补中益气汤联合穴位刺激治疗中气下陷型产后盆底功能障碍的临床研究

Clinical Study on Buzhong Yiqi Decoction Combined with Acupoint Stimulation in Treating Postpartum Pelvic Floor Dysfunction with Subsi-dence of Zhongqi

[目的]研究探讨补中益气汤联合穴位刺激对中气下陷型产后盆底功能障碍的临床疗效。[方法]选择2019年9月至2020年9月的产后盆底功能障碍患者,经辨证分型后选取中气下陷型病例140例,以中医证候量化评分最接近的4例作为一个区组,随机分配至A组(补中益气汤组)、B组(穴位刺激组)、C组(补中益气汤联合穴位刺激组)及D组(电刺激生物反馈组),共35个区组。A组给予补中益气汤治疗,B组给予穴位刺激治疗,C组给予补中益气汤联合穴位刺激治疗,D组给予电刺激生物反馈治疗,治疗从产后42d开始,持续5周。比较各组治疗前后盆腔器官脱垂情况,盆底肌肌力,阴道动态压力,Valsaval动作时膀胱、子宫、直肠在盆腔的位置,尿失禁问卷评分以及中医证候量化评分等指标。[结果]随访过程中5个区组中有病例脱落,最终纳入统计30个区组,共计120例患者。与D组比较,A组和C组的盆腔器官脱垂定量分期改善均优于D组,差异均有统计学意义(P<0.05)。与A组、B组分别比较,C组和D组的1类肌肌力、2类肌肌力及阴道动态压力值显著提高,差异均有统计学意义(P<0.05)。与其余三组比较,C组的尿失禁症状评分差值变化更显著,且该组的膀胱、子宫和直肠在盆腔中的位置提升更显著,差异均有统计学意义(P<0.05);与D组比较,A组、B组和C组中医证候量化总积分前后数值变化更明显,差异有统计学意义(P<0.05),其中A组和C组的积分改变优于B组,差异有统计学意义(P<0.05)。[结论]补中益气汤联合穴位刺激治疗可以增强中气下陷型产后盆底功能障碍患者的盆底肌力,减轻尿失禁症状,提升盆腔脏器位置,恢复产后盆底功能,整体效果优于生物反馈治疗,且较单纯使用中药或穴位刺激效果更佳。

[Objective]To explore the clinical therapeutic effect of Buzhong Yiqi Decoction combined with acupoint stimulation on the postpartum pelvic floor dysfunction with subsidence of Zhongqi.[Methods]Patients with postpartum pelvic floor dysfunction from September 2019 to September 2020 were selected.After syndrome differentiation,140 cases of subsidence of Zhongqi were selected,and the 4 cases with the closest quantitative scores of traditional Chinese medicine(TCM)syndromes were taken as a block,and randomly assigned to Group A(Buzhong Yiqi Decoction group),Group B(acupoint stimulation group),Group C(Buzhong Yiqi Decoction combined with acupoint stimulation group)and Group D(electric stimulation biofeedback group),a total of 35 blocks.The treatment started on 42 th day postpartum and lasted for 5 weeks.Group A was given Buzhong Yiqi Decoction,group B was given acupoint stimulation therapy,group C was given Buzhong Yiqi Decoction combined with acupoint stimulation,and group D was given electrical stimulation biofeedback therapy.Pelvic organ prolapses,pelvic floor muscle strength,vaginal dynamic pressure,the position of the bladder,uterus,and rectum in the pelvis during Valsaval maneuvers,urinary incontinence questionnaire scores,quantitative scores of TCM syndromes and other indicators were compared before and after treatment.[Results]During the follow-up process,there were cases falling out of 5 blocks,and finally included in the statistics of 30 blocks,a total of 120 patients.Compared with group D,the quantitative staging of pelvic organ prolapse in group A and group C improved better,and the differences were statistically significant(P<0.05).Compared with group A and group B,the type 1 muscle strength,type 2 muscle strength and vaginal dynamic pressure value of group C and group D increased significantly,and the difference was statistically significant(P<0.05).Compared with the other three groups,the difference in urinary incontinence symptom scores in group C changed more significantly,and the positions of bladder,uterus and rectum in the pelvic cavity of this group improved more significantly,and the differences were statistically significant(P<0.05).Compared with group D,the changes in the total quantitative score of TCM syndromes in groups A,B and C before and after the treatment were more obvious,and the difference was statistically significant(P<0.05).Among them,the changes in the scores of group A and C were better than those of group B,and the difference was statistically significant(P<0.05).[Conclusion]Buzhong Yiqi Decoction combined with acupoint stimulation therapy can strengthen the muscle strength of patients with postpartum pelvic floor dysfunction due to subsidence of Zhongqi,relieve symptoms of urinary incontinence,improve the position of pelvic organs,and restore pelvic floor function.The overall effect is better than biofeedback therapy,which is more effective than simply using TCM or acupoint stimulation.