补中益气丸联合艾灸法对全子宫切除术后盆底功能影响的临床研究

The effect of Buzhong Yiqi pills combined with moxibustion on pelvic foor function after total hysterectomy

目的观察补中益气丸联合艾灸法运用对全子宫切除术（Total Hysterectomy,TH）术后患者盆底功能的影响.方法选择2015年3月至2016年12月在本科住院的非脱垂TH患者62例为研究对象,随机分为两组：空白对照组、治疗组,治疗组采用内服补中益气丸＋穴位艾灸（气海、关元、百会穴）治疗.最终通过术前、术后每3个月共12个月进行关于压力性尿失禁及盆底功能的妇科-泌尿病例问卷调查,并进行盆底肌肉肌力测定和POP-Q分度、性功能障碍诊断量表及评分表进行比较分析,从尿失禁、阴道顶端脱垂、盆底肌肉肌力、性功能等方面客观评价补中益气丸联合艾灸对TH术后女性盆底功能的作用.结果两组患者术后随访1年均未发生尿失禁.阴道前后壁Aa、Ap、Ba、Bp点在空白组呈进行性下降趋势,术后与术前比较差异有统计学意义（P〈0.05）,在治疗组各点术后与术前比较差异无统计学意义（P〉0.05）;C点测量值在空白组中随时间延长而降低,术后3、6、9、12个月与术前比较差异有统计学意义（P〈0.05）,治疗组术后3、6、9、12个月与术前比较差异无统计学意义（P〉0.05）.盆底肌肉肌力在空白组呈进行性下降趋势,术后3、6、9、12个月与术前比较差异有统计学意义（P〈0.05）;治疗组在术后9、12个月与术前比较差异无统计学意义（P〉0.05）.性生活评分在空白组呈进行性下降趋势,术后3、6、9、12个月与术前比较差异有统计学意义（P〈0.05）;治疗组性生活评分在术后12个月较术前提高,差异有统计学意义（P〈0.05）.结论TH对女性盆底功能的近期影响是引起阴道松弛、降低盆底肌肉肌力及性生活质量.术后给予补中益气丸口服联合穴位艾灸可以减少或延缓TH术后盆底功能障碍性疾病的发生,是简便效廉、易于掌握、值得临床推广的方法.

Objective To observe the effect of Buzhong Yiqi pills combined with moxibustion on pelvic foor function after total hysterectomy （TH）. Methods 62 cases of inpatients with TH without prolapse of uterus in our department from March 2015 to December 2016 were selected as the study subjects and were randomly divided into two groups： blank control group and treatment group. The treatment group was treated with oral Buzhong Yiqi pills and moxibustion （Qihai, Energy Pass, Baihui）. Through the preoperative and postoperative every 3 months for a total of 12 months of stress urinary incontinence （SUI） and pelvic foor function related gynaecology - urinary cases questionnaire were conducted, pelvic foor muscle strength, POP-Q degree, sexual dysfunction diagnostic scale were analyzed, the effect of Buzhong Yiqi pills combined with moxibustion on pelvic foor function after TH was objectively evaluated from urinary incontinence, vaginal apical prolapse, pelvic foor muscle strength, sexual function and so on. Results There were no SUI cases in the two groups within 1 year after surgery. Aa, Ap, Ba and Bp points of anterior and posterior vaginal walls showed a progressive decline trend in the blank control group, with statistically signifcant differences before and after surgery （P〈0.05）; there were no statistically signifcant differences before and after surgery in the treatment group （P〉0.05）. The measurement value of C point decreased with time in the blank control group, with statistically signifcant differences before and 3, 6, 9, 12 months after surgery （P〈0.05）; there were no statistically signifcant differences before and 3, 6, 9,12 months after surgery in the treatment group （P〉0.05）. The pelvic foor muscle strength showed a progressive decline trend in the blank control group, with statistically signifcant differences before and 3, 6, 9, 12 months after surgery （P〈0.05）; there were no statistically signifcant differences before and 9, 12 months after surgery in the treatment group （P〉0.05）. Sexual life score showed a progressive decline trend in the blank control group, with statistically signifcant differences before and 3, 6, 9, 12 months after surgery （P〈0.05）; sexual life score in the treatment group 12 months after surgery was higher than that before surgery, with statistically signifcant difference （P〈0.05）. Conclusion The recent infuence of TH on the pelvic foor function of women results in vaginal relaxation, reduction of pelvic foor muscle strength and sexual quality. Buzhong Yiqi pills combined with moxibustion can reduce or delay the occurrence of pelvic foor dysfunction diseases after TH, simple, easy to grasp, and worthy of clinical promotion.