不同时机针刺联合盆底肌功能训练治疗产后膀胱功能失调的效果比较

Comparison of effects of acupuncture combined with pelvic floor muscle function training at different timings on postpartum bladder dysfunction

目的比较不同时机针刺治疗联合盆底肌功能训练对产后膀胱功能失调的临床疗效。方法选取2013年12月至2018年12月该院顺产的产后膀胱功能失调患者63例,根据随机数字表法分为对照组、早期干预组和晚期干预组,每组21例。对照组予以常规盆底肌功能训练治疗,干预组在对照组的基础上予以针刺治疗,早期干预组在拔除导尿管前1周即开始针刺治疗,晚期干预组拔除导尿管后间歇导尿,并行针刺治疗。检测3组患者治疗前及治疗后4周的盆底肌力和尿动力学指标,尿失禁的发生情况,比较治疗后生活质量及总有效率。结果治疗前3组患者盆底肌力各指标和尿动力学指标差异均无统计学意义(P>0.05),治疗后各指标均较治疗前升高,差异有统计学意义(P<0.05),组间比较干预组指标均高于对照组,早期干预组高于晚期干预组,差异有统计学意义(P<0.05);治疗后尿失禁发生率早期干预组(4.8%)和晚期干预组(9.5%)低于对照组(14.3%),差异有统计学意义(P<0.05);治疗前早期干预组和晚期干预组患者生活质量(I-QOL)评分差异无统计学意义(P>0.05),治疗后两组I-QOL评分较治疗前均有提高,差异有统计学意义(P<0.05),治疗后组间总评分差异无统计学意义(t=1.352,P>0.05);总有效率早期干预组(95.2%)高于晚期干预组(85.7%)和对照组(71.4%),差异有统计学意义(P<0.05)。结论早期针刺联合盆底肌功能训练治疗产后膀胱功能失调,治愈率高,疗效显著,值得临床推广使用。

Objective To compare the clinical effects of acupuncture and moxibustion at different timings combined with pelvic floor muscle function training on postpartum bladder dysfunction. Methods Sixty-three patients with natural labor and postpartum bladder dysfunction in this hospital from December 2013 to December 2018 were selected and divided into the control group,early intervention group and late intervention group according to the random number table method,with 21 cases in each group.The control group was given the conventional basin muscle function training therapy.The intervention group was given the acupuncture treatment on the basis of the control group.The early intervention group started the acupuncture treatment at one week before the catheter was removed,and the late intervention group had intermittent urethral lcatherization after removing the urethral catheter,moreover the acupuncture treatment was conducted.The pelvic floor muscle strength and urodynamic indicators before treatment and after 4-week treatment in the three groups were measured,the urinary incontinence occurrence situation,the quality of life and total effective rate after treatment were compared. Results There were no statistically significant differences in pelvic floor muscle strength and urodynamic indicators before treatment among the three groups ( P >0.05).After treatment,all indexes were increased compared with before treatment,and the difference was statistically significant ( P < 0.05),in the intragroup comparison the indexes in the intervention group were higher than those in the control group,the early intervention group was higher than the late intervention group,and the difference was statistically significant ( P < 0.05);the incidence rate of urinary incontinence after treatment in the early inter- vention group and late intervention group was lower than that in the control group,and the difference was statistically significant (4.8%,9.5%,14.3%,χ 2 =6.861, P <0.05);there was no statistically significant difference in the quality of life (I-QOL) score between the two groups compared with before treatment ( P >0.05),the scores after treatment in the three groups were increased compared with those before treatment,and the difference was statistically significant ( P <0.05).There was no statistically significant difference in the total score between the groups after treatment ( t =1.352, P >0.05);the total effective rate in the early intervention group was higher than that in the late intervention group (95.2%,85.7%,71.4%),and the difference was statistically significant ( P <0.05). Conclusion Early acupuncture combined with pelvic floor muscle function training for treating postpartum bladder dysfunction has high cure rate and significant curative effect,and is worth clinical promotion and application.