电刺激联合生物反馈治疗产后SUI疗效及影响因素分析

Effects of electrical stimulation combined biofeedback on stress urinary incontinence and influencing factors

目的对比产后压力性尿失禁(SUI)的3种治疗方法的疗效及分析电刺激治疗效果的影响因素。方法选取2016年2月至2017年2月于产后6周至湖州市妇幼保健院妇产科进行盆底功能检查的产后SUI产妇120例,根据治疗方法分成A组、B组和C组,A组患者仅给予健康教育,B组患者给予盆底肌锻炼治疗,C组患者给予电刺激联合生物反馈治疗。对比3组患者的SUI分度、盆底肌力、治疗有效率,分析影响电刺激治疗效果的因素。结果经Fisher确切概率法检验,3组患者的总有效率比较有显著性差异(P=0.000<0.05),进一步每两组之间比较发现,A组有效率显著高于B组和C组(均P=0.000<0.05),B组有效率显著高于C组(P=0.012<0.05)。3组患者治疗前的盆底肌力经Fisher确切概率法检验,差异无统计学意义(P=0.994>0.05),3组患者治疗后的盆底肌力差异具有统计学意义(χ~2=21.641,P<0.05),B组患者治疗后的盆底肌力优于A组,C组治疗后的盆底肌力优于B组患者。多因素分析显示,产后抑郁程度、SUI严重程度、孕期体重增加量是电刺激治疗效果的影响因素(OR值分别为4.162、5.772、5.323,均P<0.05)。结论电刺激联合生物反馈治疗效果最优,可广泛应用;孕期体重增加量是电刺激治疗效果的影响因素,通过控制孕期体重可提高产后SUI电刺激的治疗效果。

Objective To compare the efficacy of three treatment methods for postpartum stress urinary incontinence（SUI）and to analyze the influencing factors of electrical stimulation treatment.Methods Totally 120 cases of postpartum SUI who receiving checkup for function of pelvic floor were selected during February 2016 to February 2017 in Huzhou Maternal and Child HealthCare Center,and they were divided into group A,group B and group C according to different treatment.Patients in group A received health education,those in group B accepted pelvic muscle exercise therapy,and those in group C were given electrical stimulation combining biofeedback treatment.SUI score,pelvic floor muscle strength and treatment efficiency were compared among three groups,and factors influencing curative effect of electrical stimulation were analyzed.Results There was significant difference in total effective rate among three groups checked by Fisher＇s exact probability method（P〈0.05）,and further comparison between each two groups revealed that total effective rate of group A was significantly higher than that of group B and group C（both P〈0.05）and that of group B was significantly higher than group C（P〈0.05）.Before treatment pelvic floor muscle of three groups was not significantly different shown by Fisher＇s exact probability method（P〈0.05）,but there was significant difference after treatment among three groups（χ~2=21.641,P〈0.05）.Pelvic floor muscle strength of group B after treatment was superior to group A,and that of group C was superior to group B.Multifactor analysis showed that degree of postpartum depression,severity of SUI and increase of weight gain during pregnancy were factors influencing therapeutic effect of electrical stimulation（OR value was 4.162,5.772 and 5.323,respectively,all P〈0.05）.Conclusion Electrical stimulation combined with biofeedback therapy has the best effect and can be widely applied.Weight gain during pregnancy is the influencing factor of electrical stimulation treatment,and the effect of postpartum SUI electric stimulation can be improved by controlling weight during pregnancy.