盆底生物反馈疗法在盆底疾病治疗中的应用

Pelvic floor biofeedback therapy in pelvic floor diseases

盆底生物反馈疗法治疗慢性便秘、尿失禁、排粪失禁、盆底痛等盆底功能障碍性疾病安全有效。但其适应证选择的异质性影响疗效评价及技术交流。盆底生物反馈疗法的最佳适应证包括：（1）盆底功能障碍以肌原性为主，不伴有严重的脏器脱垂和严重神经原性损伤；（2）患者认知及精神状况能与治疗师配合，治疗依从性好。其训练方案包括在院指导和家庭训练，主要训练流程为：（1）帮助患者定位训练的盆底靶肌肉；（2）改善盆底I型肌张力性收缩的稳定性；（3）改善盆底肌I型肌和Ⅱ型肌的活动协调性；（4）加强盆底肌肌力，改善直肠的便意感。疗效的评估涉及不同症状、评估量表的使用、患者的满意度认知及长期结果等。随着实用性随机对照研究方法的应用，通过临床设计及大数据采集和分析，相信盆底生物反馈疗法的疗效能得到进一步证实，有望推广至基层初级医疗。

Pelvic floor biofeedback therapy is safe and effective in chronic constipation, urinary incontinence, fecal incontinence and pelvic floor pain whereas the heterogeneous indication affects the efficacy evaluation and technical communication. The best indications are as follows： （1） Pelvic floor myogenic dysfunction without severe pelvic organ prolapse and severe neurogenic defect; （2） Patients have goodmental cognition and treatment adherence who fulfill the training with the therapist. The training protocol is conducted at hospital or at home, and is as follows： （1） To help patients to target the pelvic floor muscles; （2） To improve the type I muscle tonic contraction variability; （3） To improve the pelvic floor type I and type Ⅱ muscles activity coordination; （4） To enhance the pelvic floor muscle strength and rectum defecation awareness. The biofeedback efficacy is evaluated with different symptoms, questionnaire score, patient satisfaction recognition and long-term outcomes. Pelvic floor biofeedback therapy will be highlighted and extended to the primary care in near future following the pragmatic randomized controlled clinical trials, collection and analysis of big data.