进行检测,对肌力牛津改良量表(Modified Oxford Scale,MOS)评分进行主观评估。随访6个月再次评价上述指标,观察盆底肌表面电信号变化及治疗效果。结果治疗5周后,62例中54例治疗有效,总有效率为87.1%(54/62),其中阴道分娩组治疗有效率为96.9%(31/32),剖宫产组治疗有效率76.7%(23/30),阴道分娩组治疗有效率较剖宫产组高,2组差异有统计学意义(P=0.024);随访6个月后,62例中48例治疗有效,总有效率为77.4%(48/62),阴道分娩组治疗有效率87.5(28/32),剖宫产组治疗有效率66.7(20/30),阴道分娩组治疗有效率仍高于剖宫产组,2组差异有统计学意义(P=0.050)。短期治疗后,阴道分娩组肌力的MOS评分差值与剖宫产组MOS评分差值相比较,阴道分娩组MOS评分差高于剖宫产组(P=0.040);长期治疗后,阴道分娩组肌力的MOS评分差值与剖宫产组MOS评分差值相比较,阴道分娩组MOS评分差仍高于剖宫产组(P=0.030)。长期治疗与短期治疗后阴道分娩组的盆底肌Ⅰ、Ⅱ类肌纤维活力的改变量均大于剖宫产组(P<0.05),但是治疗时限对盆底肌Ⅰ、Ⅱ类肌纤维活力的改变量差异无统计学意义(P>0.05);治疗时限对MOS评分差异无统计学意义(P>0.05)。结论盆底肌生物反馈疗法能够有效治疗产后女性压力性尿失禁(stress urinary incontinence,SUI)。治疗后阴道自然分娩(vaginal delivery,VD)产妇盆底肌功能恢复快,盆底康复治疗疗效明显优于择期剖腹产(caesarean section,CS)者,分娩对盆底组织的损伤是可恢复的。

Objective To access the effect of biofeedback treatment in postpartum stress urinary incontinence under biofeedback treatment and the surface electromyography value of pelvic muscle.Methods Sixty two mild postpartum stress urinary incontinence（SUI） patients were divided into 2 groups under biofeedback treatment with SOKO9003 therapy instrument.The clinical effects between 2 groups were compared and the surface electromyography value of pelvic muscle,Modified Oxford Scale （MOS） were recorded and compared before and after treatment.Results The effective rate was 87.1（54/62）% after 5-week treatment and 77.4（48/62）%after 6-month treatment.It is increased after treatment in both groups（P〈0.05）.The effect is better in vaginal delivery （VD） group than in caesarean section （CS） group（P〈0.05）.After biofeedback treatment the difference of surface electromyography value of pelvic muscle were significantly increased in 2 groups（P〈0.05）,while the differences were statistically no significant in the treatment times（P〉0.05）.Conclusion The treatment effect was obviously both in 2 groups after biofeedback.Pelvic floor recovered better in VD group.Vaginal delivery is recoverable damage in pelvic floor.