不同时机产后生物反馈电刺激对盆底功能障碍的防治作用

Preventive and therapeutic effects of biofeedback electrical stimulation in treatment of pelvic floor dysfunction at different time points after delivery

目的观察产妇在产后不同时间进行生物反馈电刺激的防治效果。方法选取2010年3月至2015年2月在保定市第三中心医院进行产后复查并进行1个疗程盆底治疗的产妇865例,根据治疗时间段不同分3组:A组(632例),产后42 d~2个月;B组(158例),产后3~6个月;C组(75例),产后7~12个月。比较治疗前、治疗后和治疗结束5年压力性尿失禁(SUI)发生率、盆腔器官脱垂、盆底肌肌力情况。结果治疗前B组、C组与A组比较盆底Ⅰ、Ⅱ类肌纤维肌力升高、阴道前壁膨出子宫脱垂率降低差异有统计学意义(P<0.05);A、B、C 3组治疗前与治疗结束时比较Ⅰ类、Ⅱ类肌纤维肌力均提高、SUI发生率、阴道前壁膨出及子宫脱垂率均降低,差异有统计学意义(P<0.05);A组治疗结束后5年比治疗前SUI发生率、阴道前壁膨出、子宫脱垂均明显降低,Ⅱ类肌纤维肌力均提高,差异有统计学意义(P<0.05);B、C组治疗结束后5年比治疗前SUI发生率、阴道前壁膨出、子宫脱垂降低(B组除外)、Ⅱ类肌纤维肌力均提高,但差异无统计学意义(P>0.05/3)。结论产后盆底肌自我恢复能力有限,盆底康复治疗在产后1年内均有效,但42 d~2个月内疗效显著且5年的保护性作用最强。

Objective To investigate the preventive and therapeutic effects of biofeedback electrical stimulation in treatment of pelvic floor dysfunction at different time points after delivery.Methods A total of 865 parturients with pelvic floor dysfunction who were treated in our hospital for a treatment course from March 2010 to February 2015 were enrolled in the study,who were divided into three groups according to the treatment period:group A(n=632,treated from postpartum 42 day to 2 months);group B(n=158,treated from postpartum 3months to 6 months);group C(n=75,treated from postpartum 7 months to 12 months).The incidence rate of SUI,prolapse of pelvic organs,and muscle strength of pelvic floor muscles before treatment and at 5 years after treatment.were observed and compared among the three groups.Results Before treatment,as compared with those in group A,the pelvic floorⅠandⅡmuscle fiber strength was significantly increased and the anterior vaginal wall bulging uterine prolapse rate was significantly decreased in group B and group C(P<0.05).At the end of the treatment,the muscle strength of classⅠand classⅡmuscles was significantly increased,however,the incidence rates of SUI,the anterior vaginal bulge,and uterine prolapse were significantly decreased in group A,B,C(P<0.05).At 5 years after treatment,the incidence rates of SUI,the anterior vaginal bulge,and uterine prolapse were significantly decreased,and pelvic floor classⅡmuscle fiber strength was significantly increased in group A(P<0.05).Moreover,the incidence rates of SUI,the anterior vaginal bulge,and uterine prolapse were increased in group A and group C,but there were no significant differences(P>0.05).Conclusion The recovery ability of postpartum pelvic floor muscles is limited,and the perform pelvic floor rehabilitation treatment is effective within 1 year after delivery,and the effects are significant from 42 days to 2 months after chldbirth,which are the most significant at 5 years after childbirth.