金匮肾气丸联合盆底生物反馈治疗肾阳虚型产后压力性尿失禁临床研究

Jinkui Shenqi Pill Combined with Pelvic Floor Biofeedback in Treatment of Postpartum Stress Urinary Incontinence with Kidney-yang Deficiency

目的:探究金匮肾气丸联合盆底生物反馈治疗肾阳虚型产后压力性尿失禁的效果和机制。方法:选择产后约42 d诊断为肾阳虚型压力性尿失禁的足月顺产患者70例,按照随机数字表法分为对照组和治疗组,每组各35例。对照组使用盆底生物反馈;治疗组给予盆底生物反馈加口服金匮肾气丸。测定2组治疗前后的盆底肌肌电位、1 h尿垫实验的漏尿量、国际尿失禁咨询委员会尿失禁问卷(ICI-Q-SF)分值,计算总有效率并随访治疗后半年的压力性尿失禁严重程度和ICI-Q-SF分值。结果:①盆底肌肌电位:2组治疗后的Ⅱ型肌肌电位、Ⅰ型肌肌电位、Ⅰ型肌肌耐力电位均高于治疗前,差异有统计学意义(P<0.05);且治疗组高于对照组,差异有统计学意义(P<0.05)。②2组治疗后1 h尿垫实验的漏尿量比治疗前减少,差异有统计学意义(P<0.05);治疗组与对照组相比漏尿量下降,差异有统计学意义(P<0.05)。③2组治疗后ICI-Q-SF问卷调查分值比治疗前降低,差异有统计学意义(P<0.05);治疗组与对照组相比降低,差异有统计学意义(P<0.05)。④治疗组总有效率(88.60%)高于对照组总有效率(65.80%),差异有统计学意义(P<0.05)。⑤2组均未见明显的不良反应;半年后随访,治疗组的压力性尿失禁程度和ICI-Q-SF问卷调查分值低于对照组,差异有统计学意义(P<0.05)。结论:①金匮肾气丸联合盆底生物反馈可增强肾阳虚型产后压力性尿失禁患者的盆底Ⅰ型肌和Ⅱ型肌的肌力,促进盆底功能康复,减少漏尿量,改善患者的近期和远期的生活质量,治疗效果显著且持久,优于单纯盆底生物反馈治疗;②金匮肾气丸治疗肾阳虚型产后压力性尿失禁的机制可能与提高盆底肌的肌力有关。

Objective:To explore the effect and mechanism of Jinkui Shenqi pill combined with pelvic floor biofeedback in treating of postpartum stress urinary incontinence with kidney-yang deficiency.Methods:A total of 70 full-term natural labor patients diagnosed with kidney-yang deficiency stress urinary incontinence about 42 days postpartum were selected and divided into control group and treatment group by random number table,with 35 cases in each group.Control group was only treated with pelvic floor biofeedback.Treatment group was treated with pelvic floor biofeedback combined with oral Jinkui Shenqi pill.The pelvic floor muscle myoelectric potential was measured before and after treatment,the urine leakage volume in 1h urine pad test,the Short Form of International Consultation on Incontinence Questionnaire(ICI-Q-SF)scores,calculate the total effective rate and follow up the severity of stress urinary incontinence and ICI-Q-SF questionnaire scores were measured six months after treatment.Results:1)After treatment,the typeⅡmyoelectric potential,typeⅠmyoelectric potential,and typeⅠmuscle endurance potential of the two groups were higher than those before treatment,the difference was statistically significant(P<0.05),and the treatment group was higher than the control group,the difference was statistically significant(P<0.05).2)The volume of urine leakage in 1 h pad test of the two groups after treatment was less than that before treatment,the difference was statistically significant(P<0.05),and the treatment group was significantly less than the control group,the difference was statistically significant(P<0.05).3)The ICI-Q-SF questionnaire scores of the two groups after treatment were lower than those before treatment,the differences were statistically significant(P<0.05),and the treatment group was significantly lower than the control group,the difference was statistically significant(P<0.05).4)The total effective rate of the treatment group(88.60%)was higher than that of the control group(65.80%),the difference was statistically significant(P<0.05).5)Follow-up six months later,the degree of stress urinary incontinence and ICI-Q-SF questionnaire scores of the treatment group were lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusion:1)Jinkui Shenqi pill combined with pelvic floor biofeedback could enhance the muscle strength of pelvic floor typeⅠand typeⅡmuscles in patients with postpartum stress urinary incontinence with kidney-yang deficiency,improve pelvic floor function recovery,reduce urine leakage,and improve patients'short-term and long-term quality of life,the treatment effect was significant and lasting,and was more effective than pure pelvic floor biofeedback therapy alone;2)The mechanism of Jinkui Shenqi pill in treating postpartum stress urinary incontinence with kidney-yang deficiency may be related to the increase of pelvic floor muscle potential.