不同时机盆底康复治疗产后盆底功能障碍性疾病的近期疗效

Short-term effects of pelvic floor rehabilitation at different timings on postpartum pelvic floor dysfunction

目的观察产后42 d诊断盆底功能障碍的产妇,在不同时间段采用生物反馈联合电刺激的治疗效果。方法选取2014年6月至2017年1月在四川省妇幼保健院就诊,产后42 d复查诊断盆底功能障碍后进行盆底治疗1疗程的产妇378例,根据产后不同治疗时间段分组,A组(314例),产后42 d～3月;B组(50例),产后3～6月;C组(14例),产后6月～2年,比较盆底治疗前后产妇盆底肌力、压力性尿失禁(stress urinary incontinence,SUI)及脏器脱垂情况。结果 A组在盆底治疗前后,盆底电测肌电值、Ⅰ类、Ⅱ类肌力较训练前增强,SUI发生率、阴道前壁脱垂率、子宫脱垂率、阴道后壁脱垂率较之前均明显降低,差异有统计学意义(P<0.05)。B组的盆底电测肌电值、Ⅰ类、Ⅱ类肌力较训练前增强,SUI发生率较之前均明显降低,差异有统计学意义(P<0.05);阴道前壁脱垂率、子宫脱垂率、阴道后壁脱垂率与治疗前相比,差异无统计学意义(P>0.05)。C组的盆底电测肌电值、Ⅰ类、Ⅱ类肌力较训练前增强、SUI发生率较之前降低,差异无统计学意义(P>0.05)。结论产后盆底康复治疗在产后42 d～3月内,疗效显著。产后3～6月和产后6月～2年因脏器脱垂进行治疗的人群,需要增加疗程进一步观察治疗效果。

Objective To observe the short-term effect of electric stimulation-biofeedback pelvic floor rehabilitation therapy at different postpartum periods for pelvic floor dysfunction(PFD)women in 6 weeks postpartum.Methods 378 cases of PFD diagnosed at 42 days postpartum visit in Sichuan Provincial Hospital for Women and Children were selected to undergo therapy of biofeedback combined with electrical stimulation,according to treatment at different postpartum periods,the patients were divided into three groups:Group A(n=314)(treated at postpartum day 42~month 3),Group B(n=50)(treated at postpartum month 3~6),and Group C(n=14)(treated at postpartum month 6~year 2).The changes of pelvic floor muscle strength,stress urinary incontinence and pelvic organ prolapsed before and after treatment in different postpartum periods were compared.Results In group A,the voltage of total pelvic floor muscle,the voltage of muscle fiber I and fiber II increased significantly after therapy of biofeedback combined with electrical stimulation(P<0.05).The incidence of stress urinary incontinence and pelvic organ prolapsed decreased significantly after therapy(P<0.05).In group B,the voltage of total pelvic floor muscle,the voltage of muscle fiber I and fiber II increased significantly after therapy of biofeedback combined with electrical stimulation(P<0.05).The incidence of stress urinary incontinence and decreased significantly after therapy(P<0.05).In group C,there was no significant difference between the front and the back.Conclusion Electric stimulation-biofeedback pelvic floor rehabilitation in treatment of PFD may have obvious short-term effect for the women treated at postpartum day 42~month 3.More therapy procedures should be needed in women with pelvic organ prolapsed treated at postpartum month 3~6 and women treated at postpartum month 6~year 2.