早期盆底肌康复锻炼联合场景生物反馈对顺产产后压力性尿失禁患者的治疗效果

Effect of early pelvic floor muscle rehabilitation exercise combined with scene biofeedback therapy on patients with postpartum stress urinary incontinence in vaginal delivery

目的探讨早期盆底肌康复锻炼联合场景生物反馈对顺产产后压力性尿失禁(postpartum stress urinary incontinence,PSUI)患者的治疗效果。方法回顾性分析2020年10月至2021年12月金华市中心医院收治的112例顺产PSUI患者的临床资料。根据不同的治疗方法分为对照组(n=55)与研究组(n=57)。对照组进行早期盆底肌康复锻炼,研究组在对照组基础上联合场景生物反馈。比较两组患者的盆底肌功能、阴道细胞因子[转化生长因子β1(transforming growth factorβ1,TGF-β1),基质金属蛋白酶-2(matrix metalloproteinase-2,MMP-2)及金属肽酶抑制因子-2(tissue inhibitor of matrix metalloproteinase-1,TIMP-2)]、症状评分、生活质量及盆底肌肌力和疲劳度。结果治疗前后两组前静息阶段、后静息阶段盆底表面肌电位比较,差异均无统计学意义(P>0.05)。治疗后,两组的快速、持续及耐力收缩阶段盆底表面肌电位均显著高于治疗前,且研究组显著高于对照组(P<0.05);两组TGF-β1、TIMP-2水平、尿失禁生活质量问卷(incontinence quality of life,I-QOL)评分及Ⅰ类、Ⅱ类肌纤维肌力均较治疗前显著增高(P<0.05),MMP-2水平、症状评分及Ⅰ类、Ⅱ类肌纤维疲劳度较治疗前显著下降,且研究组各指标变化程度均显著优于对照组(P<0.05)。结论早期盆底肌康复锻炼联合场景生物反馈治疗顺产PSUI更有助于改善患者盆底肌功能、临床症状及阴道因子水平,提高生活质量。

Objective To explore the effect of early pelvic floor muscle rehabilitation exercise combined with scene biofeedback therapy on patients with postpartum stress urinary incontinence(PSUI).Methods A retrospective analysis of the clinical data of 112 patients with PSUI who were admitted to the Jinhua Central Hospital for vaginal delivery from October 2020 to December 2021.They were divided into a control group(n=55)and a study group(n=57)according to different treatment methods.The control group underwent early pelvic floor muscle rehabilitation exercises and the study group combined scene biofeedback on the basis of the control group.The pelvic floor muscle function,vaginal cytokines[transforming growth factorβ1(TGF-β1),matrix metalloproteinase-2(MMP-2)and metallopeptidase inhibitor-2(TIMP-2)],symptom scores,quality of life and pelvic floor muscle strength and fatigue.Results There was no statistically significant difference in pelvic floor surface muscle potential between the two groups before and after treatment in the pre-rest and post-rest phases(P>0.05).After treatment,the pelvic floor surface muscle potential was significantly higher in both groups during the rapid,sustained and endurance contraction phases than before treatment,and were significantly higher in the study group than those in the control group(P<0.05).The levels of TGF-β1,TIMP-2,incontinence quality of life(I-QOL)scores and muscle strength of classⅠand classⅡmuscle fibres in both groups were significantly higher than those before treatment(P<0.05),and the levels of MMP-2,symptom scores and fatigue of classⅠand classⅡmuscle fibres were significantly lower than those before treatment,and the degree of change in all indicators in the study group was significantly better than those in the control group(P<0.05).Conclusion Early pelvic floor muscle rehabilitation exercise combined with scene biofeedback for vaginal delivery PSUI is more helpful to improve patients’pelvic floor muscle function,clinical symptoms and vaginal factor levels,and improve their quality of life.