不同时机的个体化盆底康复治疗对压力性尿失禁疗效分析

Analysis of the effect of individualized pelvic floor rehabilitation on stress urinary incontinence at different timings

目的探讨盆底康复治疗对压力性尿失禁的疗效及最佳治疗时机。方法选择2016年1月至2018年9月在上海健康医学院附属第六人民医院东院就诊的123例轻中度SUI患者,根据进行盆底康复治疗时间分为4组,A组(38例),产后2月内;B组(25例),产后2~6月;C组(23例),产后7~12月;D组(37例),产后1年以上。4组患者治疗前后分别进行问卷调查、1 h尿垫试验、排尿日记及阴道收缩压检测,对比各组的治疗效果。结果随访过程中,A组有2例患者未坚持治疗,D组有4例患者失访,故最终有117例患者纳入本研究。4组患者的平均年龄分别为(30.22±3.58)岁、(30.12±3.51)岁、(29.13±3.00)岁、(31.64±3.94岁)岁,平均体质量指数(body mass index,BMI)分别为(22.77±1.59)kg/m^2、(23.15±1.68)kg/m^2、(22.33±1.42)kg/m^2、(22.20±1.58)kg/m^2。4组患者的年龄、BMI、产次、分娩方式、胎儿大小分别进行比较,差异均无统计学意义(P>0.05)。各组患者治疗结束后,ICI-Q-SF评分降低,1 h尿垫试验漏尿量明显减少,阴道收缩压明显提高,差异均有统计学意义(P<0.05)。各组患者治疗结束后组间比较,A、B、C 3组ICI-Q-SF评分、1 h尿垫试验漏尿量、阴道收缩压比较差异均无统计学意义(P>0.05),但D组的ICI-Q-SF评分和1 h尿垫漏尿量要高于A、B、C 3组,而阴道收缩压低于A、B、C 3组,差异均有统计学意义(P<0.05)。治疗结束6个月后,A组有效率为86.8%,B组为92.0%,C组为91.3%,均明显高于D组(有效率62.2%),差异有统计学意义(P<0.05)。结论产后不同时机进行盆底康复治疗均可改善患者盆底功能,能够有效减少尿失禁发生,而最佳治疗时机以产后1年内为宜。

Objective To investigate the effect of individualized of pelvic floor rehabilitation on stress urinary incontinence(SUI) at different timings.Methods According to the different timing of pelvic floor rehabilitation,123 women with SUI in Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine & Health Sciences from January 2016 to september 2018 were divided into four groups:group A(n=38) received treatment within 2 months postpartum, group B(n=25) received treatment at 2-6 months postpartum, group C(n=23) received treatment at 7~12 months postpartum, group D(n=37) received treatment at more than 1 year postpartum. Pelvic floor rehabilitation was performed on all patients for 10 times.Before and after treatment, the International Consultation on Incontinence questionnaire-short form(ICI-Q-SF), one hour padweigh test(PWT), voiding diary and vaginal contraction pressure were recorded and assessed. Results During the follow-up, 2 patients in group A did not complete the treatment, and 4 patients in group D were lost to follow-up, so 117 patients were finally included in this study. There were no significant differences among the groups regarding age, BMI, parity, delivery mode and birth weight(P>0.05).After the end of treatment, the patients in each group had significantly lower ICI-Q-SF score, reduced urine leakage in one hour PWT, and increased vaginal contraction pressure(P<0.05). The ICI-Q-SF score and urine leakage in one hour PWT in group D were higher than those in group A,B and C after treatment, while the vaginal contraction pressure was lower(P<0.05).The effective rate was 62.2 % in group D at 6 months follow-up, which was significantly worse than that in group A( effective rate 86.8 %),B( effective rate 92.0 %) and C( effective rate 91.3 %)(P<0.05). Conclusion The pelvic floor rehabilitation at different early postpartum periods is conductive to enhancing the pelvic floor muscle strength, improving the pelvic floor function and reducing urinary incontinence.The optimal time for pelvic floor rehabilitation is within one year after delivery.