盆底肌生物反馈电刺激联合盆底肌训练治疗产后轻中度压力性尿失禁的效果

Effectiveness of pelvic floor muscle biofeedback electrical stimulation combined with pelvic floor muscle training for mild to moderate postpartum stress urinary incontinence

目的分析盆底肌生物反馈电刺激联合盆底肌训练(pelvic floor muscle training,PFMT)以及单纯PFMT对产后轻、中度压力性尿失禁(stress urinary incontinence,SUI)的疗效。方法回顾性分析2017年1月至2021年1月在济宁医学院附属医院就诊的1087例轻、中度SUI的产妇,根据治疗方法不同分为电刺激+PFMT组(504例)和PFMT组(583例)。采用χ^(2)检验、独立样本t检验、独立样本或配对样本秩和检验,比较2组治疗前、后及治疗后3个月的客观指标(盆底肌肌力检测和阴道动态压力值检测、1 h尿垫试验)与主观指标[包括尿失禁影响问卷简表(incontinence impact questionnaire short form,IIQ-7)、尿失禁问卷简表(incontinence questionnaire-urinary incontinence short form,ICI-Q-SF)、盆腔器官脱垂-尿失禁性生活问卷简表(pelvic organ prolapse/urinary incontinence sexual function questionnaire,PISQ-12)]。结果2组患者治疗前阴道动态压力值、1 h尿垫试验以及主观指标等比较差异无统计学意义(P值均>0.05)。组内比较:治疗后及治疗后3个月与治疗前相比,2组Ⅰ类肌肌力[电刺激+PFMT组:4及5级(即正常)分别为43.5%(219/504)、42.1%(212/504)与1.2%(6/504),χ^(2)值分别为864.27和861.46;PFMT组:4及5级分别为19.2%(112/583)、20.1%(117/583)与1.5%(9/583),χ^(2)值分别为1148.26和1038.29]和Ⅱ类肌肌力[电刺激+PFMT组:分别为48.4%(244/504)、50.8%(256/504)与4.8%(24/504),χ^(2)值分别为862.96和819.24;PFMT组:分别为37.4%(218/583)、38.9%(227/583)与5.0%(29/583),χ^(2)值分别为1029.47和998.54]均明显改善(P值均<0.05),且阴道动态压力值均明显升高[电刺激+PFMT组:(89.3±5.4)、(82.2±4.6)与(67.5±12.7)cmH2O(1 cmH2O=0.098 kPa),t值分别为802.13和845.54;PFMT组:(80.2±4.3)、(78.6±4.5)与(66.9±14.2)cmH2O,t值分别为288.37和244.94],1 h尿垫试验漏尿量均明显减少[电刺激+PFMT组:2.0 g(2.0~3.0 g)、2.0 g(1.0~3.0 g)与6.0 g(5.0~6.0 g),Z值分别为825.39和802.13;PFMT组:4.0 g(3.0~5.0 g)、3.0 g(3.0~4.0 g)与5.0 g(4.0~6.0 g),Z值分别为836.34和811.25],2组IIQ-7评分[电刺激+PFMT组:3分(2~4分)、4分(3~4分)与8分(7~9分),Z值分别为959.52和825.87;PFMT组:5分(4~5分)、5分(4~6分)与8分(7~10分),Z值分别为916.27和903.18]、ICI-Q-SF评分[电刺激+PFMT组:3.5分(3~4分)、4分(3~5分)与10分(9~12分),Z值分别为952.79和924.94;PFMT组:6分(4~7分)、6分(5~7分)与11分(10~12分),Z值分别为1049.89和998.15]、PISQ-12评分[电刺激+PFMT组:10分(7~12分)、9分(7~12分)与21分(17~24分),Z值分别为862.55和887.17;PFMT组:13分(11~16分)、14分(12~16分)与22分(18~25分),Z值分别为1026.73和934.86]均明显降低(P值均<0.05)。组间比较:与PFMT组相比较,电刺激+PFMT组的上述指标均明显改善(P值均<0.05)。结论盆底生物反馈电刺激联合PFMT和单独PFMT治疗均能增强盆底肌肌力,提高阴道动态压力值,改善患者漏尿症状,提高生活质量,而且前者联合治疗模式的疗效更加明显。

Objective To analyze the effects of pelvic floor muscle biofeedback electrical stimulation(PEMS)combined with pelvic floor muscle training(PFMT)and PFMT alone on mild to moderate stress urinary incontinence(SUI)after delivery.Methods This retrospective study involved 1087 postpartum women with mild or moderate SUI who were admitted to the Affiliated Hospital of Jining Medical University from January 2017 to January 2021.According to the treatment approaches,they were divided into two groups:the PMES+PFMT group(n=504)and the PFMT group(n=583).Chi-square test,independent sample t-test and rank sum test were used to compare the objective indicators(pelvic floor muscle strength test,vaginal dynamic pressure value test,1-h pad test)and subjective indicators[incontinence impact questionnaire short form(IIQ-7),incontinence questionnaire-urinary incontinence short form(ICI-Q-SF),pelvic organ prolapse/urinary incontinence sexual function questionnaire(PISQ-12)]before,immediate and three months after treatment between the two groups.Results There was no significant difference between the two groups in the values of vaginal dynamic pressure before treatment,1-h pad test results and subjective indicators(all P>0.05).Comparison within groups:Indicators were improved in both groups immediate and three months after treatment compared with before treatment,including strength of typeⅠmuscle[PMES+PFMT group:grade 4 and 5(normal):43.5%(219/504)and 42.1%(212/504)vs 1.2%(6/504),χ^(2)=864.27 and 861.46;PFMT group:grade 4 and 5:19.2%(112/583)and 20.1%(117/583)vs 1.5%(9/583),χ^(2)=1148.26 and 1038.29]and classⅡmuscle strength[PMES+PFMT group:48.4%(244/504)and 50.8%(256/504)vs 4.8%(24/504),χ^(2)=862.96 and 819.24;PFMT group:37.4%(218/583)and 38.9%(227/583)vs 5.0%(29/583),χ^(2)=1029.47 and 998.54;all P<0.05].Vaginal dynamic pressure increased[PMES+PFMT group:(89.3±5.4)and(82.2±4.6)vs(67.5±12.7)cmH2O(1 cmH2O=0.098 kPa),t=802.13 and 845.54;PFMT group:(80.2±4.3)and(78.6±4.5)vs(66.9±14.2)cmH2O,t=288.37 and 244.94],and 1-hour urine leakage reduced[PMES+PFMT group:2.0 g(2.0-3.0 g)and 2.0 g(1.0-3.0 g)vs 6.0 g(5.0-6.0 g),Z=825.39 and 802.13;PFMT group:4.0 g(3.0-5.0 g)and 3.0 g(3.0-4.0 g)vs 5.0 g(4.0-6.0 g),Z=836.34 and 811.25],and IIQ-7 scores[PMES+PFMT group:scores of 3(2-4)and 4(3-4)vs 8(7-9),Z=959.52 and 825.87;PFMT group:5(4-5)and 5(4-6)vs 8(7-10),Z=916.27 and 903.18],and ICI-Q-SF score[PMES+PFMT group:3.5(3-4)and 4(3-5)vs 10(9-12),Z=952.79 and 924.94;PFMT group:6(4-7)and 6(5-7)vs 11(10-12),Z=1049.89 and 998.15],and PISQ-12 score[PMES+PFMT group:10(7-12)and 9(7-12)vs 21(17-24),Z=862.55 and 887.17;PFMT group:13(11-16)and 14(12-16)vs 22(18-25),Z=1026.73 and 934.86,all P<0.05)decreased.Compared with the PFMT group,the above indexes were all better in the PMES+PFMT group(all P<0.05).Conclusion PFMT alone or in combination with PMES can both enhance pelvic floor muscle strength,increase vaginal dynamic pressure,alleviate urine leakage and improve the quality of life and PMES+PFMT is better and more effective.