桃红四物汤加减治疗产后盆底功能障碍

Treatment of Postpartum Pelvic Floor Dyssynergia with Modified Taohong Siwu Decoction

目的:观察桃红四物汤加减治疗产后盆底功能障碍的临床疗效。方法:135例产后盆底功能障碍患者按随机数字表法分为对照组和观察组。对照组给予常规治疗,包括:盆底电刺激,每次20~30 min,每周2次;盆底肌训练收肛,每次10 s,间歇5 s,持续45 min,每日2次。观察组在对照组治疗基础上给予桃红四物汤加减,每日300 mL,水煎服,分早晚两次服用。两组均以15 d为1个疗程,治疗2个疗程。比较两组患者治疗前后的症状,并评定治疗前、治疗第15天、治疗第30天的盆底肌力、膀胱活动度积分,各项代谢相关指标,临床疗效。结果:治疗后,观察组的气短、乏力的主症评分,脉虚、懒言、自汗的次症评分均显著低于对照组(P<0.05)。治疗第15天、第30天,观察组盆底肌力、膀胱过度活动症评分均显著优于同期对照组(P<0.05)。观察组尿失禁漏尿量为(9.79±1.78) g·h^-1、(6.25±1.02) g·h^-1,均显著低于同期对照组的(12.01±2.11) g·h^-1、(8.85±1.62) g·h^-1(P<0.05)。观察组Ⅰ型胶原、Ⅲ型胶原的表达量均显著高于对照组(P<0.05)。治疗后,观察组基质金属蛋白酶的表达量显著低于对照组,组织金属蛋白酶抑制物的表达量显著高于同期对照组(P<0.05)。观察组有效率为91.43%,显著高于对照组的78.46%,两组比较,差异有统计学意义(P<0.05)。结论:桃红四物汤加减治疗产后盆底功能障碍临床疗效显著,可降低气短、乏力的主症评分和脉虚、懒言、自汗的次症评分,改善基质金属蛋白酶、组织金属蛋白酶抑制物的表达,提高Ⅰ型胶原、Ⅲ型胶原的水平。

Objective:To observe the clinical effect of modified Taohong Siwu Decoction on postpartum pelvic floor dyssynergia.Methods:135 patients with postpartum pelvic floor dyssynergia were divided into control group and observation group according to random number table.The control group was given routine treatment,including:pelvic floor electrical stimulation,20-30 minutes each time,twice a week;pelvic floor muscle training,10 seconds each time,5 seconds intermittently,lasting for 45 minutes,twice a day.On the basis of the treatment of the control group,the observation group was given modified Taohong Siwu Decoction,300 mL per day,decocted in water,twice in the morning and evening.Both groups took 15 days as one course of treatment,and two courses of treatment.Before and after treatment,the symptoms of the two groups were compared,and the scores of pelvic floor muscle strength,bladder activity,metabolism related indexes and clinical effects were evaluated.Results:After treatment,the main symptom scores of shortness of breath and asthenia,the secondary symptom scores of pulse deficiency,lazy speech and self perspiration in the observation group were significantly lower than those in the control group(P<0.05).On the 15 th and 30 th day of treatment,the scores of pelvic floor muscle strength and bladder overactivity in the observation group were significantly higher than those in the control group(P<0.05).The urinary incontinence leakage in the observation group was(9.79±1.78) g·h-1,(6.25±1.02) g·h-1,significantly lower than that in the control group(12.01±2.11) g·h-1,(8.85±1.62) g·h-1(P<0.05).The expression of type Ⅰ collagen and type Ⅲ collagen in the observation group was significantly higher than that in the control group(P<0.05).After treatment,the expression of matrix metalloproteinase in the observation group was significantly lower than that in the control group,and the expression of tissue metalloproteinase inhibitor was significantly higher than that in the control group(P<0.05).The effective rate of the observation group was 91.43%,which was significantly higher than that of the control group(78.46%).Conclusion:Modified Taohong Siwu Decoction has a significant clinical effect in the treatment of postpartum pelvic floor dyssynergia.It can reduce the main symptom score of shortness of breath and asthenia,the secondary symptom score of pulse deficiency,lazy speech and spontaneous sweating,improve the expression of matrix metalloproteinase and tissue metalloproteinase inhibitor,and improve the level of type Ⅰ collagen and type Ⅲ collagen.