电刺激结合盆底肌训练对多发性硬化症女性下尿路功能障碍的临床疗效分析

Effect of electric stimulation combined with pelvic floor muscle training on lower urinary tract dysfunction in women with multiple sclerosis

目的评估不同的康复计划在干预多发性硬化症(MS)女性下尿路功能障碍(LUTD)中的作用。方法选取2015年6月至2018年6月在西安医学院第二附属医院收治的81例MS女性患者为研究对象,按照随机数字表法分为3组,每组各27例。第Ⅰ组采用骨盆底肌肉训练(PFMT)与肌电图(EMG)生物反馈和虚拟神经肌肉电刺激(VNES),第Ⅱ组采用PFMT与EMG生物反馈和阴道内VNES,第Ⅲ组采用PFMT与EMG生物反馈和经皮胫神经刺激(TTNS)。所有患者接受12周干预。评估干预前、后3组患者24h尿垫试验、3天膀胱日记、尿动力学研究结果,采用膀胱过度活动症症状评分表(OABSS),国际失禁问卷调查表-简表(ICIQ-SF)评估3组患者对排尿异常的自我认知以及对生活质量的影响。结果与干预前比较,12周后3组患者24h尿垫重量、尿急、排尿不畅、急迫性尿失禁和残余尿量显著下降,最大尿流量显著增加,差异有统计学意义(P<0.05)。与干预前比较,第Ⅱ组和第Ⅲ组的夜尿次数和尿不尽明显减少,差异有统计学意义(P<0.05)。3组患者干预前后差值比较,第Ⅱ组患者24h尿垫重量、残余尿量和急迫性尿失禁的降低水平,及最大尿流量的提高水平明显优于其他两组,差异有统计学意义(P<0.05)。与干预前相比,3组患者在OABSS评分和ICIQ-SF评分方面显著改善,差异有统计学意义(P<0.05);3组干预后ICIQ-SF评分比较,Ⅱ组和Ⅲ组评分改变更加明显,组间差异有统计学意义(P<0.05)。结论阴道内VNES或TTNS联合使用PFMT可有效改善MS患者的下尿路功能障碍。PFMT和VNES的组合在减少膀胱过度活动症方面具有一定优势。

Objective To evaluate the role of different rehabilitation programs in the treatment of lower urinary tract dysfunction (LUTD) in women with multiple sclerosis (MS). Methods From June 2015 to June 2018, 81 MS female patients in the Second Affiliated Hospital of Xi'an Medical College were selected as the study subjects and divided into three groups according to the random number table method, with 21 cases in each group. Pelvic floor muscle training (PFMT) and electromyography (EMG) biofeedback and virtual neuromuscular stimulation (VNES) were used in group I, PFMT and EMG biofeedback and vaginal VNES were used in group II, and PFMT and EMG biofeedback and transcutaneous tibial nerve stimulation (TTNS) were used in group III. All patients were treated for 12 weeks. The 24-hour urinary pad test, 3-day bladder diary and urodynamic study were evaluated before and after treatment. The self-recognition of urinary dysfunction and the impact on quality of life were assessed by questionnaires [OABSS, ICIQ-SF]. Results Compared with before intervention, 24-hour pad weight, urinary urgency, dysuria, urgent incontinence and residual urine volume decreased significantly, and maximum urine flow increased significantly in three groups after 12 weeks ( P <0.05). Compared with before treatment, the number of nocturnal urine and urine in group II and group III were not significantly reduced, and the difference was statistically significant ( P <0.05). Compared with the difference before and after intervention, the reduction level of 24h pad weight, residual urine volume and urgent urinary incontinence and the improvement level of maximum urine flow in group II were significantly better than those in other two groups with statistical significance ( P <0.05). Compared with before intervention, the OABSS score and ICIQ-SF score of three groups were significantly improved ( P < 0.05 );after intervention, the ICIQ-SF score of three groups changed more significantly ( P <0.05), and there was a significant difference between the two groups. Conclusions Vaginal VNES or TTNS combined with PFMT can effectively improve lower urinary tract dysfunction in MS patients. The combination of PFMT and VNES has some advantages in reducing overactive bladder.