芒针透刺结合电针及盆底肌训练改善产后压力性尿失禁的效果观察

Observation on effects of elongated needle penetration combined with electric acupuncture and pelvic floor muscle training on improving postpartum stress urinary incontinence

目的:研究芒针透刺结合电针及盆底肌训练改善产后压力性尿失禁(PSUI)的效果。方法:选取2019年1月~2022年6月期间明确诊断为PSUI的68例患者为研究对象,采用随机数字表法将其分为观察组(n=34)及对照组(n=34),对照组采取电针结合盆底肌训练,观察组在参照组基础上加用芒针透刺,两组均干预8周。比较两组干预前及干预8周后72h排尿日记结果(每日失禁次数、每日排尿次数、平均单次尿量)、中医症状积分、尿流动力学指标[腹压漏尿点压力(ALPP)、最大尿道闭合压(MUCP)、膀胱顺应性(BC)]、盆底表面肌电(持续收缩波幅、耐久收缩波幅、快速收缩最大波幅)、生活质量[尿失禁生活质量问卷(I-QOL)]及不良反应。结果:干预8周后,两组每日失禁次数、每日排尿次数均降低,且观察组低于对照组(P<0.05),平均单次尿量增加,且观察组高于对照组(P<0.05);两组中医症状积分均降低,且观察组低于参照组(P<0.05);两组ALPP、MUCP、BC水平均升高,且观察组高于对照组(P<0.05);两组盆底表面持续收缩波幅、耐久收缩波幅、快速收缩最大波幅均升高,且观察组高于对照组(P<0.05);两组患者I-QOL各维度(行为限制、心理限制、社会障碍)评分均升高,且观察组高于对照组(P<0.05);干预期间,两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:芒针透刺结合电针及盆底肌训练可有效改善PSUI患者临床症状、尿流动力学指标及盆底表面肌电水平,对提高患者生活质量有利。

Objective:To study the effects of elongated needle penetration combined with electric acupuncture and pelvic floor muscle training on improving postpartum stress urinary incontinence(PSUI).Methods:68patients diagnosed with PSUI from January 2019to June 2022were selected as study subjects and were divided into observation group(n=34)and reference group(n=34)by the random number table method.The reference group received electric acupuncture combined with pelvic floor muscle training,and the observation group was additionally given elongated needle penetration on the basis of the reference group.Both groups were intervened for 8weeks.The 72h voiding diary results(frequency of daily incontinence,frequency of daily urination,average single urination volume),TCM symptom score,urodynamic indicators[abdominal leak point pressure(ALPP),maxi⁃mum urethral closure pressure(MUCP),bladder compliance(BC)],pelvic floor surface electromyography(sustained contrac⁃tion amplitude,durable contraction amplitude,rapid contraction maximum amplitude),quality of life[Incontinence Quality of Life Questionnaire(I-QOL)]and adverse reactions were compared between the two groups before intervention and after 8weeks of intervention.Results:After 8weeks of intervention,the frequency of daily incontinence and frequency of daily urination in both groups were decreased,and the indicators in observation group were lower than those in reference group(P<005),and the aver⁃age single urination volume was increased,and the volume in observation group was more than that in reference group(P<005).The TCM symptom score in both groups was reduced,and the score was lower in observation group than that in reference group(P<005).The levels of ALPP,MUCP and BC were increased in both groups,and the levels in observation group were higher than those in reference group(P<005).The sustained contraction amplitude,durable contraction amplitude and rapid contrac⁃tion maximum amplitude were increased in both groups,and the above three indicators in observation group were higher compared with those in reference group(P<005).The scores of I-QOL dimensions(behavioral limitation,psychological limitation,social disorder)were enhanced in the two groups,and the scores were higher in observation group compared to reference group(P<005).During intervention,there were no statistical differences in the incidence rates of adverse reactions between the two groups(P>005).Conclusion:Elongated needle penetration combined with electric acupuncture and pelvic floor muscle training for pa⁃tients with PSUI can effectively improve the clinical symptoms,urodynamic indicators and pelvic floor surface electromyography and enhance the quality of life of patients.