四维超声评价针刺联合盆底肌训练治疗产后压力性尿失禁的临床疗效

Evaluation of Clinical Effect of Acupuncture Combined with Pelvic Floor Muscle Training on Postpartum Stress Urinary Incontinence by Four-Dimensional Ultra⁃sound

目的探讨四维超声评价针刺联合盆底肌训练治疗产后压力性尿失禁(Postpartum stress urinary incontinence,PSUI)的临床疗效。方法采用随机双盲试验,选取2022年5月—2022年10月期间广州中医药大学第一附属医院收治的60例PSUI患者作为研究对象,按随机数字表法分为对照组和治疗组,每组各30例。对照组行单纯进行盆底肌训练,治疗组采用针刺联合盆底肌训练。连续治疗4周后,观察比较两组患者治疗前后尿失禁症状[国际尿失禁咨询委员会尿失禁问卷简表(International urinary incontinence advisory committee urinary inconti⁃nence questionnaire short form,ICI-Q-SF)评分、泌尿生殖简表(Urogenital distress inventory,UDI)评分],采用四维超声观察患者盆底结构[膀胱颈移动度(Bladder neck descent,BND)、尿道旋转角(Urethral rotation angle,UR)、膀胱尿道后角(Retro-vesical angle,RA)、肛提肌裂孔面积(Levator hiatus area,LHA)],检测膀胱压力容积参数[膀胱初始容量(First ruinary sense,FS)、咳嗽时腹压漏尿点压力(Cough abdominal pressure leakage point pressure,CLPP)、强烈尿感容量(Strong urinary sensitivity volume,SD)]指标,评估两组患者临床疗效及不良反应情况。结果治疗后两组患者ICI-Q-SF、UDI评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者盆底结构相关参数BND、UR、LHA和RA均较治疗前降低,差异有统计学意义(P<0.05);且治疗组均低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者膀胱压力容积FS、CLPP、SD水平均较治疗前升高,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)。治疗后治疗组总有效率93.33%(28/30)高于对照组80.00%(24/30),差异有统计学意义(P<0.05)。治疗期间,治疗组盆底腔室不良反应发生率3.33%(1/30)低于对照组13.33%(4/30),差异有统计学意义(P<0.05)。结论针刺联合盆底肌训练能显著改善PUSI症状,减少漏尿,经四维超声检测发现患者盆底结构恢复,且膀胱功能改善明显,疗效显著,预后良好。

Objective To evaluate the clinical effect of acupuncture combined with pelvic floor muscle training on postpartum stress urinary incontinence(PSUI)by four-dimensional ultrasound.Methods Sixty patients with PSUI treated in the First Affiliated Hospital of Guangzhou University of Chinese Medicine from May to October in 2022 were selected and assigned into control and treatment groups(n=30)according to the random number table method.The control group received pelvic floor muscle training alone,and the treatment group received acupuncture combined with pelvic floor muscle training.The treatment in both groups lasted for 4 weeks.The urinary incontinence symptoms[International Urinary Incontinence Advisory Committee Urinary Incontinence Questionnaire Short Form(ICI-Q-SF)score and Urogenital Distress Inventory(UDI)score]were observed before and after treatment.The four-dimensional ultrasound was employed to examine the pelvic floor structure[bladder neck mobility(BND),urethral rotation angle(UR),retro-vesical angle(RA),and levator hiatus area(LHA)].In addition,the bladder pressure volume indexes[first ruinary sense(FS),cough abdominal pressure leakage point pressure(CLPP),and strong urinary sensitivity volume(SD)]were measured.Finally,the clinical efficacy and prognosis were evaluated.Results After treatment,the ICI-Q-SF score,UDI score,BND,UR,LHA,and RA of pa⁃tients in the two groups decreased,and the decreases were more significant in the treatment group(P<0.05).After treat⁃ment,FS,CLPP,and SD in the two groups increased and were higher in the treatment group than in the control group(P<0.05).The treatment group had higher total response rate[93.33%(28/30)vs 80.00%(24/30),P<0.05]and lower incidence of adverse reactions[3.33%(1/30)vs 13.33%(4/30),P<0.05]than the control group.Conclusion Acu⁃puncture combined with pelvic floor muscle training can significantly alleviate the symptoms of PUSI and reduce urine leak⁃age.The four-dimensional ultrasound examination showed that this therapy recovered the pelvic floor structure and im⁃proved the bladder function,with significant therapeutic effect and good prognosis.